Changes in the way you pee : difficulty starting or straining, a weak flow, stop-start peeing, needing to pee urgently or often, feeling you still need to pee when you have just finished, and getting up in the night (NHS)
Other symptoms : erectile dysfunction, blood in the urine or the semen, and, in advanced disease, lower back pain and losing weight without trying (NHS)
These symptoms far more often mean benign prostatic enlargement, which is very common with age, than cancer; the NHS advice is not that they are alarming but that a change in them should be checked (NHS)
See a GP if you are having trouble peeing or have other symptoms, if you are over 40 and genetic testing has shown you carry a faulty BRCA2 gene, or if you are worried about your risk; you can ask about a PSA test even without symptoms, and the GP will weigh your risk in deciding whether it is the right test for you (NHS)
At the appointment the GP will ask whether anyone in the family has had prostate, pancreatic, ovarian or breast cancer, may examine the prostate with a gloved finger through the back passage, and may offer a PSA blood test with results in one to two weeks (NHS)
MRI-influenced biopsy is offered at Likert 3 or above; at Likert 1 or 2 omitting biopsy can be considered after a shared discussion of the risks and benefits, and systematic biopsy is offered to anyone who still wants one (NG131 1.2.3, 1.2.4)
Mapping transperineal template biopsy is not offered as part of an initial assessment outside a trial (NG131 1.2.5)
After a negative biopsy with an MRI Likert score of 3 or more, the case is discussed at the MDT with a view to repeating the biopsy; after a negative biopsy with Likert 1 or 2, PSA is repeated at 3 to 6 months (NG131 1.2.10, 1.2.12)
CT is considered where MRI is contraindicated and knowing the T or N stage would change management (NG131 1.2.14)
The pathology report gives the histological type, the Gleason score and the grade group, the tumour length in each core, the percentage of Gleason pattern 4 and whether intraductal or invasive cribriform carcinoma is present; on a prostatectomy specimen it adds extraprostatic extension, seminal vesicle invasion, margins and nodes (RCPath G084, October 2024)
Isotope bone scans are not routinely offered in Cambridge Prognostic Group 1 or 2 (NG131 1.2.16)