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Prostate cancer


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due June 2022

Prostate cancer develops when cells in your prostate gland start to grow in an uncontrolled way. In some men, the cancer grows very slowly. But some men have prostate cancer that grows quickly and can spread to other parts of the body, such as the bones.

About prostate cancer

Prostate cancer is the most common type of cancer in men in the UK. In fact, around one in eight men born today will go on to develop the condition. It’s more common in men over 65 and in black men.

Only men have a prostate gland. It’s about the size of a walnut at puberty, and continues to grow throughout life. It sits underneath your bladder and surrounds your urethra, which is the tube you pass urine through. It produces the fluid that makes up part of your semen.

Symptoms of prostate cancer

Prostate cancer often has no symptoms, particularly in its early stages. However, if the cancer grows and spreads, it may cause the following symptoms.

  • Problems passing urine, such as needing to go urgently or often, or being unable to go at all. Some men also find they have trouble starting to urinate, have a weak flow of urine or feel like their bladder hasn’t fully emptied.
  • Blood in your urine.
  • Pain when you urinate.
  • A urine infection.
  • Difficulty getting an erection.

If the cancer has spread to other parts of your body, these symptoms can develop:

  • feeling tired and generally unwell
  • pain in your bones or your back
  • losing weight

As men get older, the prostate gland gets bigger naturally and this is called benign prostatic hyperplasia (BPH). It’s so common in older men that it’s seen by doctors as a natural process. BPH can also cause problems when you’re passing urine and many of the symptoms are the same as they are if you have prostate cancer. If you have problems passing urine always see your GP.

An image showing the position of the prostate gland and surrounding structures

Diagnosis of prostate cancer

If you have symptoms, your GP will ask about them and examine you. They may also ask you to have the following tests.

  • A PSA test. This is a blood test to measure the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein that can be made by both normal and cancerous cells. A raised PSA level doesn’t always mean you have cancer, as PSA tends to increase naturally as you get older. You can find out more about PSA tests in the FAQs below.
  • A digital rectal examination (DRE). Your doctor will check the size, shape and feel of your prostate through the wall of your rectum (back passage). They do this by gently putting a gloved finger into your back passage. This can feel uncomfortable, but it shouldn’t be painful.

The NHS runs an informed choice programme, called Prostate Cancer Risk Management. The programme is aimed at men over 50 who are worried about prostate cancer. You can ask your GP about having a PSA blood test and some men are diagnosed this way. As part of the programme your GP will give you information about the possible benefits and possible harms of having the test.

Depending on your test results, your GP may refer you to a specialist. This is likely to be a urologist who is a specialist in treating prostate conditions.

Your urologist may suggest a prostate biopsy. This is when small samples of tissue are taken from your prostate and sent to a laboratory to be looked at. Before the biopsy, you’ll usually have an MRI scan to show what area should be focused on. While the biopsy is being carried out, ultrasound helps to guide the biopsy needles. You’ll either have a local anaesthetic or a general anaesthetic for the biopsy. The results can show whether you have cancer, and if you do, what type of cancer it is.

If the biopsy shows you have prostate cancer, you may be asked to have more tests to see whether it has spread. A computerised tomography (CT), or bone scan can help your doctor see if there is cancer anywhere else.

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Treatment of prostate cancer

There are several different ways to treat prostate cancer. A team of specialists at the hospital, called a multidisciplinary team, will work together to determine the best treatment for you.

The treatment the team recommends will be based on established guidelines, your health and whether the cancer has spread or not. They will also take into account your age, any other health conditions you have and your wishes. They may recommend more than one type of treatment. Often, younger men with localised disease have surgery, while older men may have non-surgical treatments; but this does vary.

Your PSA level and Gleason score help your doctor to plan treatment. The Gleason score is a grading system for cancer cells that predicts how quickly your tumour might grow and spread. Your doctor can work it out from the results of the biopsy. When your doctor is talking to you about your cancer, they may also use these terms to describe it.

  • Localised. This is when the cancer is only in your prostate gland.
  • Locally advanced. This is when the cancer has started to grow out of the prostate or has spread to the area just outside it.
  • Advanced. This is when the cancer has spread outside the prostate and into other parts of your body.

Deciding on treatment

Your doctor will discuss your treatment options with you to help you decide what’s right for you. They may use a decision aid to help you choose. These help you make choices, based on information about the options, what matters to you, and weighing up the pros and cons of treatments.

It’s your choice whether to have any treatment. Many treatments for prostate cancer carry the risk of side-effects and some of these can have a significant effect on your day-to-day life. They can affect your relationships, social and work life. Ask your doctor to explain these to you, so you can weigh up the risks and benefits of your treatment options.

Watchful waiting

This is when you don’t have treatment, but your doctor does regular check-ups to see whether the cancer is growing. Your doctor may suggest this if your cancer is growing very slowly, as it may never need treatment. You may also be offered watchful waiting if you have other health conditions which mean treatment isn’t an option or you don’t want treatment because of the risk of side-effects.

If tests show that the cancer is growing, or if you start to get symptoms, your doctor may suggest treatment. This may help to ease your symptoms rather than cure the cancer.

Active surveillance

Active surveillance is a more active form of watchful waiting, when your risk of the cancer spreading is regularly measured. It’s an option if the cancer is slow-growing and unlikely to spread or if you don’t want to have treatment straightaway. Your doctor will do regular tests, including biopsies, to see if the cancer is changing. If it does change, you’ll be offered treatment to remove the cancer. Treatment will aim to cure the cancer, rather than treating the symptoms or slowing down its growth.

Surgery

Radical prostatectomy is an operation to remove the prostate gland. You’ll be offered this treatment if the cancer is just in your prostate, or it has only spread just outside it. If the cancer has spread just outside the prostate, your surgeon may take out the lymph nodes nearby. You may also be offered radiotherapy or hormone therapy as well as surgery.

Prostatectomy can be done by making a cut in your abdomen (tummy), or by doing keyhole surgery, which uses smaller cuts.

Having your prostate gland removed can cause some distressing side-effects, such as problems getting an erection and involuntary leaking of urine (urinary incontinence). Your doctor will talk to you about the chances of this happening and about your treatment options.

Radiotherapy

Radiotherapy can be used as a treatment on its own or alongside other treatments. You may be offered it if the cancer is only in or around the prostate gland, as well as when the cancer has spread. Radiotherapy can also be used to reduce pain or control other symptoms.

Radiotherapy uses radiation to destroy the cancer cells. There are two main types of radiotherapy for prostate cancer.

  • External beam radiotherapy. This is where a beam of radiation from outside your body is targeted on cancer cells to destroy them. You would usually have treatment every weekday over seven to eight weeks.
  • Brachytherapy. This is when radioactive seeds are placed directly into your prostate gland and left there. You can also have a radioactive substance put inside the prostate using a fine tube which is then taken out.

Hormone therapy

Hormone therapy blocks or lowers the amount of testosterone your body makes, which can slow down the growth of the cancer. It’s often used before, during or after radiotherapy. Hormone therapy can be used to treat cancer or to control it.

Hormone therapy can cause some distressing side-effects, such as problems getting an erection, less desire for sex and hot flushes. Your doctor will talk to you about the chances of this happening and about your treatment options.

Other treatments

There are several other treatments for prostate cancer. These include:


HIFU and cryotherapy are less common in the UK. If you do choose one of these treatments, make sure it is at a hospital that specialises in that treatment.

Causes of prostate cancer

Doctors don’t yet know the exact reasons why some men develop prostate cancer and others don’t.

Prostate cancer can run in families. Certain genes, such as one called BRCA2, can put people at higher risk. So, if you have a close relative with prostate cancer, such as a brother or father, you’re more likely to develop it. Men who eat a lot of high-fat foods may be more likely to develop prostate cancer too.

You’re also more likely to develop prostate cancer if you’re black or over 50.

Frequently asked questions

  • If your PSA level is raised, it doesn’t necessarily mean you have prostate cancer. In fact, around seven out of ten men with a raised PSA level won’t have cancer.

    PSA is a protein produced by both normal and cancerous cells in your prostate. It’s measured with a blood test and it’s normal for all men to have a small amount of it in their blood. The blood test isn’t specific enough to tell whether any increase in PSA comes from cancerous cells or not.

    Your PSA level can go up naturally as you get older. There are also other prostate conditions that can cause your PSA levels to go up. These include:

    • benign prostatic hyperplasia (BPH)
    • urinary retention – when you’re unable to pass urine
    • prostatitis (inflammation of the prostate)
    • urinary infections

    Because the PSA test isn’t always a reliable test for prostate cancer, you will always have other tests, such as biopsy, to diagnose cancer. Having an MRI scan, with a dye injected into your body to help produce a detailed image for doctors, may sometimes be another alternative.

    It’s also important to know that some men with prostate cancer have a normal PSA level. So, if you have had a normal PSA test result but have symptoms, or are worried you may have cancer, speak to your GP.

  • It might do. Both the cancer and treatment can affect your relationships, your sex life and how you feel about yourself as a man. This can be very distressing and for some men it can have a big impact on their quality of life. If you’re worried about your sex life, relationships or your mental health, it’s important to talk to someone about it – ask your nurse or doctor for support. Finding out you have cancer can make you feel low and depressed, which may affect how you feel about your body and about having sex. Your relationship with your partner, or how you feel about being in a relationship, can change too.

    The treatments themselves can affect both your desire to have sex and your erections. The extent can vary depending on the type of treatment you have. Hormone therapy, surgery and radiotherapy can all affect your ability to get an erection and to keep one. This is called erectile dysfunction. Some treatments, such as hormone therapy, can also affect ejaculation and your fertility. If you want to have a family in the future, talk to your doctor about storing your sperm before treatment starts.

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

  • In the UK, there isn't a screening programme for prostate cancer. There are two main reasons why.

    • The prostate-specific antigen (PSA) test, which can check for prostate cancer, is only reliable when combined with other tests and information. It can indicate that a man has prostate cancer, but it can also miss prostate cancer and suggest that someone has it when they don’t.
    • Sometimes a raised PSA level leads to a man being treated for prostate cancer, when the cancer is slow-growing and wouldn’t have caused any problems in his lifetime. This means some men could have treatment they don’t need and side-effects from it.

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


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Related information

    • Prostate cancer. Medscape. emedicine.medscape.com, updated September 2018
    • Prostate cancer. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2017
    • Prostate cancer. BMJ Best Practice. bestpractice.bmj.com, last updated September 2018
    • Prostate anatomy. Medscape. emedicine.medscape.com, updated September 2017
    • Prostate gland. Encyclopaedia Britannica. www.britannica.com, updated March 2017
    • Prostate cancer. PatientPlus. www.patient.info, last edited January 2017
    • Diagnosing prostate cancer. Macmillan Cancer Support. www.macmillan.org.uk, reviewed May 2018
    • Prostate cancer risk management programme: overview. Public Health England. www.gov.uk, last updated March 2016
    • Prostate cancer: diagnosis and management. National Institute for Health and Care Excellence (NICE). 2014. www.nice.org.uk
    • Just diagnosed. Prostate Cancer UK. www.prostatecanceruk.org, accessed March 2019
    • Choosing a treatment. Prostate Cancer UK. www.prostatecanceruk.org, updated September 2016
    • Prostate cancer guidelines. European Society of Urology. 2018. uroweb.org
    • Prostate Specific Antigen. PatientPlus. www.patient.info, last edited September 2016
    • Sex and relationships. Prostate Cancer UK, www.prostatecanceruk.org, updated June 2017
    • Erectile dysfunction. PatientPlus. www.patient.info, last edited April 2016
  • Reviewed by Graham Pembrey, Lead Editor, Bupa Health Content Team, April 2019
    Expert Reviewer, Raj Persad, Consultant Urologist
    Next review due April 2022



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