Prostate cancer

Expert review by:

Professor Andrew Protheroe, Consultant Oncologist

Content review by:

Pippa Coulter, Freelance Health Editor

Page last reviewed: December 2023
Next review date: December 2026

Prostate cancer is the most common type of cancer in men in the UK. It develops when cells in your prostate gland become cancerous and start to grow in an uncontrolled way. Sometimes, prostate cancer grows so slowly, you won’t ever need treatment. But some people have treatment to cure or control the cancer.

About prostate cancer

Your prostate gland sits below your bladder and surrounds your urethra, which is the tube you pee through. Your prostate produces the fluid that makes up part of your semen. The prostate gland is about the size of a walnut and gets bigger as you get older.

Prostate cancer can affect anybody who has a prostate gland. This includes men, transgender women, some non-binary people, and some intersex people. Prostate Cancer UK has more information on the risk of prostate cancer in transgender women.

There are different types of prostate cancer. But nearly all people with prostate cancer have a type called adenocarcinoma. Prostate cancer can spread from your prostate gland to other places around your body. Whether or not your cancer has spread and, if so, how far, will affect your treatment options. For more information about this, see our section on treatment for prostate cancer.

Causes of prostate cancer

Doctors don’t yet know exactly what causes some people to develop prostate cancer.

But there are some things that can increase your risk of prostate cancer. These include the following.

Your age – prostate cancer mainly affects people over 50.
Your ethnicity – you’re twice as likely to get prostate cancer if you’re black than if you’re white.
Family history – certain genes can put people at higher risk. So, if a close relative has had prostate cancer, you’re more likely to get it.
Diet – people who eat a lot of high-fat foods may be more likely to develop prostate cancer.

Symptoms of prostate cancer

Prostate cancer usually has no symptoms in its early stages.

If the cancer grows, it may cause problems when you pee. These may include:

needing to go more often
needing to go more urgently
having a weak urine stream
finding it difficult to start peeing
dribbling after you finish peeing
getting up at night to pee

These symptoms are more likely to be caused by an enlarged prostate than by prostate cancer. Many men get an enlarged prostate as they get older. It’s caused by an overgrowth of tissue in your prostate gland. It’s not cancer.

Prostate cancer can cause other symptoms as it starts to grow. These may include:

blood in your pee
pain when you pee
not being able to pee
a urine infection
difficulty getting an erection
pain in your lower tummy or around your genital area
feeling tired and generally unwell
pain in your bones or your back
losing weight or losing your appetite

If you have these symptoms, contact your GP.

Diagnosis of prostate cancer

If you have symptoms, your GP will ask about them and examine you. They may ask you to have the following tests.

A PSA test. This is a blood test to measure the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein made by your prostate gland. A raised PSA can be a sign of prostate cancer. But other conditions can also make your PSA go up. And PSA increases naturally as you get older. Around three-quarters of men with a raised PSA level don’t have prostate cancer.
A digital rectal examination (DRE). Your doctor will check the size, shape, and feel of your prostate through the wall of your rectum (back passage). They do this by gently putting a gloved finger into your back passage. This can feel uncomfortable, but it shouldn’t be painful.

If you’re transgender, non-binary or intersex and have a prostate, it’s important to make sure your GP knows. That way, they can make sure you’re offered these tests when you need them. If you’re not sure whether or not you have a prostate, your doctor will be able to tell you. They can do this by asking you some questions, and by examining you if needed.

PSA tests if you don’t have symptoms

If you’re over 50, you can request a PSA test at your GP surgery even if you don’t have symptoms. There are benefits and risks of having a PSA test. Your GP can give you information about this.

There isn’t a screening programme for prostate cancer in the UK. This means you don’t automatically get invited for PSA tests to check for prostate cancer. Although the PSA test can sometimes spot cancer, it’s not a good enough test for a screening programme.

Seeing a specialist

Depending on your PSA and DRE results, your GP may refer you to a specialist for further investigation. This will usually be a urologist, who is a specialist in treating prostate conditions.

Your specialist will recommend tests you can have to help diagnose prostate cancer. These may include an MRI scan and a prostate biopsy. In some hospitals, you may be offered an MRI scan first of all. The MRI can show how likely it is you have prostate cancer, and also help your doctor to decide if you need a biopsy.

In a prostate biopsy, your doctor takes small samples of tissue from your prostate to check for cancer cells. They use a special needle to do this. To reach your prostate, the needle may be:

inserted through the wall of your back passage (transrectal biopsy)
inserted through your perineum – the skin between your anus and scrotum (transperineal biopsy)

Your doctor will usually use ultrasound during the biopsy, to help guide the biopsy needle. You’ll have either a local anaesthetic or a general anaesthetic for the biopsy.

If the biopsy shows you have prostate cancer, your doctor may recommend tests to see whether or not it has spread and, if so, how far. This is called cancer staging. These tests may include:

a CT scan
an MRI scan
a bone scan
a PET scan – often using a dye called prostate specific membrane antigen (PSMA)

Prostate cancer test results

Your doctor may tell you your cancer stage. This explains how far your cancer has spread in or around your prostate. It also shows if it’s spread to your lymph nodes or other parts of your body. The main four stages are:

T1 – the cancer is so small it can’t be felt or seen on a screen (early or localised prostate cancer)
T2 – the cancer is bigger but still only in the prostate (early or localised)
T3 – the cancer has spread to the tissues just outside the prostate (locally advanced)
T4 – the cancer has spread to other nearby organs (advanced or metastatic)

Your doctor may also speak to you about your Gleason score. This gives an idea of how aggressive your cancer is. It’s based on how the cancer cells look under a microscope. They may also use the results from all your tests to work out the risk of your cancer spreading. They may give you a risk category or ‘grade group’ to describe this. Your doctor will explain exactly what this means.

Your doctor will also use all your test results to help plan the best treatment for you.

Men’s Health Check

We offer a male health check service to detect the signs of prostate and testicular cancer and advise you should any follow up healthcare be needed.

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Treatment of prostate cancer

If you have prostate cancer, you’ll be cared for by a team of specialist doctors and other health professionals. This should include a specialist prostate cancer nurse. There are several different ways to treat prostate cancer. The treatment options you will be offered will depend on several things, including:

whether the cancer is localised to the prostate gland or has spread anywhere else in your body (the stage)
how quickly the cancer is growing and spreading (your Gleason score)
your PSA results
your age and general health

Which cancer specialist you will see will depend on the options you have to treat your cancer. Your doctor will discuss your treatment options with you. They’ll talk through the benefits and risks of each option. It’s your choice whether or not to have any treatment. Tell your doctor if you have any preferences about your treatment.

The main treatment options for prostate cancer are listed below.

Watchful waiting

This is when you plan to live with the cancer. You don’t have treatment to cure your cancer, but your doctor will monitor it. If needed, you can have treatments to control it or to manage symptoms. Anyone can choose this option. It’s often a good option if:

your cancer is growing very slowly, so it may never need treatment
you have other health conditions which mean treatment of your prostate cancer isn’t the best option at this time

Active surveillance

With active surveillance, your doctor monitors your cancer, and offers you treatment to remove it when needed. You have regular tests, including PSA tests, to check if the cancer is spreading. It’s aimed at people whose cancer hasn’t spread outside the prostate. It means you avoid or delay treatment until it’s really needed.

Surgery

Surgery for prostate cancer involves an operation to remove your prostate gland and some of the tissue around it. This is called radical prostatectomy. You may be able to have surgery if the cancer is only in your prostate or has spread only to the area just outside it. Your surgeon may also remove the lymph nodes nearby if there’s a risk the cancer might have spread.

The surgery can be done in several different ways.

Through a single cut in your abdomen (tummy), just below your belly button.
Through a cut in your perineum – the skin between your anus (back passage) and scrotum.
With keyhole (laparoscopic) surgery. This uses tiny instruments inserted through several small cuts in your tummy to perform the surgery. Some surgeons use a robotic system to help them with keyhole surgery.

Having your prostate gland removed can cause some side-effects. These include problems getting an erection and leaking urine (incontinence). There are ways to manage these problems.

Radiotherapy

Radiotherapy uses radiation to destroy the cancer cells. Radiotherapy can be used as a treatment on its own or alongside other treatments. You may be offered it if the cancer is only in or around the prostate gland, as well as when the cancer has spread. Radiotherapy can also be used to reduce pain or control other symptoms in cancer that’s spread.

There are two main types of radiotherapy for prostate cancer.

External beam radiotherapy. This is where a beam of radiation from a machine is directed onto the affected area. You may have scans or images to make sure the radiation is being directed to the right area.
Brachytherapy. This is when radioactive ‘seeds’ are placed into your prostate gland. They steadily release radiation into your prostate over a number of months. Or you may have a radioactive substance put inside the prostate using a fine tube which is then taken out.

Radiotherapy for prostate cancer can sometimes cause damage to your bowel. This is called enteropathy. Symptoms can include diarrhoea and pain in your bottom. Tell your doctor if you get these symptoms. They’ll check what’s causing it and offer you treatment to help.

Hormone therapy

Prostate cancer cells need the hormone testosterone to help them grow. Hormone therapy blocks or lowers the amount of testosterone your body makes. This can slow down the growth of the cancer. Hormone therapy may be used before, during or after radiotherapy.4 It can be used to treat cancer or to control it.

Hormone therapy can cause some side-effects. These include problems getting an erection, loss of interest in sex, and hot flushes. Your doctor will discuss ways to manage these side-effects.

Other treatments

There are other treatments you may be offered if your cancer has spread. These won’t cure the cancer but may help to control it or reduce symptoms. These treatments include the following.

Chemotherapy. These are medicines that destroy cancer cells. You may have chemotherapy to shrink prostate cancer and slow down its growth. This may help you to live longer and delay or improve symptoms.
Bisphosphonates. These are medicines that can help with bone pain or help prevent bone damage. You may have them if the cancer has spread to your bones. You may also have them if you’re taking hormone therapy because this can weaken your bones.

Getting help and support

Being diagnosed with cancer can be distressing for you and your family. Make sure you get support when you need it to deal with the emotional aspects as well as physical symptoms. Talk to your doctor or nurse if you’re finding your feelings hard to cope with. They can help you get the support you need. The organisations listed under ‘Other helpful websites’ can provide further information, advice, and support.

Most people don’t get any symptoms in the early stages. If the cancer grows it can cause problems when you pee. These include going more often, needing to go more urgently, and having a weak stream. These symptoms are more commonly caused by an enlarged prostate. For more information, see our section on symptoms of prostate cancer.

The four main stages of prostate cancer are:

T1 (localised) – in the prostate only
T2 (localised) – bigger, but still only in the prostate
T3 (locally advanced) – spread just outside the prostate
T4 (advanced) – the cancer has spread to other nearby organs

The cancer stage tells your doctor how far it’s spread. This will help with planning treatment. See more on this in our section on diagnosis of prostate cancer.

Not necessarily. PSA is a protein produced by both normal and cancerous cells in your prostate. If your PSA is raised, it doesn’t always mean you have prostate cancer. It may be due to other problems with your prostate or just to increasing age. To find out more, read our section on diagnosis of prostate cancer.

It might do. Both the cancer and treatment can affect your relationships, sex life and how you feel about yourself. This can have a big impact on your quality of life. If you’re worried about your sex life, relationships, or mental health, it’s important to talk to someone about it. Ask your nurse or doctor for support.

Prostate cancer

About prostate cancer

Causes of prostate cancer

Symptoms of prostate cancer

Diagnosis of prostate cancer

PSA tests if you don’t have symptoms

Seeing a specialist

Prostate cancer test results

Men’s Health Check

Treatment of prostate cancer

Watchful waiting

Active surveillance

Surgery

Radiotherapy

Hormone therapy

Other treatments

Getting help and support

More on this topic

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Prostate cancer

About prostate cancer

Causes of prostate cancer

Symptoms of prostate cancer

Diagnosis of prostate cancer

PSA tests if you don’t have symptoms

Seeing a specialist

Prostate cancer test results

Men’s Health Check

Cancer awareness: prostate cancer

Prostate cancer | Awareness | Watch in 1:06 minutes

Treatment of prostate cancer

Watchful waiting

Active surveillance

Surgery

Radiotherapy

Hormone therapy

Other treatments

How cancer develops

Cancer explained | Watch in 1:48 minutes

Getting help and support

More on this topic

Radiotherapy

PSA testing for prostate cancer

Other helpful websites

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