• Urinating more often or getting up a number of times during the night
• Difficulty (starting or stopping) or pain when urinating
• Bladder doesn’t feel empty
• Pain in the hips, lower back or upper thighs
• Difficulty getting or keeping an erection
• Blood in semen or urine
• Fatigue

Prostate Specific Antigen (PSA) Test PSA is produced by both normal and cancerous prostate cells. A high level of PSA can be a sign of cancer. PSA blood tests are also used to monitor how well prostate cancer treatment works or to decide whether you need treatment. If your PSA is stable, it is a sign that a cancer is not growing or spreading.

Digital Rectal Exam (DRE) PSA testing together with DRE can identify prostate cancers in their infancy. During a digital rectal exam your doctor will examine your prostate gland by gently inserting a lubricated gloved finger into your rectum, feeling the surface of the prostate gland and checking for abnormalities, such as a lumpy, hard prostate.

Rectal Ultrasound This involves a small ultrasound device being placed into the rectum (back passage) to produce a picture of the prostate gland. This test should not hurt but can be uncomfortable.

Prostate TRUS Biopsy TransRectal UltraSound (TRUS) is used to take an image of the prostate gland and allows a small sample of cells to be taken accurately during a biopsy.

Template, or saturation, biopsy This may be recommended if the suspicion for cancer is still high despite a clear TRUS biopsy, or if the TRUS biopsy cannot reach the suspicious area.  It involves a general anaesthetic and many more needles are used to sample the whole gland.

MRI scan An MRI scan gives very good pictures of the prostate gland and can help localise the position of the cancer within it. Multi-parametric, or functional, MRI scans allow even greater certainty of the cancer’s position. It can also show any evidence of spread to the nearby lymph glands and pelvic bones.  It should be performed before the biopsy so that any bleeding or swelling doesn’t interfere with the quality of the images.

Other Scans If the cancer is higher risk then other scans, such as CT scan, bone scan, or PET scan, may be required to exclude spread of the cancer to other areas of the body.