Prostate cancer

Expert reviewers, Professor Raj Persad, Consultant Urological Surgeon and Dr Naveen Puri, Bupa Associate Clinical Director
Next review due June 2022

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

About prostate cancer

Prostate cancer can affect anybody who has a prostate gland. This includes:

  • men
  • transgender women (including if you have had gender affirmation surgery, which doesn’t remove the prostate gland)
  • some non-binary or intersex people

Studies looking at how common prostate cancer is are mostly based on data from men. From them, we know that 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.

The prostate gland is 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 pee 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. You may find you have trouble starting to urinate, have a weak flow of urine or feel like your 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, you might:

  • feel tired and generally unwell
  • have pain in your bones or your back
  • lose weight

As you get older, the prostate gland gets bigger naturally and this is called benign prostatic hyperplasia (BPH). It’s so common in older age 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.

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. The PSA test may also not work as well if you are having hormone therapy that can affect the prostate gland . 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 people over 50 who are worried about prostate cancer. You can ask your GP about having a PSA blood test and it’s possible to be 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.

If you are transgender, non-binary or intersex and have a prostate, it’s important to make sure that your GP is aware of this. That way, they can make sure you are offered the tests above when you need them. If you’re not sure whether or not you have a prostate, your doctor will be able to tell you. They can do this by asking you some questions, and by examining you if needed.

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, if you are younger and the cancer has not spread from your prostate gland, you may have surgery, while if you are older, you 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 when your doctor regularly measures the risk of the cancer spreading. It’s similar to watchful waiting , but your doctor might take biopsies as well as doing other tests. It’s an option if the cancer is slow-growing and unlikely to spread or if you don’t want to have treatment straightaway. If the cancer changes, 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.


You can have an operation to remove your prostate gland. This is called radical prostatectomy. 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 also 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 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 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 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.

If you are transgender, non-binary or intersex, you may have been having hormone treatment for some time. This treatment can reduce the likelihood of prostate cancer happening, but it does not remove the risk completely.

Other treatments

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

  • high-intensity focused ultrasound (HIFU), which heats and destroys cancer cells
  • cryotherapy, which freezes cancer cells
  • chemotherapy (which uses medicines to destroy cancer cells) combined with hormones, for more advanced prostate cancer

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 prostate cancer happens.

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, you’re more likely to develop it. People 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, research in men suggests that around seven out of ten 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 to have a small amount of it in your blood if you have a prostate. 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 it’s possible to have prostate cancer and 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. This can be very distressing and it may have a big impact on your 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 your desire to have sex, your enjoyment of sex and your ability to have sex in the same way as before. 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 your sex life includes being the receptive partner in anal sex, prostate cancer can also change how you experience sex. Radiotherapy can make your prostate less sensitive. If you have surgery to remove the prostate, stimulating it will no longer be possible.

    Changes like these don’t mean you have to give up on sex or that there aren’t other ways to enjoy closeness and pleasure. Talk to your doctor for advice to find out what options are available to you. If you have problems getting an erection, there are treatments that may help, such as medicines, a vacuum pump or injections.

  • 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 someone 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 you being treated for prostate cancer, when the cancer is slow-growing and wouldn’t have caused any problems in your lifetime. This means you could have treatment you 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


    Discover other helpful health information websites.

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  • Reviewed by Graham Pembrey, Head of Health Content, Bupa Health Content Team, April 2019
    Updated to reflect feedback from the transgender, non-binary and intersex community, June 2021. With thanks to The Clare Project.
    Expert Reviewers Raj Persad, Consultant Urologist and Naveen Puri, Bupa Associate Clinical Director
    Next review due April 2022