Worrying about my dad.

sometimes the scan is done first followed by biopsy while other hospitals do the biopsy followed by scan. One isn't necessarily better than the other - the trick is to get both done.

If the scan is done first and shows any grey areas the urologist can aim for those areas when he does the biopsy. On the other hand, if the scan shows no suspicious area then some men would be sent away without ever getting the biopsy. My husband had a completely clear scan but the cancer was actually in every bit of his prostate and in his bladder - it just happened to be the kind that doesn't show on scans :-(

It seems from what you have said that the hospital does not consider your dad to be at high risk of cancer, they don't seem to have him on the cancer care pathway. If his PSA moves around between 5 and 8, that suggests more likely to be infection or enlarged prostate (prostate cancer PSA does not usually go up & down).

If he does go for a scan first, that will not avoid the need for a biopsy so it is going to be uncomfortable whichever order he does it in.

PSA above a normal level (at your dad's age that's a PSA over 3.4 I think) indicates a problem that needs checking but not how severe it might be. An enlarged prostate gives off more PSA than a small one. We have men with PSA over 30 and in one case over 100 who do not seem to have PCa while someone like Si was diagnosed with a normal PSA but spread all over his body.

Scans are not 100% reliable as Lyn has just illustrated. However, if Dad does want one done privately it's best to go for the 3Tesla rather than the 1.5Tesla as it is higher definition and a better chance of enabling any cancer to be identified. Biopsies can and sometimes miss cancer too,although the template Tansperineal one is more reliable than the normal TRUS one and is less likely to result in an infection too. The drawback of this is that it is considerably more expensive and usually involves the patient being anesthetized. It is therefore much less often done compared to the TRUS.

Yes PSA numbers are important as the higher the numbers the more likelihood of spread. Also, even with low numbers the time taken and rate of increase is important as it gives an indication of how the disease is progressing. Withi relatively small numbers an increase over norm for a man's age may be due to reasons other than PCa, an infection or and enlarged Prostate (BPH) being the two most usual.

Generally speaking ,Prostate Cancer is a slowly progressing disease so appointment priority is given where there are strong reasons for believing a man may have PCa, particularly where it may be more advanced and require more urgent treatment.