What is PSA?
PSA, or prostate-specific antigen, is a protein made by the prostate gland. A small amount naturally leaks into your bloodstream, where it can be measured with a simple blood test. As a general rule, the higher the level, the greater the chance there may be prostate cancer — but PSA is not a cancer test on its own.
What can raise your PSA?
Many conditions other than prostate cancer can cause a raised PSA. That is why your PSA result should always be interpreted by a specialist, taking into account your symptoms, medical history and examination findings. Common causes of a raised PSA include:
- A benign (non-cancerous) enlargement of the prostate, which is very common with age.
- A urine infection or inflammation of the prostate (prostatitis).
- Recent vigorous exercise, cycling, ejaculation or a catheter.
- Simply getting older — PSA tends to rise gradually over time.
- Underlying prostate cancer.
What happens after a high PSA?
If your PSA is raised without an obvious cause a high-resolution 3T MRI scan of the prostate will be recommended. Compared with a standard 1.5T MRI scan, it provides more detailed images, helping to determine whether a biopsy is needed and, if so, precisely where it should be targeted.
Performing an MRI scan before a biopsy allows many men to avoid an unnecessary invasive procedure. When a biopsy is required, a transperineal biopsy is recommended as first-line, which carries a very low risk of infection.
What is prostate cancer?
The prostate is a small gland, about the size of a walnut, located below the bladder. It surrounds the urethra - the tube urine passes through from the bladder. Prostate cancer develops when cells in the gland start to grow in an uncontrolled way.
Many prostate cancers grow so slowly that they are unlikely to cause harm, while others are more aggressive and require prompt treatment. Determining the type of cancer you have and whether it has spread is essential to recommending the most appropriate treatment. Modern imaging and diagnostic tests make it possible to assess this accurately and tailor treatment to your individual needs.
Symptoms and who should be checked
Early prostate cancer usually causes no symptoms at all. When symptoms do appear they are usually caused by a benign (non-cancerous) prostate enlargement. Nevertheless, it's worth speaking to a specialist if you notice:
- Needing to pass urine more often, especially at night.
- A weak or slow urinary stream, or difficulty getting started.
- Blood in your urine or semen.
How prostate cancer is diagnosed
Diagnosis usually begins with a supersensitive PSA blood test and a digital rectal examination (DRE), followed by a high-resolution 3T MRI scan before any biopsy. The scan helps decide whether a biopsy is needed at all and, if it is, exactly where it should be targeted.
Your treatment options
Treatment is tailored to the type and stage of your cancer, your general health and your own priorities. Options include:
- Active surveillance — Careful monitoring of low-risk cancer to delay treatment or avoid it altogether.
- High-intensity focused ultrasound (HIFU) — Focal treatment that targets cancer with precisely-delivered ultrasound energy, sparing surrounding tissue.
- Robotic prostatectomy — Precise nerve-sparing surgery to remove the prostate, whilst minimising side-effects.
- Radiotherapy — Usually combined with hormone treatment and often utilising a hydrogel spacer and fiducial placement to protect surrounding tissue.
- Hormone therapy — Often used temporarily alongside radiotherapy, or occasionally used alone or with other agents in more advanced disease.
Why choose Mr Walton
Mr Walton has over 25 years clinical experience, including more than 13 years as a Consultant Urologist specialising in prostate cancer management. He is the Lead Cancer Clinician for Urology at Nottingham University Hospitals and performed the East Midlands' first robotic prostatectomy in 2014. With more than 1,000 robotic prostatectomies performed, he offers genuine expertise and experience, with an understanding that after a diagnosis of prostate cancer, men need time, information and support to make a decision that is right for them.