Prostate cancer symptoms: Does it involve a rectal exam? What to expect from the PSA test

Prostate cancer is the most common type of cancer in men in the UK, and because the disease develops slowly, there may be no signs you have it for many years.

It was revealed at the beginning of this week that Bill Turnbull is currently struggling with the disease, and the BBC Breakfast presenter, along with doctors, is now urging men to get tested.

The PSA test is the recommended method for checking if you have the disease. But what does it entail – is it a blood test, a urine sample or a rectal examination?

Professor Hashim Ahmed, Consultant Urological Surgeon at the Bupa Cromwell Hospital, is asking men not so shy away from having a prostate check, and details what to expect from the test.

Men over the age of 50 who have talked through the advantages and disadvantages of having a PSA test with their GP or practice nurse are eligible for a Prostate Specific Antigen (PSA) test.

The first stage of the process is a simple blood test.

A rectal exam can then help identify obvious abnormalities on the surface of the prostate even if the PSA is normal.

Dr Ahmed explains: “If you have a raised PSA, or the rectal exam shows a lump, your doctor may refer you for a MRI scan in a specialised unit, which is a much more effective way of detecting prostate cancer.”

He added that it’s important to note that your PSA can be high if you have prostate cancer but it can also be higher than normal if there is an infection, inflammation or you have a large prostate.

Recent sexual activity before the test or cycling due to the pressure from a saddle can also raise your PSA levels, so make sure your GP is aware of anything that could affect the test.

But if you need a biopsy, does it have to be through the back passage and does it hurt?

Dr Ahmed said: “A biopsy check for prostate cancer involves taking tissue samples from the prostate. Some expert centres now only biopsy the prostate if the MRI shows suspicious areas.

“One of the common ways to biopsy the prostate is through the back passage, called transrectal ultrasound biopsy or TRUS biopsy. This procedure takes about 20 to 30 minutes and your doctors can discuss the biopsy and the side effects.

“Some urologists now biopsy the prostate using the transperineal approach (through the skin behind your scrotum). This is a cleaner approach that is more accurate but it requires sedation or general anaesthetic to carry out.”

Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra.

When this happens symptoms can include:

• Needing to urinate more frequently, often during the night
• Needing to rush to the toilet
• Difficulty in starting to pee (hesitancy)
• Straining or taking a long time while urinating
• Weak flow
• Feeling that your bladder has not emptied fully

How did Bill Turnbull find out he had prostate cancer?