Urology Prostate Service

Introduction

This document aims to give you, your relatives and carers information about the Prostate Diagnostic Clinic.

You have been referred by your GP because you may have 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.

There are several common conditions that can cause these findings. This means you will need to have some further tests. There is however a possibility that you could have prostate cancer, and this is why these tests are important.

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 flows through a small tube called the urethra. The urethra passes through the prostate before reaching your penis.

What is a PSA blood test?

A PSA blood 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 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 urine.
• Sexual activity or riding a bike a few hours before having a PSA test.

What is the Prostate Diagnostic Clinic?

• This clinic 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.
• Your initial assessment will be over the telephone and depending on the results of any investigation we will make an appointment with you to inform you of the results.
• The referral sent by your GP will be reviewed by a Senior Nurse Specialist and Consultant Urologist if required. You will then receive either a telephone call within a few days or an appointment for a face-to-face consultation in the clinic.
• The consultation will allow us to assess you for the appropriate tests. It will last around 10 to 20 minutes and will be with a Senior Nurse Specialist. You will be asked questions to gather information about your previous or current health problems. There will also be questions about your waterworks.
• Questions will 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.
• 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 will be tracking your progress throughout this process.

Where is the Rapid Diagnostic Clinic held?

Your appointment 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 could be at:

• North Tees Hospital, Stockton-On-Tees.
• Hartlepool Hospital.
• Community Diagnostic Centre, Stockton-On-Tees.

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.

To make sure that the MRI images are clear, you may have been given 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 you may have. If this is the case, we may suggest you to go straight to biopsy.

What is an MDT?

You may hear the term MDT being mentioned. An MDT stands for Multi-Disciplinary Team meeting, and is made up of 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 within 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 next 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 the procedure. The samples will then be sent to the laboratory to be examined under microscope to check for cancer within the prostate.  Your results will be available at the follow-up appointment with the urology team.

How long does the Biopsy take?

You will be in the procedure room for up to 40 minutes. Your appointment may last a few hours in total as you are on a theatre list and lists may need to be changed on the day of procedure.

Is there anything I should do before the biopsy?

You will be in the procedure room for up to 40 minutes. Your appointment may last a few hours in total as you are on a theatre list and lists may need to be changed on the day of procedure.

What if I am taking blood thinning medication (anticoagulants)?

If you take a blood thinner, depending on what it is, you may be instructed to stop 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.

What should I bring to the appointment?

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

What will happen on the day of biopsy?

• You will attend North Tees Hospital.
• 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. Your blood pressure and observations will be taken.
• You will be taken to the procedure room and one of the nurses or doctors who is doing your procedure will talk you through a consent form. There will be an opportunity to ask any relevant questions at this point.
• You will be given a dose of antibiotics by injection.
• You will then be assisted into getting into position on the examination couch. You will lie on your back, and your legs will be placed in stirrups. You may be asked to manoeuvre down the couch towards the practitioner. Please inform the nurse if you have any mobility or joint problems.
• Your perineum will be cleaned with sterile cleaning fluid and a sticky drape will be applied.
• Your perineum will be anaesthetised with local anaesthetic.  There will be some 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.
• The practitioner will insert the ultrasound probe 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.
• A guidance needle will 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 manoeuvre up the couch and the practitioner will remove your legs from the stirrups and you will be slowly sat upright. 
• You will be escorted to the private consultation area and asked to change into your normal clothes.
• Your blood pressure, pulse, respirations and oxygen saturations will be repeated.
• You will be given a sample bottle as we need you to pass urine before you go home. If you have a urinary catheter we will talk to you about getting a sample before you go home.
• You will be asked to stay for a short while (10-15 minutes) 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 symptoms 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 have any questions, please contact the following:

University Hospital North Tees

Urology Department.

Telephone: 01642 383801

Monday to Friday, 08:00 am to 04:00 pm

Comments, concerns, compliments or complaints

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