Prostate Cancer
Sooner or later, many men will face prostate cancer. In fact, prostate cancer is the most common form of cancer among men. For women, that is breast cancer. With more than 15,000 new diagnoses in 2024, prostate cancer is almost as frequently diagnosed in men as breast cancer is in women. Moreover, prostate cancer is often more advanced at the time of diagnosis, with metastases being more common than in breast cancer. In 2023, metastases were present in 3,000 cases of prostate cancer compared to 1,000 cases of breast cancer (source: NOS).
PSA Testing
Unlike breast cancer, there is no national screening program for prostate cancer. To say the least, I find this odd. Prostate cancer can be detected early by measuring the level of prostate-specific antigen (PSA) in the blood. If this value exceeds 4, a general practitioner will usually refer you to a urologist. In the past, a urologist would immediately perform a biopsy—a procedure in which a hollow needle is used to collect prostate tissue. These biopsy samples would then determine whether cancer was present and, if so, what type.
MRI Fusion Technology
Thanks to modern MRI technology, imaging can now provide a much clearer indication of whether cancer is present. A biopsy is only necessary if the MRI shows a high probability of cancer. Additionally, biopsy techniques have improved significantly. Nowadays, MRI images can be fused with real-time ultrasound images, allowing highly precise biopsies to be taken from areas of the prostate that appear suspicious on the MRI.
This precision technique also eliminates the need for biopsies to be taken through the rectum. Instead, they can be performed through the skin, which is first numbed. This makes the procedure much less invasive for the patient and reduces the risk of infection. One of the clinics that uses this so-called MRI fusion technique is the Andros Clinic.
Referral
My father, following the example of his younger brother and a brother-in-law, also chose this clinic. When a routine PSA test showed elevated levels, his general practitioner referred him to a urologist. My father opted for the Andros Clinic due to its patient-friendly diagnostic techniques and the absence of a waiting list. His first consultation was on January 8. A new PSA test was conducted, and he underwent a urine flow test, which measures the strength of the urine stream and assesses how much urine remains in the bladder using an ultrasound. The urologist also performed a rectal exam, checking the size, shape, firmness, and surface of the prostate.
MRI with Contrast
The second consultation took place on January 23, when an MRI scan was performed. My father received an IV beforehand so that contrast fluid could be administered during the MRI. He received the MRI results on January 29. The findings strongly indicated prostate cancer. He was scheduled for an MRI fusion biopsy on February 3, and on Tuesday, February 11, he was expected back at the urologist to discuss the biopsy results and treatment options.
Diagnosis
The initial shock came when my father received the MRI results. By then, it was already almost certain that he had prostate cancer. What remained uncertain was how aggressive the cancer was. The urologist calmly explained, using the Gleason score, that my father had a moderately aggressive form of prostate cancer and that there was no reason to believe it had spread beyond the prostate. This outcome made the diagnosis somewhat less daunting. While the cancer was indeed present, there was reason for optimism.
Treatment Options
This was further confirmed when the urologist discussed the treatment options. Given my father’s age—he is seventy-seven—there were two possibilities. The first option was active surveillance, meaning no immediate treatment but regular monitoring of the cancer’s progression through PSA tests, MRIs, and possibly additional biopsies. The second option was radiation therapy, aimed at curing the cancer. However, radiation therapy comes with potential complications, such as (temporary) urinary incontinence, erectile dysfunction, and bowel problems.
A Personal Anecdote
When I turned fifty last year, I gifted myself a PSA test from MijnLabtest.nl. For 35 euros, I received a finger-prick test kit and got the results within a week. My PSA level was 0.38 ng/ml. A normal PSA value for a man around fifty is below 1.5 ng/ml. At this level, the risk of developing prostate cancer in the next ten to fifteen years is negligible. However, since prostate cancer runs in my family, I have a higher risk. To be on the safe side, I plan to test my PSA again when I turn fifty-five.
Purpose
The reason for writing this blog is probably clear—it’s the journey my father is currently going through. But I also have another goal: I want more men to realize that early detection of prostate cancer through a PSA test is both valuable and simple. For more information, consult your general practitioner.