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  • Q&A with Australian Health Practitioners

    How is prostate cancer diagnosed?

    Related Topics
    Cancer Prostate Cancer
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    Dr Bhaumik Shah

    Medical Oncologist (Cancer Specialist)

    Dr Shah believes in family centered care and long consultations to put all anxieties at ease. He has trained in different illustrious institutes to obtain … View Profile

    There are chiefly two ways in which prostate cancer is diagnosed.

    A) There is a screening blood test called PSA which indicates any abnormality in structure of prostate. Many a times GPs do offer this test to people above age of 50 for screening of prostate cancer. The interpretation of test is very tricky. The cutoffs to diagnose cancer is not clearcut. There are other noncancerous causes of rise of PSA as well. Still some of the prostate cancers are suspected due to rising PSA. That leads to a cosult with a urologist who may perform prostate biopsy to diagnose prostate cancer.

    B) Prostate cancer can be diagnosed due to symptoms as well. They can be
    - increasing difficulty passing urine
    - increased frequency of passing urine
    - blood in urine
    - pain in pelvis
    - less commonly prostate cancer can be diagnosed because of its spread to spine or hips causing back or hip pain.

    It must be stressed that all of these symptoms can be due to noncancerous problems in prostate as well. But if you have any of these you should get checked by your GP.

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    Dr Dick Beatty

    GP (General Practitioner)

    Dr Dick Beatty is a Full Time Vasectomist - operating across locations in South East Queensland, including Greenslopes Private Hospital. View Profile

    Just a bit more on the PSA Test.

    The Australian National Guideline Agency from 2013 to all Doctors in Australia. The long-awaited draft guidance to Australian doctors is described as the “best possible advice” to date - but they are only draft guidelines. National guidelines in the USA and UK come to very similar conclusions.

    The following is taken from the draft guidelines, and illustrates that there is currently no simple accurate screening test for prostate cancer - The PSA (+ or - prostate exam) is the best there is but there are pros and cons.

    For every 1000 low-risk, 60-year-old men tested each year over 10 years (the following are estimates):

    • Two will avoid dying of prostate cancer before age 85 (but no discernible effect on the overall risk of dying)
    • 28 will be diagnosed with prostate cancer as a result of PSA testing, many of whom would otherwise not have known.
    • 87 will undergo unnecessary biopsies and 24 will suffer significant side effects as a result.
    • 25 will undergo potentially unnecessary treatment, 7-10 of whom will be left impotent or incontinent as a result.

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    Dr Tony Gianduzzo

    Urologist

    Dr Tony Gianduzzo is a leader in development and delivery of urological services, and has now introduced Robotic-assisted Transperineal Prostatic Biopsy to the state. His … View Profile

    Possible prostate cancer diagnosis is generally driven by the PSA blood test, however at the end of the day the presence of prostate cancer can only be proven by biopsy.  Diagnosis is much more accurate than it has been in the past. Treatments are becoming more effective, with less side-effects.

    A paradox has caused a lot of controversy about prostate cancer diagnosis. Prostate cancer is the second commonest cause of male cancer death. Indeed, more men die of prostate cancer than women die of breast cancer. Nevertheless, there are many more indolent prostate cancers around that are not likely to cause any harm to the patient in the course of their natural life. The challenge is to find, diagnose and treat the cancers that are "wolves" without over-diagnosing and over-treating those that are "sheep".

    The PSA level is only part of the picture. Many factors (e.g. family history, prostatic size, prostatic consistency, etc.) are considered by a urologist when advising a patient whether further investigation is needed. Not all patients with a high PSA will need further testing. On the other hand, some patients need further testing even when the PSA is normal.

    If there is concern further evaluation may include an MRI scan followed by targeted biopsy of the prostate. If significant cancer is found, then further testing may be needed to check for possible spread before deciding on treatment.

    Better diagnosis means better treatment choices for patients with clinically significant prostate cancer, with less over-diagnosis and over-treatment of those with indolent disease.

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