Prostate cancer — what men need to know

Prostate cancer is the most common cancer in UK men — ~52,000 cases yearly — 1 in 8 lifetime risk. Black men — 1 in 4 — discuss PSA from 45.

Most diagnosed men live many years — slow-growing disease common — but aggressive subtypes exist — reason for informed screening debate.

Prostate gland basics

Walnut-sized — below bladder — surrounds urethra — PSA protein leaks into blood from normal and cancerous tissue.

Urinary symptoms — usually BPH not cancer — but assessment overlaps.

Symptoms

Localised (early):

  • often none

Locally advanced:

  • urinary frequency, hesitancy — overlap BPH
  • haematuria, haematospermia
  • ED

Metastatic:

  • bone pain — spine, hips
  • weight loss, fatigue
  • spinal cord compression — emergency

PSA testing — informed choice

Not UK population screen — man chooses after GP discussion:

Pros:

  • finds curable localised cancer

Cons:

  • false positives — biopsy anxiety
  • overdiagnosis — slow cancers never harmful
  • false negatives

Offer from 50 — 45 Black ethnicity or family history (father/brother <65)

Before test: avoid ejaculation, vigorous exercise, cycling 48h, UTI, recent biopsy — can skew PSA.

Diagnostic pathway

  1. PSA + DRE (digital rectal exam)
  2. Repeat PSA if borderline
  3. mpMRI prostate — before biopsy standard
  4. Biopsy — transperineal preferred — Gleason grade, volume
  5. Staging — bone scan/PSMA PET selected metastatic workup

Risk groups: low, intermediate, high, locally advanced, metastatic — guides treatment.

Treatment options

Low risk — active surveillance

Monitor PSA, MRI, repeat biopsy — avoid overtreatment harm — ~40% progress eventually need treatment.

Curative intent localised

  • radical prostatectomy — robotic laparoscopic common
  • external beam radiotherapy ± short hormone
  • brachytherapy — radioactive seeds

Side effects: incontinence, ED — nerve-sparing reduces — discuss upfront.

High risk / locally advanced

  • radiotherapy + long-term ADT (androgen deprivation therapy)
  • surgery selected

Metastatic

  • long-term hormone therapy — LHRH agonists/antagonists
  • abiraterone, enzalutamide, apalutamide
  • docetaxel, ** cabazitaxel**
  • radiotherapy to primary — STAMPEDE trial benefit some

Not curable but controllable years to decade+.

Living with prostate cancer

Prostate Cancer UK — Specialist Nurses

Support groups, ** erectile rehabilitation**, pelvic floor physio

Prevention — limited evidence

  • healthy weight
  • tomato-rich diet / lycopene — weak association
  • no proven prevention drug for general population

Know your risk — PSA conversation, not PSA fear or PSA avoidance by default.

Raised PSA is gateway to MRI — not automatic cancer sentence.

Common questions about prostate cancer

What are the symptoms of prostate cancer?
Early localised cancer — often no symptoms. Advanced disease — urinary problems (though BPH more common cause), blood in urine or semen, erectile dysfunction, hip or back pain from bone spread. Do not wait for symptoms — consider PSA discussion age-appropriately.
Should I have a PSA test?
Informed choice from 50 (45 high-risk groups) — PSA can be raised without cancer causing anxiety and biopsies; may miss some cancers; detects slow-growing disease that might never harm. Benefits include finding aggressive cancers early when curable. GP explains before testing.
What happens if PSA is raised?
Repeat PSA, examination, referral to urology — multiparametric MRI (mpMRI) prostate — PI-RADS scoring — targeted biopsy if suspicious. Transperineal biopsy now common — reduced infection risk vs transrectal.
How is prostate cancer treated?
Depends on risk group — active surveillance (monitor low risk), radical prostatectomy (surgery), external beam radiotherapy, brachytherapy (seed implant), hormone therapy (androgen deprivation) for advanced or high-risk, chemotherapy or newer agents for metastatic disease. Side effects include urinary incontinence and erectile dysfunction — discuss upfront.
Is prostate cancer curable?
Localised disease — high cure rates with surgery or radiotherapy. Metastatic disease — not usually curable but controllable for years with hormone therapy and newer drugs (abiraterone, enzalutamide). Many men die with prostate cancer not from it — especially low-grade disease.
What is the difference between prostate cancer and enlarged prostate?
BPH (benign prostatic hyperplasia) — urinary symptoms from non-cancerous growth — extremely common. Prostate cancer arises from glandular cells — may coexist — PSA and examination cannot fully distinguish — MRI and biopsy required if cancer suspected.

Sources

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