Men being referred to a diagnostic clinic will have a raised PSA (prostate specific antigen) discovered during a blood test.

These tests will have been done usually because of one of the following reasons:

  1. Some men will have urinary symptoms and go to their GP for advice. A blood test is arranged as part of their assessment.
  2. Some men have no symptoms but asked to be screened for prostate cancer.
  3. Some men have a strong family history and are aware of a need to assess their personal risk.

At the clinic an assessment will be made:

  • A history will be taken and symptoms assessed.
  • The patient is examined (general and prostate examination).
  • A blood test will be taken to see if the PSA result has changed since referral (20% are normal).
  • A urine sample will look for any infection.
  • The man’s flow rate will be assessed when he passes urine and an ultrasound scan will see if he retains urine in his bladder instead of emptying it completely on voiding.

It may be concluded after this that the patient does not have prostate cancer. If they have symptoms or evidence of benign disease, advice/treatment will be given so they are no longer bothered by this.

It is most important that all men’s general health is assessed. A significant benefit to health can be gained from stopping smoking, addressing obesity and encouraging exercise.

If there is any concern that the patient might have cancer, further assessments are made. An MRI scan helps in assessing if a biopsy is needed. If one is, then it is done under local anaesthetic using MRI/ultrasound fusion guidance.


It is important to offer biopsies to men that are likely to have significant prostate cancer and not miss life-threatening disease. However, prostate biopsies should not be performed unnecessarily as they carry a small risk with them (of infection).

The skill in prostate cancer diagnostics is investigating enough to find the cases that need intervention but not over investigating everyone so that excessive biopsies are performed. This avoids putting men through an unnecessary procedure and the associated anxiety and risk.

Once the diagnosis is made, the treatment options will be discussed with the patient. The aim is to fit the treatment to the patient, not the patient to the treatment.