Rectal examination: it consists of an examination of the rectum through which the doctor inserts a lubricated finger into the rectum and palpates the prostate through the rectal wall in search of nodules or abnormal areas. This test is uncomfortable, but it is not painful and takes few seconds to complete. It is sometimes useful for detecting malignant tumors in patients with normal levels of prostate antigen (PSA).
MRI – magnetic resonance imaging. A special prostate MRI scan has become the standard of care to image the prostate gland for cancer. A multiparametric prostate MRI can detect areas in the prostate gland and appoint a grade that reflects the likelihood of cancer present. A PiRADS score ( Prostate Imaging Reporting and Data System ) will be provided with every prostate MRI. This is used to assist the Urologist in the management and potentially biopsy technique used.
Determination of blood levels of PSA: It is a laboratory test that measures the concentrations of this marker (PSA) in blood. It is a substance produced specifically by the prostate that can be found in greater amounts in the blood of men who have prostate cancer. However, it should be borne in mind that PSA levels can also be raised in infections or inflammation of the prostate such as benign prostatic hyperplasia (enlargement of the prostate of non-cancerous origin).
Transrectal ultrasound guided biopsy: a procedure that involves inserting a probe about the size of a finger into the rectum to examine the prostate and extraction of a portion of prostatic tissue to which a histological study is performed to determine the existence of malignant cells. The Biopsy needle can be placed through the perineum ( skin area between the rectum and scrotum ) or through the rectum. This test will confirm the diagnosis of cancer and provides an idea of the tumour volume and the degree of aggressiveness
Gleason score 7 to 10
Gleason 6 – low-grade tumours.
Gleason 7 – intermediate-grade tumours.
Gleason 8-10 – high-grade tumours.
A more contemporary grading system is the International Society of Urological Pathologist ( ISUP ) grade group 1 to 5.
Grade group 1 = Low grade.
Grade group 2,3 = Intermediate grade
Grade group 4,5 = High grade