First, we look with imaging:

• Traditionally, CT imaging and bone scans are used to see if there is evidence of cancer outside the prostate.
• At BPS, we prefer a sensitive PSMA PET scan,  which gives us a much more accurate picture in high-risk patients.
• Even a PET scan won’t pick up a microscopic cancer smaller than 2mm - so a scan alone can’t prove that a cancer hasn’t spread.

So secondly, we use the ‘Gleason Grade’ and PSA in combination to assess the probability of spread:

• Probability tables called nomograms have been created from studies of patients who’ve had the same grade and stage of cancer as you in the past to gauge the chances that your cancer has, or will soon, spread.
• You’ll need a biopsy, and a pathologist will then analyse the tissue and assign a Gleason score. The PSA test is a simple blood test.

Making an assessment of how fast-growing your cancer is means you can weigh up whether to have surgery or radiotherapy. This decision is difficult because treatments to avoid a life-threatening spread in the future, unfortunately, may cause unwelcome side effects now and affect your quality of life on a long-term basis.

It’s important to remember that while your cancer can no longer be cured if it has already spread, it can be controlled with radiotherapy or hormone treatment.