Prostate cancer: symptoms, risk factors & treatment

Lesley Dobson / 04 March 2013

Over 250,000 men are currently living with prostate cancer.

Around 1 in 14 men in the UK are diagnosed with prostate cancer at some point in their lives, and over 40,000 new cases are diagnosed every year. This makes it the most common cancer in men living in the UK. Knowing about your prostate, and prostate cancer will help you spot the symptoms and see your doctor sooner rather than later.

Prostate cancer often develops slowly, so you may have this cancer for some time before you notice any symptoms. However some men do have a more aggressive prostate cancer which needs to be treated quickly to prevent it spreading.

Find out more about the signs and symptoms of prostate cancer

Your prostate gland is a small part of your body, about the size of a walnut, but don’t be misled by this. Despite its size, the prostate, which surrounds the urethra, (which feeds urine and semen to the penis), is capable of causing a good deal of trouble.

Found only in men, the prostate produces the fluid that carries sperm. It also makes prostate-specific-antigen (PSA) that makes semen into a liquid.

Risk factors for prostate cancer

The main risk factor for developing prostate cancer is age. Under 50s have a very low risk, but this increases with age. Most cases are diagnosed in men under 50, but around 80% of men in their eighties are likely to have some level of prostate cancer.

Other risk factors include ethnicity. Black African and Caribbean men have a higher risk than white men while Asian men are at lower risk. 

A family history of prostate cancer is another risk, especially if a close relative, including father, brother or uncle, has developed the disease. Having a close family relative who has had breast cancer may also increase your risk.

Regular exercise has been found to reduce the risk of prostate cancer, while being overweight or obese may increase it. 

There is also a possibility that diet may have an effect on risk levels, but research on this and other risk factors is still underway.

Prostate cancer symptoms

In most cases prostate cancer won’t cause any symptoms until it has developed to the stage when the prostate is putting pressure on the urethra. 

Symptoms include: 

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

The prostate gland tends to get 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 trouble 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

Prostate cancer isn’t always easy to diagnose, because the symptoms are similar to other conditions. However it’s important to see your GP is you do experience the symptoms listed above, so that they can carry out tests to find out the source of the problem.

Your GP will ask about your general health to start with, and will probably then suggest several tests. They may do a urine test to check for a urine infection. If you do have a urine infection you should wait at least a month before having a PSA test. Your GP will take some blood to check your prostate specific antigen (PSA) levels. High levels of PSA may be a sign of cancer, but may also be caused by other conditions.

Your doctor or nurse may then carry out a digital rectal examination (DRE). This involves them inserting a gloved finger into your rectum and feeling your prostate gland. They will be checking to see if it is abnormal in any way, for instance, hard or lumpy.

Once they have considered the different factors – your age, family history, PSA levels and DRE results your GP will refer you to hospital, where a specialist will examine you and discuss whether you should have further tests.

Tests for prostate cancer

There are a variety of tests that are used to gather more information.

Transrectal ultrasound-guided biopsy (TRUS). This involves having an ultrasound probe inserted into your rectum. This uses sound waves to produce a picture of your prostate gland. For the biopsy part of this test your doctor or nurse will insert a needle through the wall of your rectum, into your prostate to take samples. 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, the doctors will measure its likelihood of spreading using the Gleason score. A Gleason score of six or under indicates that it is unlikely the cancer will spread, while a score of 8 or more means there is a significant chance that this will happen.

If the results of these tests cause concern, your specialist may suggest further tests. These may include 

  • a bone scan, as this is often an area that prostate cancer can spread to 
  • X-rays, MRI and CT scans, to check on your general health, and whether the cancer has spread 
  • an abdominal ultrasound, to see the inside of your body and to check on your kidneys, and how well your bladder is emptying

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 shows 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, 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 of 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.

Prostate Cancer UK is currently running the Sledgehammer fund to help more men survive this disease and 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 – 08088080000.

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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The opinions expressed are those of the author and are not held by Saga unless specifically stated.

The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.