Unilabs’ multi-disciplinary approach to prostate cancer care

Prostate cancer is the most common cancer affecting men, particularly those over the age of 50. Often slow-growing, it can remain asymptomatic for extended periods, which is why screening is generally recommended from age 50, or even earlier for individuals with risk factors or a family history of the disease.

Unilabs is committed to being a trusted partner in the fight against prostate cancer by offering a comprehensive range of screening services, including in vitro diagnostics (IVD), pathology, and imaging, as well as participating in ongoing oncological monitoring.

In this Movember article, we speak with Unilabs’ microbiologist, Dr Giuseppe Togni, to learn more about Unilabs’ multi-disciplinary approach to diagnosis and care through the examination of three real-life clinical cases*.

Looking for signs of prostate cancer

The prostate is a small gland in the male reproductive system, located below the bladder and surrounding the urethra. Because the prostate encircles the urethra, any enlargement, inflammation, or disease—whether benign or cancerous—can affect urinary function, making urinary problems an early prostate cancer symptom. These may include frequent urination, a weak or interrupted urine stream, a sensation of incomplete bladder emptying, or urine leakage after urinating. Additionally, some men may experience pelvic or perineal pain, or notice blood in their urine or semen.

Dr Togni says any of these symptoms warrant medical evaluation. “It’s important to determine the underlying cause, which could range from benign prostatic hypertrophy or infection to inflammation or, in some cases, prostate cancer.”

A typical initial screening

One of the most common blood tests used to screen for prostate cancer is the prostate-specific antigen (PSA) test. However, because PSA is not a cancer-specific marker (elevated levels can also occur in conditions such as prostatitis or benign prostatic enlargement), other clinical examinations are regularly used as first-line assessments, including the digital rectal examination (DRE) and ultrasound imaging.

Dr Togni says this combination of tests is commonly the first step for evaluating patients with suspected prostate issues, and helps to guide further diagnostic decisions. “Let’s take Luke, 52, as an example. This man was concerned about red urine persisting for several days. After a thorough examination and medical history review, his healthcare provider ordered a PSA test, which returned within the normal range (<3.5 ng/ml). Despite the normal PSA, Luke exhibited slow urination, and the digital rectal exam indicated an enlarged prostate. Ultrasound confirmed this and revealed residual urine remaining in the bladder after urination. Based on these findings, Luke was prescribed medication to relax the prostate and urethral muscles to improve urine flow. He also scheduled regular follow-ups to closely monitor his condition and adjust treatment as needed.”

When deeper analysis is needed

Multiparametric MRI has become a cornerstone in prostate cancer screening. It enhances patient selection for biopsies by identifying suspicious areas, enables targeted biopsies, improves the detection of clinically significant cancers, and helps to reduce unnecessary procedures.

A prostate biopsy remains the definitive diagnostic test for prostate cancer and is typically recommended when there is an elevated PSA, a suspicious digital rectal examination, and/or a lesion detected on MRI. This procedure allows for detailed characterisation of the cancer’s histological type.

Among biopsy techniques is the transperineal approach, where tissue samples are taken through the skin between the scrotum and anus. This technique is gaining prominence as an effective alternative to the traditional transrectal method, offering potential benefits in safety and accuracy.

Dr Togni describes another typical example where these techniques have been used. “Simon, 61, is under regular monitoring due to his medications, which typically reduce PSA levels by about half, making PSA only a partially reliable marker in his case. During a recent check-up, his doctor recorded an increase in his prostate volume alongside a slight decline in urinary flow rate and an increase in residual urine volume. Given these changes, an MRI and a transperineal prostate biopsy were conducted. Histology fortunately indicated inflammation rather than cancer was the cause. Simon will continue his current treatment with adjustments to medicine and regular follow-ups. If his condition progresses, prostate scraping - an endoscopic procedure to remove excess prostate tissue that can obstruct the urethra – may be needed.”

When cancer is detected

Dr Togni says sometimes, prostate changes do turn out to be cancer. “Let’s take David, 76, who, unlike Simon, above, had biopsies that did confirm the presence of cancerous cells. David was given a prostatectomy, removing the prostate along with surrounding tissue, including the pelvic lymph nodes. His recovery period was challenging, requiring pelvic rehabilitation to restore continence as well as psychological support. Fortunately, David’s PSA levels have remained undetectable since the surgery.”

It’s important to note that after prostate removal, PSA should be undetectable. Any rise in PSA levels post-surgery warrants further investigation through imaging and other tests, which are essential components of comprehensive oncological follow-up.

*names have been changed for privacy reasons