Frequently asked questions

We asked Professor John Masters (Executive Director of the Prostate Cancer Research Centre), and Dr Heather Payne, (Consultant Oncologist at UCLH) to answer some of the most frequently asked questions that come into our office or are asked of our scientific or clinical staff.

Q: What is the value of the PSA test for (a) diagnosing cancer and (b) monitoring cancer after it has been diagnosed?
There is no simple answer to this one. In relation to diagnosis the upper limit of normal serum level of PSA is around 4ng/ml. But many men diagnosed with prostate cancer have PSA levels less than 4ng/ml. If the level is above 4ng/ml there is a greater likelihood of prostate cancer. If the level is between 4 and 10ng/ml about 25% of men have prostate cancer. If the level is above 20ng/ml there is a high chance of having prostate cancer that has spread. But men with benign disease or infection of the prostate can have very high levels of PSA, well above 20ng/ml, so further tests need to be done to confirm prostate cancer, whatever the level of PSA. And of course there are all sorts of variations on the PSA test, which may or may not improve its diagnostic accuracy. So the PSA test needs a lot of interpretation when it is being used for diagnosis. What the PSA test is really helpful for is following up men who have had their prostate cancer treated. If the PSA level rises after treatment there is a good chance that the cancer has started growing again. But even if the PSA does start rising, it can be many years before the cancer causes any symptoms.

Q: What is the Gleason score?
When prostate cancer is diagnosed under the microscope, the histopathologist scores the cancer on a scale up to 10, based on how close the appearance of the cancer is to normal prostate tissue. The less it appears like normal prostate, the higher the score and the more likely it is to grow fast and spread to other parts of the body.

Q: My consultant oncologist has said that I cannot have radio therapy because I have 2 artificial hips – I gather this is because the radio beam might bounce off the metal and damage other organs in the area.
It is difficult to plan and deliver radiotherapy when a man has one or two artificial hips for the reasons described and also because if you use a CT planning system the metal from the hips causes artefact of the planning images and it is difficult to actually see the prostate. It depends a bit on the planning system but it can cause some difficulty and there is an opinion that this situation is a contra-indication to external beam radiotherapy. Some patients may be suitable for brachytherapy which is planned using transrectal ultrasound and therefore the metal in the hips does not interfere with the planning or treatment. The suitability for brachytherapy will depend on the stage and grade of tumour as well as PSA.

Q: Why am I undergoing active survelliance and not being offered treatment?
Active surveillance is one option for men with early prostate cancer. The decision to have active surveillance or active monitoring as it is sometimes called should be a decision that you make with your doctor. There are many treatments for early prostate cancer and these include various types of radical prostatectomy to surgically remove the prostate or radiotherapy which can be given with external X Rays or by implanting radioactive seeds inside the prostate which is called brachytherapy. The aim of active surveillance is to regularly monitor your prostate cancer with PSA blood tests and sometimes repeat