Prostate cancer does not usually cause any symptoms until the cancer has grown large enough to put pressure on the tube that carries urine from the bladder out of the penis (urethra).

Symptoms of prostate cancer can include:

• needing to pee more frequently, often during the night
• needing to rush to the toilet
• difficulty in starting to pee (hesitancy)
• straining or taking a long time while peeing
• weak flow
• feeling that your bladder has not emptied fully
• blood in urine or blood in semen

These symptoms do not always mean you have prostate cancer. Many men's prostates get larger as they get older because of a non-cancerous condition called prostate enlargement.

Signs that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss.

Want to know more?

• Prostate Cancer UK: about prostate cancer
• Cancer Research UK: prostate cancer symptoms

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 among men of African-Caribbean and African descent 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

Want to know more?

• Prostate Cancer UK: are you at risk?
• Prostate Cancer UK: diet, physical activity and your risk of prostate cancer
• Cancer Research UK: prostate cancer risks and causes

If you have symptoms that could be caused by prostate cancer, you should visit your GP.

There's no single, definitive test for prostate cancer. Your GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.

Your doctor is likely to:

• ask for a urine sample to check for infection
• take a blood sample to test your level of prostate-specific antigen (PSA) – called PSA testing
• examine your prostate by inserting a gloved finger into your bottom – called digital rectal examination

Your GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels and the results of your prostate examination, as well as your age, family history and ethnic group.

If you're at risk, you should be referred to hospital to discuss the options of further tests.

MRI scan

If you have a raised PSA level, your doctor may refer you to hospital for an MRI scan of your prostate. If the scan shows a problem, it can be targeted later with a biopsy.

Having a biopsy to diagnose prostate cancer

There are a few types of biopsy that may be used in hospital, including the below.

A transperineal biopsy

This is where a needle is inserted into the prostate through the skin behind the scrotum. It's usually done under a general anaesthetic (while you're asleep). It has the advantage of a reduced risk of infection.

A transrectal biopsy

This is where a needle is inserted into the prostate through your rectum (back passage).

During this biopsy, an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see where to pass the needle to take small samples of tissue from your prostate.

This procedure can be uncomfortable and sometimes painful, so you may be given a local anaesthetic to numb the area and minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection.

A biopsy may also be taken during a cystoscopy examination.

Issues with biopsies

Although a biopsy is more reliable than a PSA test, there can still be issues, such as:

• missing the cancer – doctors can see the prostate using the ultrasound scan but might not always spot a tumour
• needing another biopsy if your symptoms persist or your PSA level continues to rise – you may be offered another MRI scan first
• finding small, low-risk cancers that do not need treatment but may cause you anxiety – some men choose to undergo surgery or radiotherapy that may not benefit them but still causes side effects, such as incontinence and erectile dysfunction

The samples of tissue from the biopsy are studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This is called "staging and grading" and helps doctors to decide which treatment is the most appropriate.

Want to know more?

• Cancer Research UK: the stages of prostate cancer
• Macmillan: grading and staging of prostate cancer

Further testing for advanced cancer

If there's a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.

These include:

• an MRI scan, CT scan or PET scan – these scans build a detailed picture of the inside of your body
• an isotope bone scan, which can tell if the cancer has spread to your bones – a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities

Want to know more?

• Cancer Research UK: prostate cancer tests

There's currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks.

PSA screening

Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community. There are several reasons for this.

PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result). Most men are now offered an MRI scan before a biopsy to help avoid unnecessary tests, but some men may have invasive, and sometimes painful, biopsies for no reason.

Furthermore, up to 15% of men with prostate cancer have normal PSA levels (a false-negative result), so many cases may be missed.

The PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life. Some men may face difficult decisions about treatment, although this is less likely now that most men are offered an MRI scan before further tests and treatment

Treating prostate cancer in its early stages can be beneficial in some cases, but the side effects of the various treatments are potentially so serious that men may choose to delay treatment until it's absolutely necessary.

Although screening has been shown to reduce a man's chance of dying from prostate cancer, it would mean many men receive treatment unnecessarily.

More research is needed to determine whether the possible benefits of a screening programme would outweigh the harms of:

• overdiagnosis – people being diagnosed with a cancer that would never cause symptoms or shorten life expectancy
• overtreatment – people being treated unnecessarily for tumours that would unlikely be harmful

Should you know your PSA level?

Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.

If you're a man aged 50 or over and decide to have your PSA levels tested after talking to your GP, they can arrange for it to be carried out free on the NHS.

If results show you have a raised level of PSA, your GP may suggest further tests.

Want to know more?

• PSA test for prostate cancer

Treatment for prostate cancer will depend on your individual circumstances. For many men with prostate cancer, no treatment will be necessary.

When treatment is necessary, the aim is to cure or control the disease so it affects everyday life as little as possible and does not shorten life expectancy.

Sometimes, if the cancer has already spread, the aim is not to cure it but to prolong life and delay symptoms.

Your cancer care team

People with cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists (radiotherapy and chemotherapy specialists), radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

• the type and size of the cancer
• what grade it is
• your general health
• whether the cancer has spread to other parts of your body

Good prostate cancer care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services (such as continence services) to help stop or ease these side effects.

Staging of prostate cancer

Doctors will use the results of your prostate examination, biopsy and scans to identify the "stage" of your prostate cancer (how far the cancer has spread).

The stage of the cancer will determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

Want to know more?

• What do cancer stages and grades mean?
• Cancer Research UK: the stages of prostate cancer

Watchful waiting or active surveillance

Watchful waiting and active surveillance are different approaches to keeping an eye on the cancer and starting treatment only if it shows signs of getting worse or causing symptoms.

Watchful waiting

Watchful waiting is often recommended for older men when it's unlikely the cancer will affect their natural lifespan.

If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment and wait to see if any symptoms of progressive cancer develop.

If this happens, hormone medication to control prostate cancer is usually used.

Watchful waiting may also be recommended if your general health means you're unable to receive any form of treatment.

In either of these cases, you may just have hormone treatment to treat any symptoms caused by the prostate cancer.

Active surveillance

Active surveillance aims to avoid unnecessary treatment of harmless cancers while still providing timely treatment for men who need it.

Active surveillance involves having regular PSA tests, MRI scans and sometimes biopsies to ensure any signs of progression are found as early as possible.

If these tests reveal the cancer is changing or progressing, you can then make a decision about further treatment.

Men undergoing active surveillance will have delayed any treatment-related side effects, and those who eventually need treatment will be reassured that it was necessary.

Surgically removing the prostate gland (radical prostatectomy)

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks.

A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.

Before having any treatment, 67% of men said they could get erections firm enough for intercourse.

When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.

When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.

In extremely rare cases, problems arising after surgery can be fatal.

It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

After a radical prostatectomy, you'll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation (IVF).

Want to know more?

• Prostate Cancer UK: radical prostatectomy
• Macmillan: radical prostatectomy surgery

Radiotherapy

Radiotherapy involves using radiation to kill cancerous cells.

This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Radiotherapy can also be used to slow the progression of prostate cancer that's spread and relieve symptoms.

You'll normally have radiotherapy as an outpatient in a hospital near you. It's done in short sessions for 5 days a week, usually for 4 weeks.

There are short- and long-term side effects associated with radiotherapy.

You may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment.

Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.

Short-term effects of radiotherapy can include:

• discomfort around your bottom
• diarrhoea
• loss of pubic hair
• tiredness
• inflammation of the bladder lining, which can cause painful peeing and needing to go more often (cystitis)

A recent trial showed that possible long-term side effects of radiotherapy can include an inability to get an erection.

Before having treatment, 67% of men said they could get erections firm enough for intercourse, decreasing to 22% after 6 months.

Although this improved over the next 6 months, it declined again to 27% when the men were asked again after 6 years.

Radiotherapy is also slightly more likely than other treatments to cause moderate-to-severe back passage problems, such as diarrhoea, bleeding and discomfort.

It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Some hospitals now offer new minimally invasive treatments if radiotherapy fails to work, sometimes as part of a clinical trial.

These new treatments are called brachytherapy, high-intensity focused ultrasound (HIFU) and cryotherapy.

These treatments have fewer side effects, but the long-term outcomes are not yet known. There's a higher risk of complications from surgery in men who have previously had radiotherapy.

If these treatments are not appropriate, medicine is usually used to control the cancer.

Want to know more?

• Macmillan: radiotherapy for early prostate cancer

Brachytherapy

Brachytherapy is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It's also known as internal or interstitial radiotherapy.

The radiation can be delivered using a number of tiny radioactive seeds surgically implanted into the tumour. This is called low dose rate brachytherapy.

The radiation can also be delivered through thin, hollow needles placed inside the prostate. This is called high dose rate brachytherapy.

The idea behind this method is to deliver a high dose of radiation to the prostate while minimising damage to other tissues.

But the risk of urinary problems is higher than with radiotherapy, although the risk of sexual dysfunction is the same. The risk of bowel problems is slightly lower.

Want to know more?

• Cancer Research UK: internal radiotherapy (brachytherapy) for prostate cancer

Hormone therapy

Hormone therapy is often used in combination with radiotherapy. For example, you may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment.

It may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.

Hormone therapy alone does not cure prostate cancer. It can be used to slow the progression of advanced prostate cancer and relieve symptoms.

Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow.

The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone.

Hormone therapy can be given as:

• injections to stop your body making testosterone
• tablets to block the effects or reduce the production of testosterone
• a combination of the 2

The main side effects of hormone treatment are caused by their effects on testosterone. They usually go away when treatment stops.

They include loss of sex drive and erectile dysfunction (this is more common with the injections than with the tablets).

Other possible side effects include:

• hot flushes
• sweating
• weight gain
• swelling and tenderness of the breasts

An alternative to hormone therapy is to surgically remove the testicles (orchidectomy). This does not cure prostate cancer, but by removing the testosterone, it controls the growth of the cancer and its symptoms.

Many men prefer to have hormone treatment to block the effects of testosterone.

Want to know more?

• Cancer Research UK: hormone therapy for prostate cancer

Trans-urethral resection of the prostate (TURP)

TURP is a procedure that can help relieve pressure from the tube that carries urine from your bladder out of your penis (urethra) to treat any problematic symptoms you may have with urination.

It does not cure the cancer.

During TURP, a thin metal wire with a loop at the end is inserted into your urethra and pieces of the prostate are removed.

This is carried out under general anaesthetic or a spinal anaesthetic (epidural).

Find out more about TURP

High-intensity focused ultrasound (HIFU)

HIFU is sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate.

An ultrasound probe inserted into the bottom (rectum) releases high-frequency sound waves through the wall of the rectum.

These sound waves kill cancer cells in the prostate gland by heating them to a high temperature.

The risk of side effects from HIFU is usually lower than other treatments.

But possible effects can include erectile dysfunction (in 5 to 10 in every 100 men) or urinary incontinence (in less than 1 in every 100 men). Back passage problems are rare.

A fistula, where an abnormal channel forms between the urinary system and the rectum, is also rare, affecting less than 1 in every 500 men.

This is because the treatment targets the cancer area only and not the whole prostate.

But HIFU treatment is still going through clinical trials for prostate cancer. In some cases, doctors can carry out HIFU treatment outside of clinical trials.

HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven.

Want to know more?

• Cancer Research UK: high-intensity focused ultrasound (HIFU) for prostate cancer

Cryotherapy

Cryotherapy is a method of killing cancer cells by freezing them. It's sometimes used to treat men with localised prostate cancer that has not spread beyond their prostate gland.

Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die.

The aim is to kill cancer cells while causing as little damage as possible to healthy cells.

The side effects of cryotherapy can include:

• erectile dysfunction
• incontinence – this affects less than 1 in 20 men

It's rare for cryotherapy to cause a fistula or problems with the back passage.

Cryotherapy is still undergoing clinical trials for prostate cancer. In some cases, doctors can carry out cryotherapy treatment outside of clinical trials.

It's not widely available and its long-term effectiveness has not yet been conclusively proven.

Treating advanced prostate cancer

If the cancer has reached an advanced stage, it's no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

• radiotherapy
• hormone treatment
• chemotherapy

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

Want to know more?

• Prostate Cancer UK: guide on how to manage the symptoms of advanced prostate cancer

Chemotherapy

Chemotherapy is often used to treat prostate cancer that's spread to other parts of the body (metastatic prostate cancer).

Chemotherapy destroys cancer cells by interfering with the way they multiply. It does not cure prostate cancer, but can keep it under control to help you live longer.

It also aims to reduce symptoms, such as pain, so everyday life is less affected.

The main side effects of chemotherapy come from how it affects healthy cells, such as immune cells.

They include:

• infections
• tiredness
• hair loss
• a sore mouth
• loss of appetite
• feeling sick (nausea)
• being sick (vomiting)

Many of these side effects can be prevented or controlled with other medicines that your doctor can prescribe.

Steroids

Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it. This is called castration-resistant prostate cancer (CRPC).

Steroids can be used to try to shrink the tumour and stop it growing. The most effective steroid treatment is dexamethasone.

Other medical treatments

There are a number of new medications that could be used if hormones and chemotherapy fail. Your medical team can tell you if these are suitable and available for you.

NICE has issued guidance on medications called abiraterone, enzalutamide and radium-223 dichloride.

All of these may be used to treat men with metastatic prostate cancer that no longer responds to standard hormone therapy.

Read the NICE guidelines on:

• enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with docetaxel
• abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen
• radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases

Deciding against treatment

Some men may decide against treatment for prostate cancer, particularly if they're at an age where they feel treating the cancer is unlikely to significantly extend their life expectancy.

The decision is entirely yours and your care team will respect it.

If you decide not to have treatment, your GP and hospital team will still give you support and pain relief. This is called palliative care.

Support is also available for your family and friends.

Want to know more?

• End of life care

Depending of the type of prostate cancer you have, your life may be affected in different ways.

Prostate cancer often gets worse slowly, and men may have it for years without symptoms. During this time, men with low-risk prostate cancer that hasn't spread beyond the prostate gland may not need treatment.

Men whose cancer is more likely to spread may decide to have surgery or radiotherapy that aims to cure the cancer. However, these treatments can have side effects.

Want to know more?

• Cancer Research UK: living with prostate cancer
• healthtalk.org: real stories about living with prostate cancer

Impact on everyday activities

If you have no symptoms, prostate cancer should have little or no effect on your everyday activities. You should be able to work, care for your family, carry on your usual social and leisure activities, and look after yourself.

However, you may be understandably worried about your future. This may make you feel anxious or depressed and affect your sleep.

If your prostate cancer progresses, you may not feel well enough to do all the things you used to. After an operation or other treatment, such as radiotherapy or chemotherapy, you'll probably feel tired and need time to recover.

If you have advanced prostate cancer that has spread to other parts of your body, you may have symptoms that slow you down and make it difficult to do things. You may have to reduce your working hours or stop working altogether.

Whatever stage your prostate cancer has reached, try to give yourself time to do the things you enjoy and spend time with those who care about you.

Want to know more?

• Cancer Research UK: coping with prostate cancer
• Prostate Cancer UK: guide on how to manage fatigue

Complications of prostate cancer

Erection problems

If you have erectile dysfunction, speak to your GP. It may be possible to treat you with a type of medicine called phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.

The most commonly used PDE5 is sildenafil (Viagra). Other PDE5s are available if sildenafil isn't effective.

Another alternative is a device called a vacuum pump. It's a simple tube connected to a pump. You place your penis in the tube and then pump out all the air.

This creates a vacuum, which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis. This keeps the blood in place and allows you to maintain an erection for around 30 minutes.

Urinary incontinence

If your urinary incontinence is mild, you may be able to control it by learning some simple exercises. Pelvic floor exercises can strengthen your control over your bladder.

To carry out pelvic floor exercises:

1. Sit or lie comfortably, with your knees slightly apart.
2. Squeeze or lift at the front as if you were trying to stop the passage of urine, then squeeze or lift at the back as if you were trying to stop the passage of wind.
3. Hold this contraction for as long as you can (at least 2 seconds, increasing up to 10 as you improve).
4. Relax for the same amount of time before repeating.

If your urinary incontinence is more severe, it may be possible to treat it with surgery. This would involve implanting an artificial sphincter – a sphincter is a muscle used to control the bladder.

Want to know more?

• Prostate Cancer UK: sex and prostate cancer
• Prostate Cancer UK: urinary problems and prostate cancer
• Prostate Cancer UK: guide on how to manage urinary problems

Relationships

Being diagnosed with prostate cancer often brings families and friends closer, although it can put pressure on relationships too.

Most people want to help, although they may not know what to do. Some people find it hard to talk about cancer and may try to avoid it.

Being open and honest about how you feel and what your family and friends can do to help may put others at ease. But don't feel shy about telling people you want some time to yourself, if that's what you need.

Want to know more?

• Macmillan: emotional effects of cancer
• Talking to your kids about cancer
• Prostate Cancer UK: guide on how to manage sex and relationships

Talking to others

If you have questions, your doctor or nurse may be able to reassure you, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline. Your GP surgery will have information on these.

Some men find it helpful to talk to other men with prostate cancer at a local support group or through an internet chat room.

Want to know more?

• Prostate Cancer UK: online community
• Prostate Cancer UK: confidential helpline on 0800 074 8383 to speak to a specialist nurse

Money and financial support

If you have to reduce or stop work because of your prostate cancer, you may find it hard to cope financially. If you have prostate cancer or are caring for someone who does, you may be entitled to financial support:

• if you have a job but can't work because of your illness, you're entitled to Statutory Sick Pay from your employer
• if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
• if you are caring for someone with cancer, you may be entitled to Carer's Allowance
• you may be eligible for other benefits if you have children living at home or if you have a low household income

Find out early what help is available to you. Speak to the social worker at your hospital, who can give you the information you need.

Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate giving them free prescriptions for all medication, including medicine for unrelated conditions.

The certificate is valid for 5 years, and you can apply for it through your GP or cancer specialist.

Want to know more?

• GOV.UK: benefits
• Your guide to care and support: what benefits can carers get?
• Find your nearest Citizens Advice
• Q&A: free prescriptions
• Money Advice Service