Normally, your doctor will look at your individual circumstances to decide if further tests are necessary. They make this decision taking into account, for example, your age, symptoms and whether there is a family history of prostate cancer. They may decide that the best course of action is to have your doctor recheck your PSA again in six months or a year – only a small proportion of those men who have a raised PSA will have prostate cancer. Or they may decide to send you for an MRI or a biopsy.

This is a special scan using a powerful magnetic field to create a detailed image of the prostate and the surrounding tissues – the image is detailed enough to spot potential cancer growing there. Depending on the hospital you go to, or your circumstances, you may be offered a multi-parametric MRI instead. This gives four different types of images – so provides an even more detailed image than the MRI – and can help a doctor determine how quickly any cancer present is likely to grow.

This is offered if your PSA and other previous assessments suggest that it warrants it. It helps give your doctor a better idea of what is going on in the prostate and helps them decide if you need a biopsy of the prostate.

Unlike a biopsy an MRI is noninvasive, although the machine can be noisy and some men may find lying in the scanner uncomfortable if they don’t like being in confined spaces. However, it should take no more than 30-40 minutes.

The MRI will be looking for areas that look unusual – which will typically be referred to as lesions in your MRI report. These aren’t necessarily cancer – they could be an area of inflammation, for example – but could also be a cluster of cancer cells. When the radiographer who does the MRI spots a lesion, they “score” them using a system known as PI-RADS.

This is a score, graded from 1-5, which represents how likely it is that any lesions spotted on your MRI are in fact cancer in the prostate. A score of 1 means it is very unlikely that you have prostate cancer that needs treatment. A score of 5, however, suggests a high risk (70-80 per cent) that you have prostate cancer that needs treatment. A score of 4 means it is likely you have cancer that needs treatment, whereas 3 is sometimes called ‘borderline’ (approx. 20% chance of finding cancer), meaning it is impossible to tell from the result if you have prostate cancer that needs treatment or not. A biopsy will usually be recommended if you have a score of 4 or 5, and sometimes 3, depending on personal circumstance and risk factors.

Yes, you can request digital copies of your scans.

A computerised tomography scan or CT scan helps build images of the internal structures of the body – not just the bones as an X-ray would, but also the blood vessels and soft tissues – and can detect if your cancer has spread elsewhere in the body.

To have a CT scan, you lie on your back and pass through a thin, ring-shaped machine. The scans should be completed in 10-20 minutes. It won’t hurt and, unlike an MRI, does not generate a lot of noise; nor are you enclosed, so it is less likely to make you feel claustrophobic.

This refers to the size of the cancer and how far it has spread. The stage will normally be represented as a letter T (for tumour), followed by a number from 1 to 4.

T1 means it is so small it may not be seen on a scan.

T2 means it is still enclosed within the prostate.

T3a means it has just broken beyond the perimeter of the prostate, and T3b means it is invading the sperm tubes. Both are referred to as being ‘locally advanced’.

T4 means it has already spread elsewhere surrounding structures such as the rectum OR pelvic wall.

There may also be an ‘N’ number, which reflects whether the cancer has spread to the lymph nodes in the pelvis. – Zero (N0) means no nearby lymph nodes are affected; 1 (N1) signifies that the cancer has spread to one or more nodes.

The “M” number refers to the presence of metastasis – M0 means no metastasis present and M1 means metastasis present.

Fig 1: T1 refers to prostate cancer that is localised to the prostate, in a small proportion of one half of the gland. The original classification of T1 was complicated and split into 1a, 1b and 1c. 1a and 1b were diagnosed after a TURP operation, and 1c was diagnosed after screening biopsy but this has been changed after the introduction of MRI.

Fig 2: T2 means it is still enclosed within the prostate, but involving either both halves of the prostate or more than 50% of one half.

Fig 3a: T3a means it has just broken through the capsule of the prostate.

Fig 3b: T3b means it is invading the sperm tubes.

Fig 4: T4 means invading surrounding structures beyond the sperm tubes such as the pelvic side wall or the rectum. T3 and T4 are referred to as locally advanced.

If you have been diagnosed with low-risk cancer that is confined to the prostate, it is likely that your urologist will recommend you just stay under surveillance, with regular PSA checks and MRIs.

For those with the next level, intermediate or high-risk localized prostate cancer, you aim to make your decision about starting treatment within three or six months.

Finally, for patients with advanced disease the situation is a bit different. The recommendation is to start treatment, which is likely to be hormone therapy to begin with, as soon as possible.

You are usually offered this option if the tests conducted suggest that you have low-risk, slow-growing cancer that is confined to the prostate.

It means that rather than having any active treatment, such as radiotherapy or surgery, your cancer will be monitored to see if it progresses.

You will typically have a PSA blood test every three months, an annual MRI and a repeat biopsy about 2 years after your initial biopsy. The MRI may be repeated more frequently if your PSA climbs quickly.

This varies from centre to centre, but you will normally have a repeat biopsy one or two years after your first. Further biopsies after this may be required if there are any changes in your physical examination, PSA, or MRI results.

A follow-up appointment is a chance for the doctor (or nurse) to see how you are and to check on any side effects, and for you to raise any concerns you may have.

Normally, prior to the appointment you will be asked to have a PSA test, and this meeting is a chance to review the results. If there is a rise compared to a previous result, further tests, such as an MRI or a physical examination of the prostate (if you still have one), may be suggested.

Don’t be embarrassed to raise any concerns you have, as these appointments are intended to provide you assurance and to help you access any further help you may need.