Prostate cancer: symptoms, risk factors & treatment

Prostate cancer is the most common cancer among men in the UK. About one in every eight men will develop prostate cancer at some point in their lives.

It may not be the part of your body that you think about most often, but knowing about your prostate, and prostate cancer will help you identify the symptoms, and see your GP as soon as possible.

Unlike some cancers prostate cancer often develops slowly. You may have this cancer for a while before you notice any symptoms.

Many of the symptoms of prostate cancer are common in older men. This may be because they have a non-cancerous enlargement of the prostate gland, which isn’t cancerous (see below).  If yours is a slow-growing cancer, that isn’t likely to cause you many problems, you may not need treatment.

However, it’s important that you see your GP promptly, once you notice any signs that something isn’t right, as some men have more aggressive prostate cancer. In these cases having treatment as soon as possible is important to stop the cancer spreading.

Your prostate is a small part of your body, a walnut-sized gland that surrounds your urethra (which feeds urine and semen into the penis).  The prostate gland also produces the fluid that carries sperm. It also makes prostate-specific-antigen (PSA) that makes semen into a liquid.

You probably rarely think about your prostate when everything is running smoothly, but prostate cancer is the most common male cancer. Every year there are more than 40,000 new cases of this condition.

Risk factors for prostate cancer

Age is the main risk factor when it comes to prostate cancer. Men under 50 have a very low risk of developing prostate cancer. This cancer is mostly found in men over 50, and as you grow older your risk rises. The average age at which men have a diagnosis of prostate cancer is between 65 and 69 years.

Another risk factor is your ethnic background. Black men are considerably more likely to develop prostate cancer than white men. About 1 in 4 black men in the UK develop prostate cancer. Because of this greater risk, if this applies to you, it’s a good idea to talk to your GP about prostate cancer once you’re over 45.

If one of your family members, such as your father, brother or uncle, has developed prostate cancer, this increases your risk. And having a close family relative who has had breast cancer may also increase your risk.

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Prostate cancer symptoms

Prostate cancer can be hard to spot in its very early stages. This is because it doesn’t produce any symptoms until it has developed to the point where the prostate is putting pressure on the urethra. (The urethra is a thin tube that travels from the bladder to the genitals, to allow us to pass urine).Symptoms of prostate cancer include:

• trouble passing urine
• having to urinate more often (especially at night)
• having to suddenly rush to the loo
• pain when you urinate
• feeling that your bladder isn’t completely empty
• in rare cases, finding blood in your urine

The prostate gland tends to become larger once you’re over 50. Around nine out of ten men have an enlarged prostate by the time they reach 90. This enlargement can cause the same symptoms as prostate cancer, including emptying your bladder and weak flow of urine. Some of these symptoms can also be caused by non-cancerous conditions, such as benign prostatic hyperplasia (BPH)

Prostate cancer diagnosis

Diagnosing prostate cancer can be difficult, because the symptoms are similar to those of other conditions. That doesn’t mean that you should put off seeing your GP. They need to check on your symptoms and arrange any tests you need.

Your GP will ask about your general health, and may do a urine test to check for a urine infection. They will also take some blood to check your prostate specific antigen (PSA) levels This is known as a PSA test. High levels of PSA may be a sign of prostate cancer, or other conditions.

You may also have a digital rectal examination (DRE), where your GP or nurse inserts a gloved finger into your rectum to feel your prostate gland. This is to check whether it is abnormal in any way – hard or lumpy for instance. If this is the case, it may suggest that you have prostate cancer. However, you may have a prostate that feels normal, but may still be cancerous.

Once your GP has considered this evidence, as well as your age, family history, PSA levels and DRE results, they will decide whether you need to see a specialist for more tests. If the results aren’t clear, they may ask you to make an appointment to have another check-up with them.

Tests for prostate cancer

Once you’ve been referred to hospital, and have seen your prostate cancer specialist, you are likely to have a number of diagnostic tests.

A transrectal ultrasound-guided biopsy (TRUS) involves having an ultrasound probe inserted into your rectum, so your doctor can see images of your prostate on a screen. For the biopsy part of this test your doctor or nurse will insert a needle through the wall of your rectum, into your prostate, so that they can take samples for analysis. This test may not always locate a tumour, if you have one, so isn’t entirely reliable.

Your tissue samples will be studied in the hospital’s laboratory. If evidence of cancer is found in the tissue, your doctors will use something called the Gleason score to measure the likelihood of the cancer spreading.

A Gleason score of six or under means it’s unlikely that the cancer will spread. A score of eight or more means that there is a significant chance that it will spread.

An MRI (Magnetic Resonance Imaging) scan allows your doctors to see a detailed image of your prostate, and the area around it. If you do have cancer, they will be able to see whether this has spread.

Some hospitals have a new type of scanner. This is known as a multi-parametric MRI (mpMRI) scan. In a large, recent, trial, this scanner was found to be more accurate than standard MRI scanners. The trial, involving 11 NHS hospitals, and 576 men with suspected prostate cancer, found that the mpMRI scanners, followed up with a biopsy, were almost twice as effective at detecting aggressive prostate cancer.

The mpMRI scanners can also indicate the size of the cancer and its location. This is important, because, if the scan is carried out before a biopsy, it can let your medical team know if you have a fast-growing cancer in your prostate, and can even give information on how likely the cancer is to grow.

If your hospital has one of these scanners, (not all do) ask if you can have a scan before a biopsy is carried out (as opposed to afterwards) it could save you from having an unnecessary biopsy that could cause discomfort and complications, and avoid you having possibly unnecessary treatment.

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Possible side effects of a TRUS prostate biopsy

Prostate biopsies do involve the risk of some side effects. These may include feeling pain or discomfort in the rectum for a few days.

It's not unusual to see traces of blood in your urine or faeces for a couple of weeks, and in your semen for up to a couple months. If you start seeing more blood (which may be red or brown), or the bleeding carries on for longer than this, see your GP.

In some cases (under 1 in 100 men), larger amounts of blood can appear from your rectum, and/or in your urine. Passing a lot of blood clots or having heavy bleeding can be a sign that something isn’t right. If this happens, talk to the relevant staff at the hospital that carried out the procedure as soon as possible, or go to your nearest A&E department.

Prostate biopsies can also be linked to urine infections – and symptoms include dark or cloudy strong-smelling urine, pain on passing water, pain in your lower abdomen, needing to urinate more often. Make sure that you finish the course of antibiotics you've been given. If the problem continues see your GP or hospital specialist again.

A smaller number of men, around 3 in 100, can get an infection that spreads into the blood stream. This is a life-threatening condition called sepsis and requires immediate hospital treatment.  Find out more about sepsis at NHS Choices.

Symptoms include:

• a high temperature (fever), chills and shivering

• a fast heartbeat
• fast breathing
• confusion or changes in behaviour.

Prostate Cancer staging

This is the system that doctors use to describe how far cancer has spread. Prostate cancer staging uses the TNM system. T stands for Tumour, N for Lymph Node and M for metastases (cancer spread). The numbers used in the staging show how far the cancer has spread. So, for example, T2a means that the tumour is in only half of one of the prostate gland’s lobes. N0 means that there are no cancer cells in lymph nodes close to the prostate.

If you don’t understand the staging system ask your doctor or nurse to explain it to you, or check online (see below).

Prostate cancer treatment

The types of treatment you have will depend on whether and how far your cancer has spread. If your cancer is localised it means that it hasn’t spread beyond your prostate. If it is slow growing, your doctor may suggest watchful waiting (check-ups at your GP’s surgery), or active surveillance (regular hospital tests, including prostate biopsies).

Locally-advanced prostate cancer treatment

If your cancer is locally advanced this means that it has spread just beyond the prostate. Treatment options may include watchful waiting, or external beam radiotherapy, where the prostate gland has high energy X-ray beams directed at it, to prevent cancer cells from growing.

Advanced prostate cancer treatment

If you have advanced prostate cancer this means that it has spread from your prostate gland to other parts of your body, such as your bones and lymph nodes. At this stage doctors can’t cure the cancer but may be able to give treatment that will keep it under control for a number of years. Treatment options may include chemotherapy to kill off cancer cells, and hormone therapy to stop testosterone being produced.

If you would like to read more about prostate cancer, how it is diagnosed, staged and treated, there are a number of very good websites with extensive information.

Information and help for prostate cancer

Prostate Cancer UK has a free support line, manned by Specialist Nurses – 0800 074 8383.

Macmillan Cancer Support has extensive information on prostate cancer and has a free support line – 0808 808 0000.

Cancer Research UK has an extensive section on prostate cancer, as well as a free nurse helpline – 0808 800 4040

NHS Choices also has a clearly-written section on prostate cancer, with links to other useful sites.

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