31st December 2024

Diagnosis of prostate cancer

If prostate cancer is clinically suspected on the basis of history and clinical examination, NICE recommends multi-parametric MRI prostate as the first-line investigation. This is to help identify whether biopsy is necessary and, if so, identify potential targets for biopsy. In patients who are too frail or multimorbid for radical prostate cancer treatment (i.e. surgery or radiotherapy) then MRI is not indicated.

Biopsy enables Gleason histological grading and is done under ultrasound guidance either via the rectum (transrectal ultrasound, TRUS) or perineum. The majority of patients experience haematuria and blood in their semen. Less common but more serious complications include sepsis, clot retention, rectal bleeding and severe haematuria.

Further staging with isotope bone scans is not performed routinely but is required for those with high-grade tumours, tumours that have spread outside of the prostate capsule and/or with clinical or biochemical evidence of bone metastases.