The Prostate Pathway

Information for patients from Urology

This leaflet is for men referred by their GP to our Urology Department on a rapid access pathway. It explains how the pathway works and what you should expect at each stage.

You will have a series of appointments over the next six weeks. Please make sure you are available for all of them. We will have to remove you from this cancer pathway if:

Why have I been referred?

You have been referred by your GP because you have one or more of the following.

This is an urgent referral, to make sure the cause of your symptoms can be diagnosed and treated quickly. Your GP will have discussed this with you.

What is a PSA test?

PSA is a protein produced by the prostate. In a healthy prostate, small amounts of PSA will be found in your blood. However, your GP has found that you have elevated (raised) PSA levels in your blood, that need further investigation.

There are many reasons to explain your elevated blood test result. You could have:

Elevated PSA levels are found in older men.

What will happen at my first appointment?

As soon as we receive your urgent referral an appointment will be made for you. This appointment will either be face-to-face in the hospital or by telephone / video call.

During this appointment, we will discuss your referral and take a detailed history of your general and urological health.

Please give the urologist or cancer nurse specialist a list of your regular medication(s) at this appointment.

At the end of your appointment, the urologist or cancer nurse specialist will discuss the next steps with you. This will either be an appointment for you to have:

We may discharge you back to the care of your GP following this appointment. If this happens, the urologist or cancer nurse specialist will:

Please make sure your telephone contact details held by your GP and the hospital are up-to-date and be ready to answer any calls. Please note all calls from the hospital will display on your phone as no caller identification.

You will be discharged back to your GP if

If this happens, your GP will need to refer you again in the future.

What is an MRI scan?

An MRI scan uses strong magnetic fields and radio waves to create a detailed picture of your prostate and the surrounding area. This helps us to target the right area for your biopsy. We recommend that all patients have an MRI scan before they have a biopsy.

It may not be safe to have an MRI scan if you have a pacemaker or metal in your body. At your first appointment, please tell the urologist if you have implants of any kind.

What happens after my MRI scan?

A multidisciplinary team (MDT) will meet and review your MRI scan. This team includes:

If your MRI scan shows you have an abnormality, you will be referred for a prostate biopsy. You will be sent information explaining what will happen during the biopsy, with a letter detailing your appointment time and date.

If your MRI shows you have a low risk of significant prostate cancer we may still recommend a prostate biopsy, as you have risk factors that increase your risk of having prostate cancer. These risk factors include:

Please contact the Cancer Care Line on 01227 868666, if you want to discuss this further.

If your MRI scan shows you have a low risk of significant prostate cancer and you do not have any of the risk factors listed above, you will be told by letter that you will not be having a biopsy.

It is important for you to know that there is still a small risk that MRI scans can fail to find prostate cancer. An MRI is not a 100% infallible investigation in diagnosing prostate cancer. East Kent Hospitals data shows that this can happen with up to seven in every 100 patients. Knowing this, you can choose to have a biopsy, even if your MRI results show you have a low risk of significant cancer and you do not have any of the risk factors. We will also review you in three months with another PSA test and consider organising a biopsy if this remains elevated. Please contact the Cancer Care Line on 01227 86 86 66 if you want to discuss this further.

The prostate biopsy

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Your Prostate Pathway

Prostate biopsies are carried out in the Outpatient Department Clinic D at Kent and Canterbury Hospital. Please make sure you come to this appointment with a comfortably full bladder (if possible), as we need to measure your flow of urine when you arrive. This will happen soon after your arrival. Please let the clinic nurses know if the urgency to empty your bladder is uncomfortable.

We take biopsies of the prostate through your perineum (transperineal) under local anaesthetic (the area is numb but you are awake for the procedure). If you are referred for a biopsy, we will send you a leaflet called Having a transperineal biopsy of the prostate. Please contact the Outpatient Department on 01227 766877 if you have not received this leaflet with your appointment letter.

When will I receive my biopsy results?

We will aim to arrange an appointment with you within two weeks, to give you the results of your biopsy. You will discuss your results with your clinical nurse specialist at this appointment. This appointment will be a telephone / video call.

We advise you to have someone with you to support you during this appointment and listen to the information discussed. The cancer nurse specialist will provide you with the results of all your investigations, and explain what the next steps are.

What if I have any questions or concerns?

If you have any questions about your test results, please contact your cancer nurse specialist. They are available to answer your questions and talk through your concerns.

The telephone service is available Monday to Friday 9am to 5pm, Saturday and Sunday 8am to 4pm. The Macmillan CNS’s run phone clinics during the week. If appropriate, you will be booked on to the next available telephone clinic which may not be the same day.

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