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Prostate cancer

Prostate cancer is an abnormal and uncontrolled growth of cells found in your prostate gland. It’s the most common cancer in men in the UK.

Your prostate gland is about the size of a walnut and lies at the base of your bladder. The main function of your prostate gland is to produce fluid that makes up part of your semen.

Your prostate surrounds your urethra – the tube that carries urine from your bladder and out through your penis. If your prostate gets larger, it can press on this tube, making it difficult for you to pass urine.

Each year, about 35,000 men in the UK are diagnosed with prostate cancer, making it the most common cancer in men. About six out of 10 men diagnosed with prostate cancer are aged 65 and over.

Prostate cancer is different from most other cancers because small growths of cancer inside the prostate are very common and can be harmless for many years. It’s thought that one in eight men may have cancer cells in their prostate at some point in their lives. However, these cells usually grow very slowly, and for many men, never cause any problems.

In others, however, the cells may grow more rapidly. Sometimes, cancer cells spread outside of the prostate gland to another part of your body and form a new tumour called a secondary tumour. The spread of cancer is called metastasis. Prostate cancer most commonly spreads to the bones.

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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the position of the prostate gland and surrounding structures

Details

  • Symptoms Symptoms of prostate cancer

    The symptoms of prostate cancer are similar to those produced by a common benign (non-cancerous) condition called benign prostatic hyperplasia. This is where your prostate becomes enlarged.

    You may have:

    • difficulty passing urine
    • a sudden need to pass urine
    • a frequent need to pass urine
    • a need to pass urine during the night
    • blood in your urine or semen
    • pain when passing urine
    • difficulty getting an erection (erectile dysfunction)

    Although these symptoms aren't always caused by prostate cancer, if you have them, see your GP.

    If prostate cancer spreads to other parts of your body, other symptoms can develop, such as:

    • tiredness and feeling generally unwell
    • pain in your bones
    • weight loss

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  • Diagnosis Diagnosis of prostate cancer

    Your GP will ask about your symptoms and will ask to examine you. He or she may ask you to have some of the following tests.

    • A digital rectal examination (DRE) – a physical examination of your prostate. Your doctor will feel your prostate through the wall of your rectum (back passage). If you have prostate cancer, it may feel harder than usual, or knobbly.
    • A blood test to measure the amount of prostate specific antigen (PSA) in your blood. PSA is a protein that is made by both normal and cancerous prostate cells. The test can be unreliable as a high PSA level doesn't always mean that you have cancer – it can be caused by other prostate conditions.

    Depending on the results of these tests, your GP may refer you to a urologist for further tests. A urologist is a doctor who specialises in identifying and treating conditions of the urinary system. Your urologist may suggest you have the following tests.

    • A prostate biopsy. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these or cancerous or not.
    • An ultrasound to examine your prostate gland, using a small device inserted into your rectum. 
    • If these tests suggest you have prostate cancer, you may be offered some scans. These may include CTMRI and bone scans to help your doctor see whether your cancer has spread, and if so, how far.
  • Treatment Treatment of prostate cancer

    There are a number of treatment options for prostate cancer, as described below. The treatments you’re offered will depend on your personal circumstances. This might include your overall health, your risk of getting side-effects from the treatment, whether the cancer has spread, and if so, how far. Your PSA level and Gleason score can also help your doctor plan the best course of treatment for you. The Gleason score is a grading system that allows doctors to predict how quickly your tumour may grow and spread. For more information about the Gleason score, see our FAQs section.

    Your doctor will discuss your treatment options with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    Watchful waiting

    Some men with prostate cancer have a tumour that grows very slowly and doesn’t cause any symptoms. If this is the case, your doctor may suggest monitoring your cancer with regular check-ups, but not treating you straight away. This is called watchful waiting. Your doctor may also suggest this if you have another health condition which means you’re not well enough to have certain treatments, such as surgery.

    The aim of watchful waiting is to avoid or delay treatment until you need it. This means that you will only be offered treatment if you start to show signs that your condition is progressing.

    If your cancer shows signs of growing or starts to cause symptoms, your doctor may suggest treatment to control it and manage your symptoms. For example, you may be offered treatment with hormones. The aim of this treatment is to slow the growth of your cancer and manage any symptoms you may develop. This treatment aims to ease your symptoms rather than cure it.

    Active surveillance

    Active surveillance is similar to watchful waiting in that you choose not to have treatment straight away. However, your doctor will monitor you more closely than with watchful waiting. The aim of active surveillance is to treat and get rid of your cancer as soon as it shows signs of progressing.

    During active surveillance your doctor will ask you to have regular blood tests to check your PSA levels. He or she may also ask you to have regular examinations of your prostate. You should also be offered a biopsy after one year of active surveillance. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the types of cell and if these are benign (not cancerous) or cancerous. Having these tests means that if your cancer starts to grow, your doctor will pick this up quickly and offer you treatment straight away.

    If your cancer shows signs of progressing, your doctor may recommend that you have treatment aimed at getting rid of your cancer. For example, you may be offered surgery or radiotherapy.

    Surgery

    An operation to remove your prostate gland is, along with radiotherapy, one of the main treatments for prostate cancer. You may be offered surgery if you’re otherwise healthy and if your cancer hasn't spread beyond your prostate.

    Surgery to remove the whole of your prostate is called a radical prostatectomy. Your surgeon may do this by making a cut in your abdomen (tummy), or by doing keyhole surgery, which uses smaller cuts. Because technology has advanced so much, there are many different ways of removing your prostate during surgery. Your doctor will talk to you about your treatment options.

    Sometimes, if part of the cancer is pressing on your urethra, you may be offered an operation called transurethral resection of the prostate (TURP). This can help relieve your symptoms and make it easier for you to pass urine.

    Some men also have their testicles removed (an orchidectomy). Your testicles produce the hormone testosterone and your tumour needs this to grow. Removing your testicles lowers the amount of testosterone in your blood which helps to control the cancer and shrink the tumour. This treatment isn’t used very often as there are now hormone treatments that can do this without the need for surgery.

    Radiotherapy

    Radiotherapy is a commonly used treatment for prostate cancer. You may be offered radiotherapy to treat prostate cancer that hasn’t spread outside the prostate gland. You may also be offered radiotherapy to treat cancer that has spread and to control any pain. Radiotherapy uses radiation to destroy the cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. This is known as external beam radiotherapy. This treatment is usually given in daily doses over four to eight weeks. You can also have radiotherapy by having radioactive seeds or wires placed into your prostate gland – this is known as brachytherapy. However, this treatment may not be suitable for everyone and your doctor will discuss your treatment options with you.

    Hormone therapy and other medicines

    Hormone therapy blocks the action of testosterone. This can slow the growth of prostate tumours. You may be offered this type of treatment to reduce the risk of early prostate cancer coming back after you’ve had treatment. You may also be offered hormone therapy to shrink an advanced prostate tumour.

    Chemotherapy uses medicines to destroy cancer cells. Your doctor may suggest chemotherapy if the cancer has spread to other parts of your body. It can also be used if hormone therapy isn’t working.

    If the above treatments don’t help, you may be offered treatment with other medicines such as abiraterone or enzalutamide. However, the availability of the medicines can vary depending on your personal circumstances. Speak to your doctor if you’d like more information about your treatment options.

    Experimental treatments

    If you have cancer that hasn’t spread beyond your prostate, your doctor may offer you certain newer treatments as part of a clinical trial. These include the following.

    • High-intensity focused ultrasound (HIFU). This uses high-intensity ultrasound energy to heat and destroy cancer cells in your prostate gland.
    • Cryotherapy. This destroys cancer cells in your prostate by freezing them.

    Research into how well these treatments work is still ongoing. As with any treatment, there are various side-effects associated with HIFU and cryotherapy. Your doctor will explain the risks and benefits of these treatments to you.

    Deciding on treatment

    It’s your choice whether or not to have any treatment. It’s important to realise that many treatments for prostate cancer carry the risk of side-effects. These may include loss of libido, urinary incontinence and problems with getting and keeping an erection (erectile dysfunction). There may also be other side-effects specific to each treatment. Ask your doctor to explain these to you, so you can weigh up the risks and benefits of your treatment options.

    You might be able to take part in a clinical trial as new treatments become available and are tested. If you’d like to know more about this, ask your doctor for information about clinical trials.

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  • Causes Causes of prostate cancer

    The exact reasons why you may develop prostate cancer aren't fully understood. But you're more likely to develop it if:

    • you're over 50
    • you have close relatives who have had prostate cancer, for example your father or brother
    • several women in your family have had breast cancer – you may have inherited a gene which can increase your risk of prostate cancer
    • you're black Caribbean or black African
  • Prevention Prevention of prostate cancer

    Research suggests that you may be able to reduce your risk of developing prostate cancer by making certain lifestyle changes. These include stopping smoking and exercising regularly. You should aim to do at least 30 minutes of physical activity five days a week.

    Some research studies suggest that a eating a diet rich in tomatoes may reduce your risk of getting prostate cancer. However, more research is needed to investigate how strong the link between tomatoes and prostate cancer is. But the good news is, we do know that eating plenty of fruit and veg is important for your general good health.

  • FAQs FAQs

    I have a high PSA level. Does that mean I have prostate cancer?

    Answer

    You may be offered a blood test to measure your prostate-specific antigen (PSA) level. This can help to diagnose prostate cancer, although other tests are also needed. However, having a high PSA level doesn't necessarily mean you have prostate cancer – it can be raised for several other reasons.

    Explanation

    PSA is a protein produced by both normal and cancerous cells in your prostate. It’s measured with a blood test. It’s normal for all men to have a small amount of PSA in their blood.

    PSA levels vary from person to person. Your GP may advise you to have further tests if:

    • you’re aged 50 to 59 and have a PSA level of 3ng/ml or higher
    • you’re aged 60 to 69 and have a PSA level of 4ng/ml or higher 
    • you’re aged over 70 and have a PSA level of 5ng/ml or higher

    A high PSA level doesn't necessarily mean that you have prostate cancer. The level can be raised for several other reasons, such as:

    • an enlarged prostate
    • prostatitis – inflammation of your prostate
    • a urinary tract infection
    • your age
    • recent intensive exercise
    • a recent prostate biopsy
    • some medicines
    • recent ejaculation

    Two out of three men with a raised PSA level don’t have prostate cancer. However, in general, the higher your PSA level is, the more likely you are to have prostate cancer.

    Occasionally, the PSA test can miss prostate cancer. It’s possible that you can be diagnosed with prostate cancer and have a normal PSA level. Because the PSA test doesn’t always pick up prostate cancer, you may be offered further tests to confirm your diagnosis.

    PSA blood tests are also used to monitor the growth of a prostate tumour and how well you’re responding to your treatment. If your PSA levels begin to rise, you may be offered treatment.

    What is the Gleason score? How does it grade prostate cancer?

    Answer

    The Gleason score is a grading system that allows doctors to predict how quickly your tumour may grow and spread outside of your prostate. This information is often used to plan your treatment.

    Explanation

    The Gleason score is a grading system for prostate cancer. It looks at cells from your prostate to predict how your tumour will grow. If you have a biopsy, a small sample of tissue will be taken from your prostate and sent to a laboratory for testing and grading. Usually, more than one sample will be taken during your biopsy.

    Grading is done by looking at the patterns of cancer cells under a microscope. There are five different types of pattern, which are graded with a number out of five. Grade one and two aren’t cancer. A score of three means your cancer isn’t very likely to grow quickly, whereas a score of five means your cancer is more likely to grow quickly.

    All the biopsy samples taken are graded, then the two most frequently occurring patterns and the highest grade are added together. The total is called a Gleason score, and this will be a number between two and 10.

    The lower the score, the less likely it is that your cancer will spread. Gleason scores are usually six or higher. Tumours that score highly are more likely to grow quickly and spread to other parts of your body. A high score is between eight and 10.

    The Gleason score acts as a guide for your doctor to help him or her plan the best course of treatment for you. However, your doctor will also take into account your PSA level and information about whether your cancer has spread or not.

    If you have any questions about prostate cancer or the Gleason score, talk to your doctor.

    Will treatment for prostate cancer affect my sex life?

    Answer

    Treatment for prostate cancer can affect your sex life. How it's affected will depend on the type of treatment you have.

    Explanation

    Treatment for prostate cancer can affect your sex life in different ways. Some of the sexual problems caused by treatment are temporary and many can be treated. Being diagnosed with cancer can affect how you feel about having sex and your relationship with your partner. However, it’s important to remember you can’t pass cancer on to your partner during sex. Talk to your doctor or nurse if you’d like more information about this.

    Erectile dysfunction is a side-effect of treatment for prostate cancer. This is when you can't get or keep an erection. Erectile dysfunction can be caused by:

    • radiotherapy to your prostate
    • surgery, such as a radical prostatectomy (surgery to remove the whole of your prostate) or orchidectomy (an operation to remove your testicles) 
    • some types of hormone therapy

    Erectile dysfunction is often temporary, but it can be permanent, especially if you’ve had a radical prostatectomy. Sometimes it improves once you’ve finished your treatment – for example, if you have hormone therapy. With other treatments, such as radiotherapy, erectile problems may not occur until several years after treatment.

    If you have problems getting an erection, there are a number of different treatments that might help, such as medicines, a vacuum pump or injections. Talk to your doctor to find out what options are available to you.

    Some men find that they have a lower sex drive after treatment. This is usually caused by an orchidectomy or hormone therapy, which leads to a lower level of the hormone testosterone. Sometimes changing to a different type of hormone therapy can help.

    Treatment can also affect the type of orgasm you have. After a radical prostatectomy, you will always have a dry orgasm. This means that when you ejaculate, no semen will come out. The strength of your orgasm and your ability to have one may be affected.

    Cancer treatments can also affect your fertility. If you plan to have a family, your sperm can usually be collected before treatment. It can then be used later for artificial insemination or in vitro fertilisation (IVF) treatments.

    If you're worried about how treatment for prostate cancer will affect your sex life, talk to your doctor.

    Why isn't there a national screening programme for prostate cancer?

    Answer

    In the UK, there isn't currently a screening programme for prostate cancer. This is because of concerns about how reliable the prostate-specific antigen (PSA) test is. Scientists don’t know for sure whether getting diagnosed early has any effect on how your condition progresses. If you're concerned about prostate cancer, speak to your GP.

    Explanation

    The most commonly used test to check for prostate cancer is called a PSA test. It involves a blood test to measure the levels of a protein called PSA. This is produced by both normal and cancerous cells in your prostate.

    The PSA test isn’t used to screen for prostate cancer in the UK. This is because it isn’t a reliable test for diagnosing prostate cancer. There can be many reasons why you may have a high PSA level, and these aren't always linked to prostate cancer. Different factors, such as getting older or a urinary infection, can raise your PSA level. Also, a screening programme that uses PSA levels to test for prostate cancer could mean that men who have a slow growing cancer may have unnecessary treatment. You can also have a normal PSA level even if you do have prostate cancer.

    Although there isn’t a screening programme, the NHS runs an informed choice programme, called Prostate Cancer Risk Management. Your GP can provide you with information about the PSA test and prostate cancer. This will help you to decide whether or not to get the test.

  • Resources Resources

    Further information

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