​Prostate-specific antigen or PSA is a protein produced only by the prostate. High PSA levels can be due to many reasons including infection, benign prostatic growth and prostate cancer. If your PSA levels are high further tests will be recommended to exclude a diagnosis of prostate cancer.

What happens if my PSA level is high or my prostate is abnormal on a rectal examination?

Your doctor will discuss the available tests with you and use the results to see if you are at-risk of having prostate cancer. The tests that we offer in NUH are further screening with prostatic health index(PHI), an MRI of the prostate or a trans-perineal biopsy of the prostate gland.

​The Prostate Health Index (PHI) test is a diagnostic blood test that calculates a personalised risk of underlying prostate cancer. It is intended to reduce the number of unnecessary prostate biopsies in PSA-tested men and to help patients make an informed decision regarding further investigations.

​Magnetic resonance imaging, or MRI scan, creates pictures of the inside of your body using magnets and radio waves. An MRI scan provides a detailed look inside your prostate. The results will help your doctor decide if you need to have a biopsy. In addition, MRI images can be used to enable targeted biopsies of suspicious areas which increase the accuracy of prostate biopsies.

​NUH offers 2 types of biopsy, the first is under local anaesthesia performed in the Urology clinic, the second is under general anaesthesia performed in the operating theatre. Your Urologist will evaluate several factors including the prostate size, size of the tumour and your general health to help guide your choice between either biopsy. 

​Your doctor will insert a lubricated ultrasound probe into your back passage (rectum) to see the prostate during a trans-perineal biopsy. An injection of local anaesthetic will be given to numb the area to be biopsied. The biopsy needle will then be passed through the skin between the testicles and the back passage. NUH performs the trans-perineal biopsy technique compared to the older technique (Trans-rectal biopsy) which involves the biopsy needle passing through the rectum. The trans-perineal technique reduces the risk of serious infection. 

​MRI/Ultrasound Fusion technology allows for using your MRI images and targeting abnormal areas that have been identified on those images by a Radiologist. Your Urologist will have the MRI images with the suspicious areas marked out available on his/her monitor. These images will then be fused with the real-time transrectal ultrasound image of the prostate. This will allows for an MRI-targeted sampling of suspicious areas, under ultrasound-guidance. This biopsy is performed under general anaesthesia in the operating theatre.

​NUH urology offers robotic radical prostatectomy to cure localised or locally advanced prostate cancer. This is a type of minimally invasive surgery which uses surgical robotic equipment to remove the entire prostate. The robotic laparoscopic technique allows surgeons to operate through small ports rather than large incisions. Surgical robotics combines minimally invasive techniques with highly advanced clinical technology. The three-dimensional vision system magnifies the surgical field and improves the ability of the surgeon to recognize and control small blood vessels. Because of robotic technology, surgeons are able to perform minimally invasive procedures with more precision resulting in shorter recovery times, reduced blood loss and reduced hospital stays.

​Beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to cure localised or locally advanced prostate cancer. Treatments are done 5 days a week in an outpatient centre for several weeks. Each treatment is painless much like getting an x-ray but with a higher dose of radiation. NUH offers radiotherapy as an alternative to robotic prostatectomy. Your Urologist will guide your decision between radiotherapy and robotic prostatectomy depending on several factors including the extent of disease and your general health.