Prostate cancer

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

The prostate gland is about the size of a walnut, and gets bigger as you get older. 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.

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. It’s more common in men over 65 and in Black men.

While there are different types of prostate cancer, nearly all people with prostate cancer have a type called adenocarcinoma. Prostate cancer can spread. When your doctor is talking to you about your cancer, they may 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 into other parts of your body.

How far your cancer has spread will affect your treatment options. See our section on ‘treatment for prostate cancer’ for more information about this.

Symptoms of prostate cancer

Prostate cancer usually has no symptoms in its early stages.

If the cancer grows, it may cause problems when you pee, including:

• needing to go more often
• needing to go more urgently
• having a weak stream
• finding it difficult to start peeing
• dribbling after you finish peeing
•  getting up at night to pee

But these symptoms are more likely to be caused by an enlarged prostate. This can happen when your prostate gland gets bigger as you get older. It is called ‘benign prostatic hyperplasia’ and is common in older men. It is not cancer.

If you have prostate cancer, it may start to spread to the surrounding tissues. This can lead to symptoms such as:

• blood in your pee
• pain when you pee
• a urine infection
• difficulty getting an erection
• a feeling of needing to have a poo when you don’t

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 or lose your appetite

If you have these symptoms, contact your doctor.

Diagnosis of prostate cancer

If you have symptoms, your doctor 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 made by both normal and cancerous cells. A raised PSA doesn’t always mean you have cancer. Other conditions can make your PSA go up. And PSA increases naturally as you get older. The PSA test may not be reliable if you’re having hormone therapy that can affect the prostate gland.
• 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.

If you’re transgender, non-binary or intersex and have a prostate, it’s important to make sure your doctor knows. That way, they can make sure you’re offered these tests when you need them. If you’re not sure whether 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.

Seeing a specialist

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

Your urologist may suggest a prostate biopsy. This is when your doctor takes small samples of tissue from your prostate and sends them to a laboratory. Before the biopsy, you’ll usually have a magnetic resonance imaging (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.

If the biopsy shows you have prostate cancer, your doctor may recommend 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. Your doctor may organise a more specialised imaging test called a PSMA PET scan.

Can I just ask for a PSA test?

You can ask your doctor about having a PSA blood test and it’s possible to be diagnosed this way. Your doctor can give you information about the possible benefits and possible harms of having the test.

Treatment of prostate cancer

There are several different ways to treat prostate cancer. A team of specialists will discuss the best treatment for you.

Your treatment options will depend upon several things, including:

• the size of the cancer
• how the cancer cells in your biopsy looked under the microscope (their ‘grade’)
• whether the cancer has spread anywhere else in your body
• your age and general health
• your personal wishes 

Deciding on treatment

Your doctor will discuss your treatment options with you to help you decide what’s right for you. It’s your choice whether to have any treatment. Many treatments for prostate cancer carry the risk of side-effects. 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 options.

You can also get information about treatments from the organisations listed below in our section ‘other helpful websites’.

Watchful waiting

This is when you don’t have treatment, but your doctor does regular check-ups. Your doctor may suggest this if:

• your cancer is growing very slowly, so it may never need treatment
• you have other health conditions which mean treatment of your prostate cancer isn’t the best option at this time

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

With active surveillance, your doctor regularly checks the risk of the cancer spreading. It’s like watchful waiting, but your doctor takes biopsies as well as doing other tests such as MRI scans. It’s an option if the cancer is slow-growing and unlikely to spread. Or you may choose this option if you don’t want to have treatment straightaway. If the cancer changes, your doctor will offer you treatment to remove it. 

Surgery

You can have an operation to remove your prostate gland and some of the tissue around it. This is called radical prostatectomy. Surgery is an option if it seems the cancer is just in your prostate. Your surgeon may also take out the lymph nodes nearby if there’s a risk the cancer might have spread.

A prostatectomy can be done in several different ways.

• By making a cut in your abdomen (tummy).
• Through a cut in the skin between your anus (bottom) and your scrotum.
• With keyhole (laparoscopic) surgery, which uses four small cuts in your tummy. Some surgeons use a robotic system to help them with keyhole surgery. 

Having your prostate gland removed can cause some side-effects. These include problems getting an erection and leaking of urine (incontinence). 

Radiotherapy

Radiotherapy. uses radiation to destroy the cancer cells. 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.

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. 
• Brachytherapy. This is when radioactive seeds are placed into your prostate gland and left there. Or you may have a radioactive substance put inside the prostate using a fine tube which is then taken out.

Hormone therapy

Prostate cancer cells need the hormone testosterone to help them grow. Hormone therapy blocks or lowers the amount of testosterone your body makes. This can slow down the growth of the cancer. Hormone therapy may be used before, during or after radiotherapy. It can be used to treat cancer or to control it.

Hormone therapy can cause some side-effects. These include problems getting an erection, less desire for sex and hot flushes.

If you’re transgender, non-binary or intersex, you may have been having hormone treatment for some time. This can reduce your chance of getting prostate cancer, but it doesn’t 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 (medicines to destroy cancer cells) for more advanced prostate cancer

Your doctor can tell you if these are an option for you. If so, ask them to explain the risks and benefits.    

Causes of prostate cancer

Doctors don’t yet know exactly why prostate cancer happens.There are some things that can increase your risk of prostate cancer. These include the following.

• Your age – prostate cancer mainly affects people over 50.
• Your ethnicity
• Family history – certain genes can put people at higher risk. So, if you have a close relative with prostate cancer, you’re more likely to get it.
• Diet – people who eat a lot of high-fat foods may be more likely to develop prostate cancer.

Living with prostate cancer

The cancer, and the treatment you have for it, can affect you in many different ways.

Everyone is different, but you may find that you have issues with:

• your feelings about having cancer – you may feel confused, frightened and upset. You may worry about it coming back after treatment
• sex and relationships – you may have problems getting an erection, or losing your desire for sex
• coping with work, childcare and money matters – you may need practical help from family and friends

You may need time to adjust after your treatment. Try to eat healthily to help your body heal, and look after your mental health.

Getting help and support

Being diagnosed with cancer can be distressing for you and your family. You may need support to deal with the emotional aspects as well as physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need. Talk to your doctor or nurse if you’re finding your feelings hard to cope with. The organisations listed under ‘other helpful websites’ will be able to provide information, advice and support too.