Guide to prostate cancer

What is the prostate?

The prostate gland is a part of the male reproductive system. It is about the size of a walnut and sits below the bladder, surrounding the urethra – the tube which carries urine from the bladder to the penis, as well as semen. Its main function is to produce seminal fluid.

When many men reach the age of 40, their prostates begin to get bigger and cause problems when urinating. This is usually a non-cancerous, treatable condition known as benign prostatic hyperplasia (BPH).

What is prostate cancer?

According to the NHS, prostate cancer is the most common cancer in men in the UK, with more than 40,000 new cases diagnosed every year – more than 110 men every day. Across the UK, around 250,000 men are currently living with prostate cancer.

When cells in the prostate grow faster than normal in an uncontrolled way this can result in a growth called a tumour.  In the early stages, the tumour is hard to detect as it can’t be seen, grows slowly, and often causes no symptoms for years.

Symptoms of prostate cancer

It’s important to note that the symptoms of growths in the prostate are very similar – whether they are cancerous or benign (BPH).

Most prostate cancers (80%) grow slowly and may not cause any symptoms or illness. Symptoms may only be noticed when the prostate is large enough to put pressure on the urethra and cause problems with urination. However, for 20% of cases, the prostate cancer cells can grow more quickly and may spread to other parts of the body.

According to the NHS, common symptoms for prostate problems (both BPH and cancer) may include:

  • increased need to urinate, often during the night
  • needing to rush to the toilet
  • difficulty in starting to urinate
  • straining while urinating
  • weak flow of urine
  • feeling the bladder has not fully emptied.

Rarer symptoms may include

  • pain when urinating
  • blood in the urine or semen.

Symptoms that the cancer may have spread include:

  • bone and back pain
  • loss of appetite
  • pain in the testicles
  • unexplained weight loss.

How is prostate cancer diagnosed?

If symptoms become worrying a visit to the GP is needed. The doctor will probably then do a blood test and rectal examination:

PSA blood test

A blood test is taken to check for levels of a protein called Prostate Specific Antigen (PSA) which is made in the prostate. It’s normal to find some PSA in a man’s bloodstream – this is called the PSA level. The PSA level reading generally increases as men get older.

If the PSA level is slightly raised (borderline) the GP will usually request a second blood test is done one to three months later to check if the PSA level is rising or staying the same.

A high PSA level is usually due to non-cancerous prostate enlargement (BPH) but very high PSA levels usually indicate that cancer is present and the GP will refer the patient to a specialist for an appointment within two weeks, in line with NHS guidelines.

Rectal examination

To check the prostate for any abnormal signs including lumps, the GP will perform a digital rectal examination (DRE) – this involves putting a gloved finger into the patient’s back passage, or rectum.

The GP may then refer the patient to hospital for more diagnostic tests. These may include:

  • rectal ultrasound
  • needle bioposy
  • MRI scan.

Specialist support

Coping with a diagnosis of prostate cancer can be difficult and waiting for test results can be very worrying. Extra emotional support may be needed from loved ones and friends. It’s important that patients get the right information about their treatment options from their medical team.

Specialist support and advice is offered by the specialist nurses in hospital and can also be obtained from Cancer Research UK nurses (on 0808 800 4040), Macmillan nurses (on 0808 808 0000), and Prostate Cancer UK nurses (on 0800 074 8383).

How is prostate cancer treated?

If prostate cancer is detected at an early stage then treatment is not always immediately necessary for some men. In these cases, the patient will be carefully monitored.

If treatment is recommended, it will usually include surgery to remove the prostate, followed by radiotherapy and hormone therapy.  As the side effects of these treatments can include erectile dysfunction and urinary incontinence many men often choose to delay treatment. Newer treatments such as high-intensity focused ultrasound (HIFU) and cryotherapy, which have reduced side effects, may be offered by some hospitals.

If the cancer is diagnosed at a later stage, it may have already spread to other parts of the body (often the bones) and cannot be cured. Treatment in these cases focuses on prolonging life and relieving the symptoms.

Recovery from prostate cancer

Prostate cancer and its treatment may cause physical changes (including extreme tiredness, bowel and bladder problems, and erectile dyfunction) as well as emotional issues. Patients should allow time to convalesce and come to terms with their experiences.

Fortunately there is plenty of support and help available – from helplines, to support groups.  Useful information on coping with prostate cancer can be found on the Cancer  Research UK website as well as the Prostate Cancer UK website

Other useful articles by

Cancer in older people

Bowel cancer in the the elderly

Useful links for more detailed information about prostate cancer:

Prostate Cancer UK: understanding the prostate

Cancer Research UK: prostate cancer symptoms

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