Prostate cancer – your questions answered

Consultant Urological Surgeon at the Bupa Cromwell Hospital
01 November 2017

In the UK, about 1 in 8 men will get prostate cancer at some point in their lives yet, for many, it’s not an easy topic to talk about.

We spoke to Professor Hashim Ahmed, Consultant Urological Surgeon at the Bupa Cromwell Hospital to ask him the questions men are often thinking but don’t want to ask. 

Do I have to have a rectal exam to check for prostate cancer?

There are a few different tests your doctor may suggest to find out if you have prostate cancer, there isn’t one single test. Your doctor may test your urine, carry out a simple blood test called Prostate Specific Antigen (PSA), and do a rectal exam.  

It’s your decision whether you want to have these tests or not. Your doctor will explain what they are and talk through any questions and concerns you might have so you can make an informed choice.

Your doctor may suggest a rectal exam if you have particular or unexplained symptoms, or if your PSA level is raised. However a rectal exam can also help identify obvious abnormalities on the surface of your prostate, even if your PSA is normal.

A rectal exam can’t confirm or rule out prostate cancer, but it can help your doctor know the best course of action to suggest next. If you have a raised PSA, or your rectal exam shows a lump, your doctor may refer you for an MRI scan in a specialised unit, which can be much more specific. You may then also have a biopsy (sample of tissue and cells) of your prostate so doctors can look at it under a microscope.

It’s important to know that your PSA can be high if you have prostate cancer but it can also be higher than normal for other reasons. For example if you have an infection, inflammation or a large prostate. Recent sexual activity before the test or cycling due to the pressure from a saddle can also raise your PSA levels, so make sure your GP knows about anything that could affect the test.

What happens during a rectal exam?

You’ll either have the exam at your GP surgery or at the hospital. You’ll lie on your side, your doctor will wear gloves and put some gel on their finger and gently insert it into your back passage. They’ll feel your prostate through the wall of your back passage. Understandably, you might feel a bit embarrassed, but your doctor will have done many of these tests and will be professional. It shouldn’t hurt but it might feel a bit uncomfortable. It only takes a few minutes to complete.

Your doctor will talk to you about the results of your tests and what will happen next.

If I need a biopsy, does it have to be through the back passage and does it hurt?

A biopsy to check for prostate cancer involves taking tissue samples from your prostate. Some health centres only take a biopsy of the prostate if the MRI scan shows suspicious areas.

One of the common ways to take a biopsy of the prostate is through the back passage, called a transrectal ultrasound biopsy or a TRUS biopsy. The procedure involves a needle that takes lots of small samples from your prostate (up to about 12). It can make a loud noise each time it takes a sample so it can help to expect this. It can be a little painful and uncomfortable but doesn’t last too long – usually about 20 minutes.

Some doctors now take a biopsy of the prostate using what’s known as the transperineal approach (through the skin behind your scrotum). This is more accurate but it means you’ll need to be sedated or have a general anaesthetic to carry out. Talk to your doctor for more information and advice.

Will I still be able to have sex if I have prostate cancer or have just undergone treatment?

It’s safe to have sex if you have prostate cancer or are having treatment. However, you may have some erectile problems depending on the type of treatment you have.

Treatments can cause problems getting an erection, ejaculating or having an orgasm.

You might also find that you have a low libido and don’t want to have sex. This doesn’t happen to everyone and if it does it doesn’t mean it will last forever. There are ways to manage this, such as rehabilitation programmes, counselling and medicines. Your doctor can give you advice about what’s available.

Are the side-effects of prostate cancer treatment worse than actually having prostate cancer?

Some of the side-effects of treatment include erectile dysfunction and issues when going to the bathroom.

Some prostate cancers are low risk and are managed well with what’s called active surveillance. This means your doctor will monitor the cancer because the chance of it causing any problems is very low. This is a very safe approach.

For men who have prostate cancer that is medium or high risk, and if left untreated, they may get urinary and erectile side-effects. It can also spread outside of the prostate and cause a range of other complications.

It’s really important to talk through your options and the pros and cons of each to help you make a decision.

Can prostate cancer make me infertile?

Your prostate is a walnut-sized gland that sits underneath your bladder and surrounds the urethra – the tube you pee and ejaculate through. Its main job is to help make semen which is the fluid that carries sperm. Cancer in the prostate can affect its ability to make semen, which can result in infertility.

Some treatments can also affect your fertility. However, even though you may not be able to make a baby in the usual way, there are some other methods. For example collecting sperm before treatment, or it may be possible to take semen from your testicles which can be used in IVF. Some of the new forms of treatment can lead to some men still being able to conceive normally.

Your doctor can talk to you about all of your options and what’s best for you and your situation.

We’re changing our approach to diagnosing prostate cancer. Bupa Cromwell Hospital and Health Clinics in London have introduced a prostate cancer diagnosis pathway as part of the London Care initiative. Learn more

Professor Hashim Ahmed
Consultant Urological Surgeon at the Bupa Cromwell Hospital

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