Suffolk Urology

Testing for prostate cancer

Multiparametric MRI scanning and transperineal template prostate biopsies

Early prostate cancer frequently causes no symptoms. Difficulty with urination is more often caused by non-cancerous enlargement of the prostate. Men may require further tests for prostate cancer if their PSA blood test is raised or their doctor examines their prostate and it feels abnormal.

PSA (Prostate Specific Antigen) is a protein produced by the prostate. The blood PSA level can be raised due to prostate cancer, but benign prostatic enlargement, infection and inflammation of the prostate can also cause raised PSA. You may well be aware that there is therefore some uncertainty surrounding the use of this test. It is normal for the level to fluctuate slightly in individuals and to increase gradually over time as benign prostatic enlargement continues to develop over the years. Also, men may have PSA levels within the normal range and still have prostate cancer.

If your blood PSA level is persistently raised then a prostate biopsy is usually required to look for possible prostate cancer. The conventional test is a TRUS (transrectal ultrasound-guided) prostate biopsy. Here, an ultrasound probe is inserted into the back passage to guide a needle up to the back of the prostate to take a series of 12 samples. This test is performed under local anaesthetic and takes 10 – 15 minutes. Prostate cancer most often arises in the back of the prostate – the area most easily accessible by TRUS.

Fortunately, many men who have prostate biopsies turn out not to have cancer in the samples taken. It is then important to continue to monitor the PSA level. If there is continuing concern, such as a further rise in PSA or equivocal results on initial prostate biopsy, then additional tests are required.

Multiparametric MRI scanning

Conventional MRI scanning has been useful in determining in men diagnosed with prostate cancer whether there is spread through the capsule (the outer lining of the prostate) or into the lymph nodes (glands within the pelvis adjacent to the prostate). It has been less accurate in determining whether areas within the prostate itself contain cancer – non-cancerous growth and inflammation within the prostate are also picked up.

Multiparametric MRI (mpMRI) is the latest generation of the technique and uses modifications including diffusion-weighted imaging (DWI), T2-weighted imaging (T2W) and dynamic contrast enhancement (DCE) to increase the reliability of assessment of abnormal-looking parts of the prostate. It can be helpful in deciding whether a man with a raised PSA requires a biopsy or whether a man with a previous negative biopsy requires a repeat biopsy.

Mr Yardy uses Mutiparametric MRI scanning at the Ipswich Nuffield Hospital provided by InHealth.

Transperineal “template” prostate biopsies

With this technique, which is performed under local or general anaesthetic, the needle used to take prostate samples is passed through the skin between the back of the scrotum and the anus (rather than via the back passage as in TRUS). The advantages are:

More areas of the prostate can be sampled – including the lower part (apex) and front of the prostate More biopsy samples can be taken (30-40)
Abnormal areas seen on MRI can be specifically targeted
Infection risk is almost zero

It is appropriate for men with continued suspicion of prostate cancer (such as rising PSA) and previous negative TRUS biopsies, and for monitoring during Active Surveillance (men diagnosed with early prostate cancer who have not received active treatment)

Blood in urine

Most people who notice blood in their urine ("haematuria") are understandably alarmed. Some people are also found to have traces of blood in their urine detected unexpectedly. The list of possible causes is very long, including infections, injuries, stones, tumours or inflammation in the kidney or bladder. Depending on presence or absence of other risk factors, people with blood in their urine will usually require a kidney scan and a flexible cystoscopy. Cystoscopy involves examination of the bladder using a fine flexible telescope usually under local anaesthetic. Although it sounds unpleasant, it is not painful.

TESTIMONIALS

I was very satisfied with all aspects of the care I received from Mr Yardy and particularly appreciated his intervention on my behalf to secure a single room at the Ipswich Hospital in view of my being a covid 19 'high risk patient' . I was also grateful that he liaised with my Haematology consultant regarding my regular medication prior to and after surgery.

Calm clear and friendly advice. Yes the procedure was not great but I was ready for it! The important thing is that I am now back to my old self and I am very grateful.

He took great care in explaining both the the situation and the options in a positive way.

Absolutely no pressure to undertake surgery or be rushed to have it done immediately.Once a plan was agreed it all happened very efficiently.

At all times he made himself availably if further information or consultation was need.

Excellent service from initial consultation through to surgery and follow up consultation. Correspondence from Wendy Gudgin (Secretary) was also excellent and very efficient.

I was very satisfied with all aspects of the care I received from Mr Yardy and particularly appreciated his intervention on my behalf to secure a single room at the Ipswich Hospital in view of my being a covid 19 'high risk patient' . I was also grateful that he liaised with my Haematology consultant regarding my regular medication prior to and after surgery.

The proceedure was carried out on my Grandson who needed to be circumcised due to medical reasons. He was treated with great understanding [George is 12] and information on the operation was explained in a clear manner. George had every confidence that this was going to be a safe and necessary.

Utterly professional and exudes confidence. As a patient he comes across as a safe and experienced pair of hands which is most reassuring.

Mr Yardy clearly explained the procedure before my operation and answered all my questions afterwards.

Explanation of possible causes of the problem was so in-depth and expertly explained and extremely reassuring.

Mr Yardy has monitored my prostate ever since an enlargement was identified 3 years ago. His approach to analysis of data is extremely thorough and his explanations are clear and concise providing sufficient detail for a layman to understand the diagnosis.

I have a further MRI scan which I hope will provide the 'all clear' but nevertheless it is my intention to continue to have regular examinations by Mr Yardy as this will give me peace of mind.

Very professional with an empathetic approach. Always willing to take the time to explain in details such things as options and possible outcomes. I would have no problem in recommending his services.

Mr Yardy and his colleague did a great job of putting me at ease before the start of the procedure. He indicated what the experience would be like in realistic terms but not such as would cause anxiety. The start of the procedure was as described. The view from the cystoscope on screen was mesmerising. Mr Yardy gave a commentary as he proceeded which was most helpful. There were a few twinges of discomfort but nothing severe. After the procedure we had a full and very helpful discussion about options and homed in on what I think is the best course of action for me. This was my second visit to the urology assessment suite (first for cytoscopy) and I have found all the staff very friendly and helpful.

Mr Yardy is kind and considerate and explains things so that I can understand. It cannot be easy talking to an elderley lady (that's me!) about the problems I present with! I was made to feel valid rather than a bit of a nuisance!

Mr Yardy was an amazing consultant who asked every detailed until he got to the bottom of my problem. With his amazing knowledge he has made made me better and i’m very great full he was my consultant.

I found Mr Yardy to be very professional and able to explain and reassure me with the problems that I presented him with.

Fantastic doctor who i trust.

My son was welcomed by two very confident happy and professional Drs..they made him feel very comfortable and at ease for a very private matter for a nearly 15 yr old. He felt at ease and was explained at every point of consultation what was happening especially his examination.

I found Mr Yardy a very pleasant man who was able to explain very clearly to me the different stages of the procedure I was considering to have done.

I found Mr Yardy to be an excellent Consultant. His manner was calming and reassuring. He was very good at explaining the procedure I was having and the outcome.

Overall my Rezum treatment has been very successful with a huge improvement in the symptoms previously experienced.

I would not hesitate to recommend Mr Yardy and his support team for the consultation and procedure that i undertook.

Mr Yardy was recommended by my oncologist following my diagnosis with advanced prostrate cancer. He handled our appointment with sensitivity and a clear picture of how we would proceed with the investigation. It was a very calming and assuring appointment after the shock diagnosis.His secretary was most helpful in keeping the process and appointments on time.

I am very satisfied with the treatment a received from George Y his explanation of what my options were on my consultation and with what will happen when i went for the TURP surgery was all very clear and easily understood.

I had been in real prostrate trouble for some time and had the prospect of a very long wait and much uncertainty in resolving this. Mr Yardy gave me very clear information extremely helpful advice and the attention and time to discuss my concerns fully. When I went into surgery I felt well prepared for the procedure and confident in getting the best care. Not only has the procedure proved very successful but throughout I felt Mr Yardy gave me his full personal attention both during the process and in the post-op recuperation and follow-up. I am truly grateful for the professional service I received and the individual care and attention offered to me as an individual.

Mr Yardy has been honest understanding and approachable. He has emphasized his willingness to be contatcted if I have felt uncertainty. I am very grateful for his understanding.

I found Mr Yardy very approachable and knowledgeable. He explained things in a way I could understand. He even managed to make me smile during a not very comfortable (but not painful) procedure. A very gentle man.

Very pleased from my first appointment to my last one with Mr Yardy. He listened to me was genuinely interested in my health and made me feel at ease throughout my consultations. As a result of Mr Yardy's advice care and treatment I am now back to full health. Thank you.

I have always found Mr Yardy to be friendly polite and very knowledge in all aspects of my experience with him.

Very good at explaining to both adults and my son (11) what would be happening and possible outcomes etc. This made the whole experience a very calm and productive one. Surgery was an excellent experience for hearing and the final result. All in all excellent.

Mr Yardy was both friendly and professional at all times. The only problem was in the level of pain experienced with the procedure which far greater than I had expected but that was probably due to my condition.

A delightful person. His manner was reassuring and so gentle. I did not feel that I was wasting his time.

"I had a telephone conference with Mr Yardy due to the Corona Virus. He came up with a clear treatment plan which he implemented with a clear and concise letter sent to relevant individuals a copy of which was sent to me.

Very easy relationship providing great reassurance when having concern initially. Appropriate checks swiftly arranged and followed up. Great confidence in his knowledge and ability during continuing monitoring. Discussions conducted in easily understood form and questions fully answered. Very appreciative of care given.

Excellent intermittent catheter (which proved to be excellent advice) and to explain steaming.


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