Prostate cancer is now the most common cancer in England, affecting around 1 in 8 men during their lifetime. Early diagnosis is crucial, as the disease can be silent and symptom-free until it spreads, when treatment becomes far more limited. At New Victoria Hospital, patients now have access to advanced diagnostic options, including fusion-guided trans-perineal biopsy – a highly accurate, minimally invasive technique that improves detection and reduces complications.

Professor Prasanna Sooriakumaran (Prof PS) highlights the need for early diagnosis, explains current methods of screening and investigation, and reflects on how Consultant Urologists at New Victoria Hospital are supporting advances in prostate cancer care.

Why early diagnosis matters

In May 2025, former U.S. President Joe Biden was diagnosed with metastatic prostate cancer that had spread to his bones, highlighting the importance of catching the disease early. Metastatic prostate cancer is a disease that has spread beyond the prostate, often to the bones or other organs, and is no longer curable. Treatments at this stage focus on controlling the disease with hormone therapy, chemotherapy, and sometimes radiotherapy. While research, including a UK-first randomised study led by Prof PS, continues to explore whether surgery could benefit carefully selected men with advanced prostate cancer, the best strategy remains preventing progression to this stage through early diagnosis. When prostate cancer is detected at an early stage (stages 1 to 3, before it has spread), cure rates are excellent – with 95% of men surviving 5 years or more.

Current screening practices

Unlike some countries, the UK does not currently have a national screening programme for prostate cancer, though large clinical trials, such as the TRANSFORM study, are ongoing to determine the best way to screen men. Evidence from Sweden suggests that regular screening can reduce the number of men diagnosed with advanced disease. In contrast, the U.S. has seen a rise in advanced cases since routine prostate-specific antigen (PSA) screening was scaled back.

In the UK, out of every 100 men who present with prostate cancer, roughly 17 will have a metastatic prostate cancer, further highlighting the importance of routine check-ups.

Our Consultant Urologists recommend PSA screening for men at higher risk, including:

• All men over 50,
• Men over 45 with a father or brother who has had prostate cancer,
• Black and Ashkenazi Jewish men over 45,
• Black and Ashkenazi Jewish men over 40 with a father or brother who has had prostate cancer.

 

“Screening high-risk groups is essential to catching cancers early, when they’re highly treatable. Early detection gives men the best chance of cure and reduces the chance of men presenting with advanced, incurable disease, as we’ve seen in cases such as that of former President Joe Biden.”
Professor Prasanna Sooriakumaran, MA(Oxon) PhD FRCS(Urol) BMedSci(Hons) BMBS(Hons) FEBU USMLE PGCert(MedLaw) ADCert(ClinInv), Consultant Urologist at New Victoria Hospital
 

What does a raised PSA mean?

The PSA blood test is often the first step in prostate cancer investigation. While a raised PSA level can be a warning sign, it is not specific to cancer and may also be elevated due to:

• benign prostate enlargement (BPE),
• prostate inflammation (prostatitis),
• urinary tract infections,
• recent ejaculation,
• or even vigorous exercise such as cycling.

Conversely, some prostate cancers can present with normal PSA levels.

MRI testing for prostate concerns

If a PSA test raises concern, patients are usually referred for a multi-parametric MRI scan, where multiple types of images are taken.

This non-invasive imaging test takes around 45 minutes and can highlight suspicious areas within the prostate. However, MRI alone cannot confirm a diagnosis, and a biopsy is required to examine prostate tissue under the microscope.

Prostate biopsy: from old techniques to fusion precision

Traditionally, a transrectal biopsy was taken through the man’s back passage (rectum) with needles stuck into the prostate while the man is awake. Not only is this method uncomfortable and carries a higher risk of infection, but it can sometimes also miss cancer due to the angle of sampling.

A safer, more accurate and less painful approach is the transperineal biopsy, performed under general anaesthetic through the skin between the scrotum and rectum. This allows more thorough sampling of the prostate with less discomfort and lower risk.

A state-of-the-art way to take prostate tissue samples, which is available at New Victoria Hospital, is the fusion-guided trans-perineal biopsy.

What are the benefits of fusion-guided trans-perineal prostate biopsy?

This technique combines MRI images with real-time ultrasound, through the use of a software, so that suspicious areas can be precisely targeted during the procedure – an “X marks the spot” scenario. This procedure presents with a number of benefits including:

• significantly improved accuracy
• reduction in the number of samples needed
• improved patient experience
• reduced chances of infection or complications than with the standard trans-rectal biopsy

Patients can go home the same day, experience less pain, and usually can return to work the following day. Biopsy results are available within one week, allowing timely discussion of the next steps.

How is fusion-guided trans-perineal prostate biopsy performed?

After your MRI scan, the biopsy is performed by a Urological Surgeon in a dedicated room.

1. You will receive a general anaesthetic, so you don’t feel any pain and don’t move during the biopsy.
2. Your Consultant Urologist will gently insert a trans-rectal ultrasound device into your back passage to generate the real-time images needed for the procedure.
3. Simultaneously, a software will cross-reference your previous MRI scans to show extremely detailed images of your prostate.
4. The images from the MRI will be superimposed onto the ultrasound images, with highlighted areas of suspicion identified.
5. Your Consultant Urologist will then insert a needle to perform the biopsy and collect the prostate cells from the highlighted areas of suspicion.

This is a highly technical procedure that requires advanced and specialised training, which not all Consultant Urologists possess. At New Victoria Hospital, we are fortunate to have specialist Consultant Urologists who have extensive experience, having performed hundreds of these biopsies with excellent patient outcomes.

Treatment options if cancer is detected

If prostate cancer is diagnosed, treatment options depend on the stage and aggressiveness of the disease. For localised prostate cancer that is confined to the prostate, options may include:

• active surveillance,
• surgery,
• radiotherapy.

Fusion prostate biopsy key points

• Prostate cancer is common, but with modern diagnostics, it can often be detected early and treated effectively.
• At New Victoria Hospital, patients have access to PSA blood testing, MRI scans, and advanced biopsy techniques, such as fusion-guided trans-perineal prostate biopsy.
• Fusion-guided trans-perineal biopsy blends MRI and ultrasound images, allowing the Consultant Urologist to collect tissue samples with enhanced precision, for an improved patient experience and outcomes.

If you are concerned about your risk factors or symptoms, please book an appointment with our Urology Consultants: call 020 8949 9020 or fill out our online enquiry form.