Everything you wanted to know about prostate cancer (and weren't afraid to ask)

After last week's deluge of press coverage following our discovery that prostate cancer has overtaken breast cancer as the third biggest cancer killer in the UK, our Specialist Nurses were understandably inundated with calls from concerned men and their families and friends.

We filmed a special Facebook Live Q&A on Friday, which tackled some of the immediate issues raised.

But we thought we'd put together the most commonly asked questions our Specialist Nurses answered from last year, after receiving more than 12,000 phone calls, emails, Live Chat requests and social media queries.

They're divided up into the top three reasons people got in touch: diagnostic investigations (tests that look into whether a man has prostate cancer), treatment options for prostate cancer and signs and symptoms that may indicate a problem with the prostate.

Diagnostic investigations

How do I get a PSA test?
All men over the age of 50 are entitled to ask their GP for a PSA test (a test that measures the amount of prostate specific antigen in the blood and can indicate a prostate problem). This is because prostate cancer mainly affects men over the age of 50 and your risk increases with age. As there are benefits and limitations to the PSA test, it’s important to have a conversation with your GP to help you decide if it’s right for you. If you’re at an increased risk of prostate cancer due to a family history of the disease and/or of black ethnicity, you might want to discuss the PSA test with your GP from the age of 45.
 
Does a raised PSA level mean I have prostate cancer?
Not necessarily. While a raised PSA may mean you have prostate cancer, there are other conditions that can cause higher PSA levels too – for example, having an enlarged prostate, prostatitis or a urine infection may cause a higher PSA result.

Why isn’t there a national screening programme for prostate cancer in the United Kingdom?
The PSA test simply isn’t accurate enough to be used as a screening tool for prostate cancer. We're currently working on a new risk assessment tool for GPs, which combined with better blood tests in development and more advanced scanning, could potentially become the basis for a national screening programme in the next five years. But because there’s currently no single test or investigation that’s rigorous enough to be able to accurately detect prostate cancer, there’s presently no national screening programme for the disease in the United Kingdom.

Can the doctor tell if I have cancer from doing a digital rectal examination (DRE)?
The doctor feels the prostate for any lumps, enlargement, irregularity or hardening of the prostate. If the doctor can feel anything abnormal, this may indicate prostate cancer but further investigations are likely to be necessary.

Will having a prostate biopsy spread any cancer that’s there?
Evidence suggests the risk of this is small, with less than one per cent of prostate cancer being spread after a biopsy. Not having a biopsy for suspected prostate cancer wouldn’t be recommended, as the benefits of accurately diagnosing and managing the cancer tend to outweigh any potential risks of spreading it.

If I ask my consultant for a multiparametric magnetic resonance imaging (mpMRI) scan, do I still need to have a biopsy?
By combining up to three different types of scan, an mpMRI scan can give a clearer picture of what’s going on in the prostate compared to a normal MRI scan. Although an mpMRI can indicate areas of abnormality and suspicion, a targeted biopsy would still be needed to get the most accurate diagnosis.

Treatment options

I’ve been asked to choose between different prostate cancer treatments. How do I know which one is best for me?
You might be given a choice of treatments – for example, surgery or radiotherapy. This will depend on your stage of cancer. There isn’t a right or wrong decision as one isn’t better than another. Things, such as side effects, impact on your daily life and secondary treatment options may all play a part. We can’t tell you what to do, but we can go through information about treatments to empower you to make the decision that’s right for you. We can also connect you with trained volunteers who have had different treatments via our One-to-one support service to hear about their experiences.

Which treatments have the least side effects?
All treatments come with side effects, but some are more likely to cause certain side effects than others. We can talk these through with you in detail to help you understand what to expect and how best to deal with potential side effects. We also have dedicated services that can help you better manage some side effects, such as our nurse-led Fatigue support service.

The consultant has said my cancer is slow growing - is active surveillance a good choice for me?
Active surveillance can be a suitable option for men with early stage, low-risk, and in some cases, medium-risk prostate cancer. It involves close monitoring of your prostate cancer with the aim of stepping in with early curative treatment if there is evidence of disease progression. Your doctor will look at your test results to decide if active surveillance is an option for you. We can discuss the pros and cons of active surveillance with you too, as well as arming you with questions to ask your doctor.

Signs and symptoms

I’m getting up through the night to go to the loo. Do I have prostate cancer?
While urinary symptoms (such as passing urine more often, difficulty starting the flow of urine, a weaker flow or feeling you haven’t fully emptied your bladder) may be a sign of a prostate problem, they can also be caused by issues that aren’t related, such as other medical conditions, certain types of medication and lifestyle influences. It’s always best to see your GP if you notice any changes to your waterworks.

I read that if a man has early prostate cancer, he often doesn’t have any symptoms. So how would I know if I had it or not?
Early prostate cancer often doesn’t cause symptoms so this can’t be relied upon. If you have factors that may increase your risk of prostate cancer – such as your age, ethnicity or a family history – or you’ are worried about prostate problems, make an appointment with your GP. The GP can then talk to you about the tests they may do to find out if you have a prostate problem.

How would I know if I had advanced prostate cancer?
Advanced prostate cancer is cancer that’s spread from the prostate to other parts of the body. New pain in your back, hips or pelvis may be a sign of a more advanced prostate cancer, but this can also be caused by things such as general aches and pains or other medical conditions. It’s always a good idea to get things checked out by your GP if you’re worried.                                  

These topics are just the tip of the iceberg when it comes to how the Specialist Nurses can support you. Whether you’re worried about, diagnosed with or facing life after prostate cancer or prostate problems, they're here for you. There’s no such thing as a silly question, and with over 200 years of nursing experience between them, you’ll always be speaking to an expert.

Get in touch, free, on 0800 074 8383 (9am-6pm Monday-Friday, 10am-8pm Wednesday), chat with us online or send us an email.