Urology cancers

Cancer types

Urological cancers include prostate, kidney, bladder and testicular.

What symptoms might need an urgent referral?

  • A raised prostate specific antigen (PSA) blood test
  • Lower urinary tract symptoms (incomplete bladder emptying, daytime/night time frequency, intermittency, urgency, reduced flow and hesitancy)
  • Blood in the semen

Prostate diagnostic tests

There are a number of investigations which you may or may not require. These will be decided upon by a specialist consultant, doctor or specialist urology diagnostic nurse, in conjunction with our dedicated Uro-Oncology Cancer Pathway Navigator.

Sometimes it is necessary to have more than one test in order to get an accurate diagnosis. Some of these investigations may have already been carried out at your first appointment.

Following any of these investigations, you may be contacted by the hospital asking you to attend for further tests for clarification of your diagnosis. This is so that your doctor has the full range of results available to discuss with you at your outpatient appointment.

A Magnetic Resonance Imaging (MRI) scanner uses a magnetic fields and radio waves to build up pictures of parts of the body by picking up signals sent out by water molecules. An MRI Scan can produce two or three dimensional images of what is going on inside a patient’s body. MRI images are so precise that doctors can often get as much information from the MRI as they would from looking directly at the tissue.

A multi-parametric magnetic resonance imaging (mpMRI) scan is a special type of MRI scan that creates more detailed pictures of your prostate than a standard MRI scan. It does this by combining four different types of image. These images give information about whether or not there is any cancer inside your prostate

For further information about the Radiology Department, including patient information leaflets, is available – Radiology

You will be contacted with your MRI result, normally by phone, and you will be advised of the next steps. If your MRI scan is reassuring, then you will likely be discharged from the ‘suspected cancer pathway’ and you will commence on a short period of PSA surveillance whereby your PSA will be checked again in a few months’ time.

If your PSA is stable at this point, then you will likely be discharged back to the GP for community PSA surveillance. This means that your GP will take over the monitoring of your PSA, with either six monthly or yearly blood tests, and they will have very strict criteria for re-referral.

If your MRI scan is suspicious for cancer, then it’s likely that you will be invited in for some further investigations in the form of prostate biopsies for a tissue diagnosis.

Prostate biopsies

Using the information we have regarding your PSA blood test, MRI scan and DRE (digital rectal examination) you might be offered a prostate biopsy procedure. This is so small tissue samples can be taken and examined under a microscope for the presence of cancer. We offer a few different types of prostate biopsy:

A trans-rectal ultrasound scan uses sound waves to make an image of the prostate. An ultrasound probe is placed into the rectum (back passage) and the image is shown on a small screen similar to a television. Guided by the ultrasound image biopsies (small tissue samples) will be taken from different areas of the prostate with a needle via the rectum.

For this procedure, images taken when you had an MRI of your prostate are “fused” with the trans-rectal ultrasound image in order for biopsies to be targeted at a specific area identified on your MRI scan.

A transperineal (TP) biopsy involves taking needle biopsies via the perineum which is the area of skin between the scrotum and the rectum (back passage). This is done under local anaesthetic (LA). This is why the procedure is called an LATP prostate biopsy.

This is done under a general anaesthetic. The doctors pass a needle through the skin between the scrotum (the skin that covers the testicles) and the anus. They use a needle which can take many small tissue samples from different areas of the prostate