Symptoms of prostate cancer
Prostate cancer often produces no symptoms in its early stages. Many men diagnosed have no symptoms at all. However, as the cancer progresses, it may cause the following symptoms:
- unable to urinate (this is called retention)
- needing to urinate urgently
- needing to urinate more often than usual
- getting up to urinate during the night
- blood in your urine
- pain when you urinate
- a weak flow of urine when you go to the toilet
- trouble starting or stopping when you urinate
If the cancer has spread outside your prostate, other symptoms can develop:
- difficulty getting an erection
- feeling tired and generally unwell
- pain in your bones or your back
- losing weight
As men get older, the prostate gland gets bigger naturally. This can cause a condition called benign prostatic hyperplasia (BPH). BPH and prostate cancer can have some similar symptoms. It is also possible to have the early stages of prostate cancer, but still to experience the symptoms, if you have BPH as well.
If you have any of these symptoms, contact your GP.
Diagnosis of prostate cancer
Your GP will ask about your symptoms 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 putting a gloved finger into your back passage. This can feel uncomfortable and is sometimes a little painful. Depending on the results, your GP may ask you to have more tests and 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. It can be done using an ultrasound scan, which helps to guide the biopsy needles and measure the prostate gland. Biopsies can show whether or not you have cancer, and if you do, what type of cancer it is.
In some cases, your doctor may refer you for a magnetic resonance imaging (MRI) scan first. If this suggests you may have prostate cancer, you may then have a different kind of biopsy where a needle is inserted through the area of skin between your testicles and your back passage (the perineum).
If a biopsy shows you have prostate cancer, you may be asked to have a scan to see whether it has spread. A computerised tomography (CT), MRI or bone scans can help your doctor see if there is cancer anywhere else.
Treatment of prostate cancer
There are a number of different ways to treat prostate cancer. Your doctor may choose more than one type of treatment, depending on the type of cancer you have and whether it has spread or not. The results of your tests will help your doctor to decide what kind of treatment is best for you.
Your PSA level and Gleason score also help your doctor to plan. The Gleason score is a grading system that predicts how quickly your tumour may grow and spread. For more information about the Gleason score, see our FAQs below.
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.
Your doctor may use a decision aid with you to help you choose. Decision aids help you make choices, based on information about the options, what matters to you, and weighing up the pros and cons of treatments.
If you have prostate cancer that grows very slowly and is unlikely to spread, and you have no symptoms, your doctor may suggest 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 also suggest this if you have another health condition which means you’re not well enough to have certain treatments, such as surgery.
If tests show that the cancer is growing, or if you start to get symptoms, your doctor may suggest treatment. The treatment helps to ease your symptoms rather than cure the cancer.
Active surveillance is used if you have cancer that is slow-growing and unlikely to spread. Your doctor will do regular tests to see if the cancer is changing. If it does change, your doctor will offer you treatment straightaway to remove the cancer. The treatment aims to cure the cancer, rather than just treating the symptoms or slowing down its growth.
If your cancer is just in your prostate gland, or it has only spread just outside it, you may have an operation to remove your prostate gland.
This 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. Your surgeon may also remove the lymph nodes that are close to your prostate.
Having your prostate gland removed can cause some distressing side-effects, such as problems getting an erection and incontinence of urine. Your doctor will talk to you about the chances of this happening and about your treatment options.
Radiotherapy is a commonly used treatment for prostate cancer. You may be offered radiotherapy to treat cancer that’s only in the prostate gland, as well as cancer that has spread. Radiotherapy can also be used to control pain.
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 is targeted on the cancerous cells, which shrinks the tumour. You would usually have treatment every day over seven to eight weeks.
- Brachytherapy. This is when radioactive seeds or wires are placed directly into your prostate gland.
Hormone therapy and other medicines
Hormone therapy stops testosterone being produced, which can slow down the growth of the tumour. It’s often used before, during or after radiotherapy. Hormone therapy can be used to treat cancer or to control it.
Having hormone therapy can cause some distressing side-effects, such as problems getting an erection and hot flushes. Your doctor will talk to you about the chances of this happening and about your treatment options.
Chemotherapy uses medicines to destroy cancer cells. Your doctor may suggest chemotherapy if the cancer has spread to other parts of your body.
There are a number of new treatments in development for prostate cancer. These include high-intensity focused ultrasound (HIFU), which heats and destroys cancer cells, and cryotherapy, which freezes them. There is also focal therapy, which uses HIFU and cryotherapy to target just the cancerous cells rather than treating the whole gland. This minimises side-effects.
To be able to have some experimental therapies, you will need to be accepted onto a clinical research trial. Ask your doctor for more information.
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. Some of these side-effects can have a significant effect on your day-to-day life, and may have an impact on 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.
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. So, if you have a close relative with prostate cancer, you’re more likely to develop it. Men who have a diet that contains a lot of fat may be more likely to develop prostate cancer too.
You’re also more likely to develop it if you’re black or over 50.
FAQ: I have a high PSA level. Does that mean I have prostate cancer?
If your PSA level is raised, it doesn’t necessarily mean you have prostate cancer. 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.
There are several different prostate conditions that can cause your PSA levels to go up. These include conditions such as benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostate) as well as prostate cancer. Your PSA level can also go up naturally as you get older. Ejaculation also causes your PSA level to rise temporarily.
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. 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.
FAQ: What is the Gleason score?
When you have a prostate biopsy, your doctor will take a number of samples. These are sent to a laboratory to be looked at under a microscope. The cancer cells from each sample are given a Gleason score. This score tells your doctor how likely the cancer is to spread.
There may be more than one kind of score in the samples. So, the scores of the two most common are added together to give the Gleason score. Usually, if you have cancer, the score is between 6 and 10.
The higher the score, the more aggressive the cancer is, and the more likely it is to spread. Knowing the Gleason score, as well as the results from other tests, can help your doctor choose your treatment.
When your doctor is discussing your diagnosis with you, they may choose simply to describe it in terms of severity, as either ‘high grade’ or ‘low grade’. This is usually easier to understand than the Gleason score.
FAQ: Will treatment for prostate cancer affect my sex life?
Treatment for prostate cancer can affect your sex life in a number of different ways. There are treatments and support that can help, so talk to your doctor or nurse for more information.
Finding out that 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.
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 to remove your prostate
- some types of hormone therapy
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.
FAQ: Why isn't there a national screening programme for prostate cancer?
In the UK, there isn't a screening programme for prostate cancer. There are a number of reasons for this.
The prostate-specific antigen (PSA) test isn’t very reliable. It can show if a man has prostate cancer, but it can also miss prostate cancer and suggest that someone has cancer 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 unnecessary treatment following a raised PSA test.
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 may help you to decide whether or not to get the test.
- Prostate cancer: diagnosis and management National Institute for Health and Care Excellence (NICE), January 2014. www.nice.org.uk
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- Prostate cancer. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2011
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- Benign prostatic hypertrophy. Medscape. emedicine.medscape.com, updated October 2015
- Genitourinary cancers. Oxford handbook of oncology. (online). Oxford Medicine Online. oxfordmedicine.com, published September 2015
- Prostate specific antigen. PatientPlus. patient.info, last checked October 2014
- Getting diagnosed. Prostate Cancer UK. prostatecanceruk.org, updated February 2014
- What tests will I have at the hospital? Prostate Cancer UK. prostatecanceruk.org, updated February 2014
- Decision aids. PatientPlus. patient.info, accessed 25 June 2016
- Map of Medicine. Prostate cancer. International View. London: Map of Medicine; 2015 (Issue 3)
- External bean radiotherapy. Prostate Cancer UK. prostatecanceruk.org, updated July 2014
- Living with prostate cancer. Prostate Cancer UK. prostatecanceruk.org, accessed 25 June 2016
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- Prostate cancer risk management programme: overview. Public Health England. www.gov.uk, last updated March 2016
- Personal communication. Professor Raj Persad. 11 July 2016
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Reviewed by Sarah Smith, Freelance Health Editor, Bupa Health Content Team, June 2016.
Peer reviewed by Professor Raj Persad, Consultant Urological Surgeon.
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