There are a number of different investigations or test which you may need. These include blood tests (such as PSA or kidney function tests), urine tests (urine dipstick, cytology or PCA3 , X-rays or scans (plain X-ray, ultrasound, CT scan, MRI scan or bone scan), and endoscopy or telescopic inspection of the bladder (flexible cystoscopy).
The most common tests which we need to do are a PSA (prostate specific antigen) test, or a test to look at the kidney function (U and E). We may also need to check your blood count (FBC), or in some cases look at your liver or bone function. Usually your blood test will be done at the end of the clinic, but in some cases you may have already had these done at your GP surgery prior to your appointment.
We ask all patients to bring a urine sample with them so that we can test it. This test is called a urine dipstick, and it looks for evidence of blood in the urine, or evidence of infection, amongst other things. This can then be sent off for a urine culture (MSU) if necessary.
For patients with suspected bladder cancer or a history of bladder cancer a urine cytology test will be needed. You will be provided with a small cup to pass urine into for this.
PCA3 is a new gene-based test carried out on a urine sample. It may be used in patients with suspected prostate cencer to give more information on the probability of prostate cancer being present. PCA3 is highly specific to prostate cancer and this gene is overexpressed in over 95% of prostate cancer cases. This is in contrast to PSA which may be increased by conditions such as benign enlargement of the prostate (BPH or BPE) or inflammation of the prostate (prostatitis). The PCA3 test result is not affected by these conditions. For more information on this test please click here
There are a number of different scans we may need to arrange after your appointment. In some cases we may be able to arrange them on the same day as your appointment, but we will need to know the reason for your referral for this and have seen your referral letter. Most of the scans can be done at the hospital where you are seen, but some of them (eg: bone scan) are done only at Addenbrooke’s Hospital.
As part of the investigations for your difficulty in passing urine or prostate symptoms, your urologist may need you to do a special test to measure how fast you pass urine (a urinary flow rate). This entails passing urine into a special funnel which measures electronically how fast your urine is expelled.
This simple test will usually be performed immediately before you see your specialist.
You should try to come to the appointment in clinic with your bladder comfortably full. If your bladder contains less than 150 mls, the result of the test may be unsatisfactory. If you have difficulty in keeping a full bladder, please inform the staff as soon as you arrive so that they can help provide you with sufficient fluid to fill up your bladder.
Often, after you have passed urine, your doctor will perform a simple ultrasound measurement of the urine that you have left in your bladder. This takes just a minute or two, and is painless.
This test can also show up anything unusual in your kidneys, bladder, testicles or prostate. It uses sound waves to build up a picture of the inside of the body.
If the test if to look at your kidneys or bladder, you will be asked to drink plenty of fluids before your test so that your bladder is full and can be seen clearly. Once you are lying comfortably on your back, a special gel is spread over the skin of your abdomen. A small scanning probe is passed over the area. It gives out sound waves and picks them up as they bounce back (echoes) from the organs inside your body. The echoes are made into a picture by a computer. The scan is painless and takes about 15-20 minutes. When it is over, you will be able to empty your bladder. You may then be scanned again to see if you leave any urine behind in your bladder.
An ultrasound scan is used to direct biopsies of the prostate for patients with suspected prostate cancer. For more information on transrectal ultrasound prostate biopsy, please click here.
A CT scan gives a series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. A CT scan may also be called a computed tomography scan, computerised tomography, and CAT scan.
It is usually done by urologists to give detailed images of the kidneys, ureters and bladder. The CT scan takes 10-30 minutes. You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly.
You will be able to go home shortly after the scan is over.
An MRI (magnetic resonance imaging) scan uses magnetism to build up cross-sectional pictures of your body. An MRI scan is often used in patients with prostate cancer, to see whether the cancer has spread into the tissues around the prostate gland or into the lymph nodes near the prostate.
During the test you will be asked to lie very still on a couch inside a metal cylinder. It can be slightly uncomfortable and some people feel a bit claustrophobic during the scan. It is also very noisy. You will be given earplugs or headphones to wear.
It is not possible for you to have an MRI scan if you have any metal in your body, such as a pacemaker, hip replacement, or certain types of surgical clips.
The scan is painless and can take about 30 minutes. You will probably be able to go home as soon as it is over
A bone scan technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
After the injection you will have to wait for up to three hours before the scan can be taken, so it is a good idea to take a book or magazine with you.
The level of radioactivity that is used is very small and does not cause any harm. Further tests, such as a plain x-ray of any abnormal area seen, may be necessary.
The bone scan is carried out at Addenbrooke’s Hospital
This procedure involves telescopic inspection of the bladder and water pipe (urethra). A small tube is passed into your bladder up your water pipe (urethra) under local anaesthetic. It is usually done to investigate whether there is any abnormality in the bladder or urethra in patients with urinary symptoms or with blood in the urine. We can also remove a stent using this telescope.
The investigation is done as an outpatient and takes about 5 minutes, but you will be at the hospital for longer than this, mainly in order to get you ready for the test. For more information, please click here.