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Rapid prostate diagnostic service   

Patient information explaining what tests are performed and what these can mean.

Introduction

This document aims to give you, your relatives and carers information about the Rapid Prostate Diagnostic Service (RPDS).

You have been referred by your GP because you may have presented with some increased urinary symptoms, or your prostate does not feel entirely normal to your GP and/or the result of your prostate-specific antigen (PSA) blood test is high. Based on these findings, there is a possibility that you have prostate cancer.

However, there are several other common conditions apart from cancer that can cause these findings, so further tests may be needed. 

What is a prostate?  

The prostate is a small gland near your bladder in males. The prostate makes fluid that forms part of your semen. When you empty your bladder, urine (pee) flows through a tube called the urethra. The urethra passes through the prostate before reaching your penis.

What is a PSA blood test?

A PSA test measures a chemical in the blood, which is released by the prostate. Your PSA level usually increases with age, so the older you are, the higher your normal level of PSA. Your GP has referred you because your PSA level is higher than normal for you, based on your age. 

Conditions that can cause a high PSA level are:

  • A prostate or urine infection.
  • Prostate inflammation.
  • Benign (non-cancerous) prostate enlargement.
  • Prostate cancer.

Other things that can affect PSA levels are: 

  • Repeatedly not emptying your bladder properly.
  • Insertion of a catheter or investigations in the urethra, for example a camera.
  • A test of your bladder for blood in your pee.
  • Sexual activity or riding a bike a few hours before having a PSA test.

What is a Rapid Prostate Diagnostic Service?

  • The RPDS service has been designed to reduce the time taken to investigate and diagnose why you have urinary symptoms, a high PSA and/or an abnormal feeling prostate.
  • The referral sent by your GP will be reviewed by a Senior Nurse Specialist and consultant urologist where required. You will then receive either a telephone call within a few days or an appointment for a face-to-face consultation in clinic.
  • Your initial assessment may be over the telephone and depending on the results of any investigations we will navigate you to the most appropriate appointment to inform you of any results. 
  • The consultation will allow us to assess you for the appropriate tests.
  • The telephone consultation will last about 10 to 20 minutes and will be with a senior urology specialist nurse or practitioner. You will be asked questions to gather information about your previous or current health history. There will also be questions asked about your waterworks.
  • Questions will also be asked to decide whether it is safe and suitable for you to have a magnetic resonance imaging (MRI) scan.
  • During this consultation you will be given information about what to expect over the next few weeks.
  • If an MRI scan is recommended this will be booked at the time of your consultation and the MRI team will be in touch to confirm when and where to attend. 
  • Following your scan, if a targeted biopsy of your prostate is recommended, then you will be added to the waiting list and the booking team will be in touch to confirm when and where to attend.
  • If your scan looks normal, there is a high chance that your prostate does not contain any concerning cancer cells. We will telephone you to inform you or arrange the appropriate appointment. 
  • Our aim is to carry out these tests as quickly as possible and keep you informed along the way. 
  • A member of the team called a Navigator will be tracking your progress through this process and will be in touch to introduce themselves to you. 

Where is the Rapid Diagnostic Service held?

Your appointments and tests could be at one of our hospital sites depending on where you live, if you can travel, and when the next available appointment is. This includes James Cook Hospital Middlesbrough, The Friarage Hospital Northallerton, Darlington Memorial Hospital or Redcar Primary Care Hospital.

What is a prostate MRI scan?

A magnetic resonance imaging (MRI) scan uses magnetic waves to produce images of the body. It does not use X-rays or radiation. A prostate MRI takes images that can show us any suspicious areas of the prostate that might be cancerous. The MRI scan appointment will take up to about an hour to perform.  

So that the MRI images are clear you may have an injection of a contrast dye called gadolinium. You will be asked to lie very still on your back on a couch for about 30 to 40 minutes while the scan takes place. There are certain patients who cannot have an MRI scan due to certain conditions or implants they may have. If this is the case with you, we may discuss with you progressing straight to a biopsy. 

What is an MDT?

You may hear the term MDT being mentioned. An MDT stands for Multi-Disciplinary Team meeting, and constitutes a mixture of doctors, nurses, allied health professionals and support workers. All have a specialised interest in Urology and work either within the urology service, or with the radiology, pathology, or oncology services. There is a formal meeting each week where many patients are discussed and a range of recommended treatment options are agreed. The outcome of this meeting will be discussed with you at your appointment. 

What is a prostate biopsy?

A prostate biopsy involves taking small samples of tissue from the prostate through the perineum (the area of skin between your back passage and scrotum). We will take up to 16 samples during your procedure. The samples will then be sent to the laboratory to be examined under a microscope to check for cancer within the prostate. Your results will be available at the follow-up appointment with the Urology team.

How long will it take?

The procedure itself will take up to 20 minutes. We allow 45 minutes for the whole appointment which includes the pre-procedure chat and time for you to have a hot drink and to pass urine afterwards. 

Is there anything I should do before the biopsy? 

There is no specific preparation you need to do before your biopsy, and you can eat and drink as normal on the day.

Blood thinners (anticoagulants)

If you take a blood thinner; depending on what it is; you may be instructed to stop it prior to the procedure. This information will be given to you by the urology team looking after you or the hospital anticoagulation team. The practitioner will inform you after the procedure when you can restart any blood thinners if they have been stopped.

We generally do not stop aspirin for this procedure.

What should I bring to the appointment?

  • A list of your current medications.
  • Any health information you think may be important.

What will happen on the day of biopsy?

You will attend the Radiology Reception at James Cook University Hospital in Middlesbrough or the Urology Investigations Unit at the Friarage Hospital in Northallerton; and check in at reception.

  • You will be called by the nurse/member of staff looking after you who will take you to a private consultation area/changing room. You will be asked to remove your clothes, including your underwear and change into a patient gown.
  • Your details will be checked at this point and the nurse will explain the procedure. You will be given one dose of oral antibiotics before the procedure.
  • You will be escorted to the procedure room and will be asked to sign a consent form. There will be an opportunity for you to ask any relevant questions at this point.
  • Your blood pressure and observations will be taken.
  • You will then be assisted into getting into position on the examination couch, on your back. Your legs will be placed in stirrups and you may be asked to move down the couch towards the practitioner. Please inform the checking in nurse if you have any mobility/joint problems.
  • The practitioner will examine your back passage with their finger, and the ultrasound probe will be inserted into your back passage. The ultrasound probe is used to guide the practitioner in obtaining the biopsies as it shows pictures of your prostate on the screen. 
  • If inserting the probe is difficult/painful then Entonox gas may be used to assist with probe insertion.
  • Your perineum will be cleaned with sterile cleaning fluid and a sterile drape that sticks to the skin will be placed appropriately.
  • Your perineum will be anaesthetised with local anaesthetic. There will be three injections either side of your perineum. They will numb the outer skin, deeper skin tissues and around the nerve bundles in preparation for the procedure.
  • A guidance needle with be inserted into the perineum and the biopsies will be taken. Up to 8 samples are taken from the right side of the prostate and up to 8 samples from the left side.
  • Once the biopsies have all been taken, the practitioner will remove the guidance needle and probe. The perineum will be cleaned with gauze and the sticky drape will be removed.
  • You will be asked to move up the couch and the practitioner will remove your legs from the stirrups and you will be slowly sat upright. Your blood pressure and observations will be re-taken.
  • You will be escorted to the private consultation area and asked to change into your normal clothes. You will be given a pad to place in your underwear to avoid any slight bleeding marking your underwear.
  • You will be offered a hot drink and given a sample bottle; we need you to pass urine before you go home. Alternative information will be given for those patients who are catheterised.
  • You will be asked to stay for a short while (10 to 15mins) to ensure you feel well.
  • You may drive home if you feel well.

What are the risks of the procedure?

  • You may experience blood in your urine for up to 3 weeks. Drink plenty of non-alcoholic fluid to flush the blood through. 
  • If you are unable to pass urine and have discomfort in your lower abdomen, then you would need to attend A&E.
  • You may experience small amounts of blood in your semen for up to 3 months. If you do experience any pain during intercourse, please contact your GP.
  • Although the risk of infection is less than 1%; if you experience ANY of the following you MUST seek medical advice, either call your GP, call 111 or visit A&E if you feel very unwell: 
  • Cloudy or offensive smelling urine.
  • Continued pain when passing urine.
  • If you develop a high temperature or feel shivery.

You may be given some additional antibiotics if you do experience any of these symptoms.

Contact numbers

If you need further advice, or have any problems, please contact the appropriate number below:

South Tees NHS Hospitals Foundation Trust

Telephone: 07788 367741

Monday to Friday, 8:00am to 4:30pm

Email: [email protected]

If you have any worries or concerns, you should contact your GP during normal surgery hours. Outside surgery hours, you should contact your GP’s surgery for the Out of Hours Service number.

Different Formats

This leaflet can be made available in other formats including large print, CD and braille and in languages other than English, upon request.

Patient Experience Team

South Tees Hospitals NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at James Cook University Hospital but also the Friarage Hospital in Northallerton, our community hospitals and community health services.

South Tees Hospitals NHS Foundation Trust

Telephone: 01642 854807 / Freephone: 0800 0282451

Email: [email protected]

Monday to Friday, 9am to 4pm

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).

James Cook University Hospital

Marton Road

Middlesbrough

TS4 3BW

Telephone: 01642 850850

The Friarage Hospital

Northallerton

North Yorkshire

DL6 1JG

Telephone: 01609 779911