Prostate Cancer

What is Prostate Cancer?

Prostate cancer starts in the cells of the prostate. The prostate is a small gland that is just below the bladder and in front of the rectum (back passage).

Prostate cancer is a common cancer. In the UK about 48,600 men are diagnosed with it each year. Prostate cancer is more common over the age of 65. It can happen at a younger age but it is uncommon under 50. You have a higher risk of prostate cancer at a younger age if you are Black or have a strong family history of prostate cancer.

There are different types of prostate cancer

early prostate cancer (or localised prostate cancer) – the cancer is only inside the prostate gland.
locally-advanced prostate cancer – the cancer has spread through the capsule surrounding the prostate gland and may have started to spread into tissue or organs close by.
advanced prostate cancer (or metastatic prostate cancer) – the cancer has spread to other parts of the body, such as the bones.

Symptoms of Prostate Cancer

Prostate cancer symptoms only happen when the cancer is large enough to press on the tube that carries the urine from the bladder (urethra). If the cancer is in the early stage it may not cause any symptoms.
The prostate gland can also become enlarged due to a prostate condition called benign prostatic hyperplasia (BPH), which is non-cancerous.

The symptoms of benign (non-cancerous) prostate conditions and prostate cancer are similar. They can include:

needing to pee more often than usual, especially at night
difficulty peeing – for example, a weak flow or having to strain to start peeing
feeling like you have not completely emptied your bladder
an urgent need to pee
blood in your urine or semen
rarely, pain when peeing or ejaculating.
If you have any of these symptoms, it is important to have them checked by your doctor. Your GP can do tests (see Diagnosis of prostate cancer below) to find out if you need a referral to a specialist doctor.

If prostate cancer spreads, it usually goes to the bones. It may cause pain in the bones, such as in the back. This is called advanced prostate cancer (or metastatic prostate cancer).

Causes of Prostate Cancer

It's not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.

These include:

age – the risk rises as you get older, and most cases are diagnosed in men over 50 years of age
ethnic group – prostate cancer is more common in black men than in Asian men
family history – having a brother or father who developed prostate cancer before age 60 seems to increase your risk of developing it; research also shows that having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer
obesity – recent research suggests there may be a link between obesity and prostate cancer, and a balanced diet and regular exercise may lower your risk of developing prostate cancer
diet – research is ongoing into the links between diet and prostate cancer, and there is some evidence that a diet high in calcium is linked to an increased risk of developing prostate cancer

Diagnosis of Prostate Cancer

You usually start by seeing your GP to have your symptoms checked. Your GP usually arranges some tests. The first tests used to diagnose prostate cancer are:

Rectal examination
PSA test

If your PSA level is raised or your rectal examination is unusual your GP refers you to a specialist doctor (urologist). Your GP may test your PSA level again if it is raised but your prostate feels normal.

At the hospital
A specialist doctor or nurse asks about your symptoms and any other medical conditions. They check if you have any risk factors for prostate cancer. The doctor may do another rectal examination and arrange another PSA test. They will talk to you about further tests you may have. These may include:

A multi-parametric MRI scan
Trans-rectal ultrasound (TRUS) biopsy
Trans-Perineal (TP) biopsy

Treatment of Prostate Cancer

A team of specialists meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). There are different treatments. Your treatment will depend on:

your general health
your age
the Gleason score, cancer grade
the stage of the cancer
the risk group of the cancer
your preferences.

Your doctor and nurse will talk to you about the different things to think about when making treatment decisions. They will explain the different benefits and disadvantages of each treatment. You and your doctor can then decide on the best treatment for you.

Treatment for early or locally advanced prostate cancer may include one or more of the following:

Radiotherapy
Surgery or radical prostatectomy
Monitoring
Hormonal therapy
Chemotherapy
Other treatments

After Prostate Cancer Treatment

You will have regular follow-up appointments after treatment for prostate cancer.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation such as Prostate Cancer UK.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat online to the specialists online.
Visit the prostate cancer forum to talk with people who have been affected by prostate cancer, share your experience, and ask an expert your questions.