Prostate examination

When is an examination needed?

You should come for examinations when your symptoms include a sudden or increased urinary frequency or reduced urine flow. Harmful symptoms may also include pain with urination or after-dribble. A high prostate-specific antigen (PSA) count may be a sign of prostate cancer, but it could also be caused by benign prostatic hyperplasia or irritation caused by inflammation.

What does the basic examination include?

The basic examination includes an appointment with a urologist along with laboratory tests, as well as an ultrasound scan conducted during the appointment.

The urologist’s appointment

The urologist interviews and examines the patient. A rectal examination by palpation will determine the size, shape and any pain of the prostate. Based on the interview and examination, the urologist will then give the patient a referral to the laboratory for urine and blood samples. In addition to this, a prostate ultrasound scan may be conducted in conjunction with the appointment.

The following things will be determined from the patient’s urine and blood samples:

  • Serum creatine level and renal activity
  • PSA (prostate-specific antigen)
  • Urine abnormalities, blood or inflammation.

The test results will arrive within 1–2 weekdays. The physician then gives these test results to the patient by either telephone or letter, coming to an agreement about any needs for further examination or treatment.

Prostate cancer examination

Suspicion of prostate cancer often arises due to high PSA (prostate-specific antigen). Suspicion may also arise from urinary symptoms or pain.

In prostate cancer, the PSA count in the bloodstream rises (PSA seeps into the bloodstream from the cancer cells), but benign prostate hyperplasia and inflammations, among other things, may also raise PSA. This is why PSA above the reference value does not automatically mean prostate cancer, but that other possible factors need to be charted. Generally, PSA measurement should be repeated, if necessary. If total PSA is anomalous, a free PSA count, which is indicated as a percentage, can be used to support PSA evaluation. The lower the free PSA percentage is, the greater the suspicion of prostate cancer. Generally, the limit value for further examinations is ≤ 15 %.

Local prostate cancer does not cause practically any symptoms. A male with local prostate cancer will nonetheless often have benign prostate hyperplasia at the same time, which causes symptoms related to micturition. These lead to further examinations, such as PSA measurement, and hence, potential suspicion of prostate cancer. By contrast, metastatic prostate cancer can have symptoms such as skeletal pain, urinary disorders and declining general condition.

Carrying out a diagnostic examination

A prostate cancer diagnosis is based on clinical examination and ultrasound-driven needle samples of the prostate taken through the rectum. Fusionbiopsy is a new and accurate method used in cancer diagnosis combining magnetic resonance imaging (MRI) and ultrasound examination. More information of Fusiobiopsy will follow on this page shortly.

Before biopsy samples are taken, the patient receives antibiotics to prevent infections. The prostate is anesthetized before samples are taken. This examination takes about 20 minutes all in all, and no sick leave is necessary following the procedure, but it will be good to avoid strenuous exertion for a couple of days. The procedure is generally painless. The most typical secondary symptoms include mild hematuria and bloody semen. Regardless of antibiotic protection, inflammatory symptoms appear in approx. 2–6% of the patients after the procedure.

Increasingly often, prostate magnetic imaging is conducted already during the diagnostic stage, and so-called targeted biopsies may be taken. HUCH has MRI-TRUS fusion imaging equipment for obtaining accurate, targeted biopsies of the suspicious area visible in the MRI image.

Making the diagnosis

A pathologist examines the biopsies for cancer. If the pathological finding is cancer, the pathologist will evaluate the aggressiveness of the cancer, using the international Gleason grading system. The Gleason grading system is also one of the most important predictors of prostate cancer.

Evaluation of the prognosis for prostate cancer involves using a risk group classification (based on clinical metastasis of the disease), the Gleason score as evaluated by the pathologist, the share of cancer in the biopsies and the plasma PSA count.

Metastasis examinations

If low risk cancer is found in a patient with no symptoms, routine metastasis examinations may not be necessary. In the case of moderate or high risk cancer or a patient with symptoms, further examinations (skeletal scintigraphy, body computer description, prostate magnetic resonance imaging, and in some cases at the doctor’s discretion, PET) are conducted to determine disease metastasis.