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Frequently asked questions about prostate cancer

Questions about  

Our Specialist Nurses receive thousands of emails and phone calls each year from men, their families and friends and health professionals asking for information about prostate cancer. Below we give answers to some of the most common questions we receive, including questions about prostate screening, prostate cancer risk factors, and having a prostate mpMRI scan.

If you would like to speak to our Specialist Nurses, in confidence, call 0800 074 8383 or fill in our email contact form.

Please note responses are based on UK practice. We hope this information will add to the medical advice you have had. Please do continue to talk to your doctor if you are worried about any medical issues.

Prostate problems

  • What does 'benign prostatic enlargement' mean?  

    Benign prostatic enlargement (BPE) is the medical term for an enlarged prostate. It means an increase in the size of the prostate that isn't caused by cancer.

    You might also hear it called benign prostatic hyperplasia (BPH). Hyperplasia means an increase in the number of cells. It is this increase in cells that causes the prostate to grow.

    An enlarged prostate is very common in men over the age of about 50. It is the most common cause of urinary symptoms in men as they get older. Possible symptoms include:

    • a weak flow when you urinate (pee)
    • a feeling that your bladder hasn't emptied properly
    • difficulty starting to urinate
    • dribbling urine after you finish urinating
    • needing to urinate more often, especially at night
    • a sudden urge to urinate – you may sometimes leak before you get to the toilet.

    Having an enlarged prostate is not the same as having cancer. Read more about the symptoms, diagnosis and treatment of an enlarged prostate.

    Last updated August 2015
    To be reviewed August 2017

Risk factors

  • Am I more likely to get prostate cancer if my father had it?  

    Inside every cell of our body is a set of instructions called genes. These are inherited from our parents. Genes control how the body grows, works and what it looks like. If something goes wrong with one or more genes (known as a fault or mutation) it can sometimes cause cancer.

    • You are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer.
    • Your chance of getting prostate cancer may be even greater if your father or brother was under 60 when he was diagnosed, or if you have more than one close relative with prostate cancer.

    Last updated January 2015
    To be reviewed January 2017

  • Is it true that black men are more likely to get prostate cancer?  

    Black men are more likely to get prostate cancer than other men. We don’t know why, but it might be linked to genes. In the UK, about 1 in 4 black men will get prostate cancer at some point in their lives.

    Read more about the risk in black men or download our leaflet, What do you know about your prostate? Information for Black men.

    Last updated March 2015
    To be reviewed March 2017

  • Does masturbating increase my risk of prostate cancer?  

    Some research suggests that masturbation and sexual activity probably don't increase your risk of prostate cancer, and might even lower it. But we don't know for certain how masturbation affects your risk because there isn't much research in this area. It is a normal, healthy and enjoyable activity for many men. Read more about who is at risk.

    Last updated December 2013
    To be reviewed December 2015

  • Does drinking alcohol increase my risk of getting prostate cancer?  

    We don't know if alcohol has any specific effect on your risk of getting prostate cancer. But we do know that drinking too much alcohol can make you put on weight. Being overweight increases your risk of advanced or aggressive prostate cancer. Being overweight also increases your risk of other health problems such as heart disease and some other cancers.

    The UK Government recommends drinking no more than 14 units of alcohol a week. It's best to spread your drinks out over the week but keep at least a few days alcohol-free every week.

    How many units are in a drink?

    • A pint of lager, beer or cider contains 2.8 units.
    • A 175ml glass of wine contains 2.1 units.
    • A 25ml measure of 40 per cent single spirit with mixer contains 1 unit.

    If you're having treatment for prostate cancer, your doctor or nurse can tell you whether alcohol may affect your treatment. If you have urinary problems after treatment, try to cut down on alcohol as it can irritate the bladder and make these problems worse. You can find out more about managing how much you drink from NHS Choices.

    Last updated January 2016
    To be reviewed January 2018

  • Is there anything I can do to prevent getting prostate cancer?  

    We don't know how to prevent prostate cancer for certain, but a healthy diet and lifestyle may be important. Eating healthily and being active can help you stay a healthy weight. This may mean that you're less likely to be diagnosed with aggressive or advanced prostate cancer. A healthy lifestyle can also improve your general wellbeing and reduce your risk of other health problems such as type 2 diabetes, heart disease and some other cancers.

    Read our pages on diet and your risk of prostate cancer for more information.

    Last updated January 2016
    To be reviewed January 2018

  • Does red wine help to prevent prostate cancer?  

    Red wine contains natural compounds called antioxidants that may help prevent damage to cells. Antioxidants are found in the skin and seeds of grapes as well as other fruits and vegetables. Red wine contains more antioxidants than white wine because it is made with grape skin, but white wine is not.

    In 2005, one small study found that red wine may help to lower a man's risk of prostate cancer. However, since then larger studies have not found this to be true. This means there is not enough evidence to say that red wine helps to prevent prostate cancer.

    Drinking a lot of alcohol might actually increase your risk of prostate cancer (see above).

    Drinking alcohol also increases your risk of some other cancers and health problems such as high blood pressure and stroke. If you do drink alcohol, you should aim to stay within the recommended limits. Find out more at NHS Choices. 

    If you would like to know more about how diet may affect your risk of prostate cancer, read our pages about healthy living.

    Last updated January 2016
    To be reviewed January 2018

  • Do vitamin E and selenium protect against prostate cancer?  

    Vitamin E

    Previous research suggested that vitamin E supplements might help prevent prostate cancer and help protect against advanced cancer.

    The latest research suggests that not having enough vitamin E might increase your risk of prostate cancer, but that taking vitamin E supplements might be harmful. The best way to get enough vitamin E is through a balanced diet, without taking supplements.

    Vegetable oils, nuts, seeds and green leafy vegetables are all rich in vitamin E.

    Selenium

    Some research suggests that not having enough selenium in your body might increase your risk of prostate cancer. Taking selenium supplements doesn't appear to protect against prostate cancer, but you can get enough selenium from your diet.

    Brazil nuts, fish, seafood, liver and kidney are all good sources of selenium.

    Visit our pages on diet and prostate cancer for more information on improving your diet.

    Last updated January 2016
    To be reviewed January 2018

Diagnosis

  • Why is there no screening programme for prostate cancer?  

    Screening programmes aim to spot the early signs of cancers in people who do not have any symptoms. By finding cancer early, it could be treated in time to cure it. In the UK there are screening programmes for breast, cervical and bowel cancer.

    There is currently no screening programme for prostate cancer. One reason for this is that the PSA test isn’t good enough at finding prostate cancer to be used as part of a screening programme – read about the disadvantages of the test.

    It’s important that the benefits of a screening programme outweigh any disadvantages. But it’s not clear that screening with the PSA test would have more benefits than disadvantages.

    Some studies have found that screening with the PSA test could mean fewer men die from prostate cancer. But it would also mean that a large number of men would be diagnosed with a slow-growing cancer that wouldn’t have caused any symptoms or shortened their life. And a large number of these men would have treatment they didn’t need which could cause side effects. Other studies have found that screening doesn’t reduce the number of deaths from prostate cancer.

    Although there's no screening programme for prostate cancer, many men who are worried about it want a PSA test. So the Prostate Cancer Risk Management Programme was set up. This programme gives men over 50 who want a PSA test the right to have one on the NHS - as long as they have talked through the pros and cons with their GP.

    Last updated August 2014
    To be reviewed August 2016

  • My GP won’t give me a PSA test, what should I do?  

    If you’re over 50, you should be able to have a PSA test – as long as you’ve talked through the pros and cons with your GP or practice nurse. But we know that some men have trouble getting the test.

    Your GP might have a good reason for not recommending the PSA test. For example, you may have other serious health problems that would cause you more problems than prostate cancer would.

    If your GP or practice nurse won’t give you a PSA test but you still want to have one, read our information about what to do next. You can also speak to our Specialist Nurses.

    What if I'm under 50?

    Prostate cancer isn't common in men under 50. If you’re under 50 and don’t have any symptoms, your GP doesn’t have to give you a PSA test. But you may still want to talk to your GP about having a test if you’re over 45 and you’re at higher risk – for example if you have a family history of prostate cancer or you’re Black.

    We’ve been working with health professionals across the UK to develop agreement about when men should be able to have a PSA test, if they want one. Read more about this work.

    Last updated March 2016
    To be updated March 2018

  • What is a baseline PSA test?  

    This involves having a single PSA (prostate specific antigen) blood test while your risk of getting prostate cancer is still low – for example in your 40s. The aim of a baseline test is not to help diagnose prostate cancer, but to help work out your risk of getting prostate cancer in the future.

    There is some research suggesting that your PSA level in your 40s could be used to predict how likely you are to get prostate cancer, or fast-growing (aggressive) prostate cancer, later in life. If the test suggests you’re at higher risk, you and your doctor may decide to do regular PSA tests in the future. This might be a good way to spot any changes in your PSA level that might suggest prostate cancer.

    However, we don’t yet know exactly what PSA level in your 40s would show an increased risk of prostate cancer, or how often you should have more tests. Because of this, baseline testing isn’t very common in the UK.

    For more information about baseline testing, speak to your GP.

    Last updated March 2016
    To be updated March 2018

  • What is a multi-parametric MRI (mpMRI) scan?  

    A multi-parametric magnetic resonance imaging (mpMRI) scan is a special type of scan that creates more detailed pictures of your prostate than a standard MRI scan. It does this by combining up to four different types of image. These images give your doctor information about whether or not there is any cancer inside your prostate, and how quickly any cancer is likely to grow.

    If you’ve just been diagnosed with prostate cancer, you may have a standard MRI scan to find out if the cancer has spread outside your prostate. This helps your doctor to work out the most suitable treatment options for you.

    But research has now shown that it may be more useful to do an mpMRI scan than a standard scan, and to do it at an earlier stage – before you have a prostate biopsy.

    There are two main ways that an mpMRI scan may be useful before a biopsy.

    • It can help your doctor decide if you need a prostate biopsy.
    • If you do need a biopsy, it should be possible to use the scans to make the biopsy more accurate.

    Helping to decide if you need a biopsy

    A large new study has shown that an mpMRI scan can accurately show whether there is anything unusual in the prostate, or the area around it, that might be cancer. If there’s anything unusual on the scan, you’ll be offered a prostate biopsy to find out whether you have cancer.

    Importantly, an mpMRI scan is less likely than a biopsy to pick up a slow-growing or non-aggressive cancer that probably wouldn’t cause any symptoms or problems in your lifetime. It usually only picks up areas of faster-growing cancer that do need treating. If you have a slow-growing cancer, it’s less likely to show up on the scan. So if your scan is clear, you’re unlikely to have prostate cancer that needs to be treated, and your doctor might decide that you don’t need to have a biopsy. This means you’d avoid the possible side effects of a biopsy. And you’d avoid being diagnosed with a slow-growing cancer and possibly having treatment that you didn’t need.

    Making prostate biopsies more accurate

    An mpMRI scan may still be useful, even if you do need to have a biopsy. This is because the doctor may be able to use the scans to decide which areas of the prostate to take samples from. This is known as a targeted biopsy.

    If you haven’t had an mpMRI scan, the doctor will usually use a thin needle to take 10 to 12 small pieces of tissue from different areas of the prostate. But if you’ve had an mpMRI scan, they may just put the biopsy needle into the areas of the prostate that look unusual on the scan. This means they’re more likely to find the cancer, if there is any. It also means they may be able to use fewer needles and take fewer pieces of tissue from the prostate.

    Some doctors might decide to do both a targeted biopsy and the usual 10 to 12 sample biopsy. Your doctor will discuss this with you.

    Other possible benefits

    Another possible advantage of having an mpMRI scan before a biopsy is that, if the biopsy finds cancer, you probably won’t need another MRI scan to find out if your cancer has spread. Your doctor can probably look at your previous scan results to find this out. This means you and your doctor can start discussing suitable treatment options as soon as you get your biopsy results.

    Doing an MRI scan before your biopsy, rather than after, means the images are clearer and your doctor will have a better idea about whether or not your cancer has spread. This is because biopsies cause bleeding and swelling in the prostate that can make the MRI less clear. If you haven’t already had an MRI scan, you’ll usually have to wait four to six weeks after your biopsy before having one. Some men feel anxious waiting for a scan to find out if their cancer has spread.

    Will I have an mpMRI scan before a biopsy?

    Research showing the benefits of doing an mpMRI scan before a biopsy has only recently been published (January 2017). Some hospitals have already started doing an mpMRI scan before deciding whether to do a biopsy. But mpMRI scans before biopsy aren’t available in all hospitals. If you’re having tests for prostate cancer, ask your doctor about having an mpMRI scan. If your hospital doesn’t do mpMRI scans before biopsy, your doctor may be able to refer you to one that does.

    If none of the hospitals in your local area do mpMRI scans before biopsy, and your doctor recommends having a prostate biopsy, this can still help to find prostate cancer. Read more about having a prostate biopsy.

    Last updated: December 2016
    To be reviewed: December 2018

  • What does 'Gleason score or 'grade group' mean?  

    Your biopsy results will show how aggressive the cancer is – in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.

    Gleason grade

    When cells are seen under the microscope, they have different patterns, depending on how quickly they’re likely to grow. The pattern is given a grade from 1 to 5 – this is called the Gleason grade. Grades 1 and 2 are not cancer, and grades 3, 4 and 5 are cancer. If you have cancer, the higher the grade, the more likely the cancer is to spread outside the prostate.

    Gleason score

    There may be more than one grade of cancer in the biopsy samples. An overall Gleason score is worked out by adding together two Gleason grades.

    The first is the most common grade in all the samples. The second is the highest grade of what’s left. Whenthese two grades are added together, the total is called the Gleason score.

    Gleason score = the most common grade + the highest other grade in the samples

    For example, if the biopsy samples show that:

    • most of the cancer seen is grade 3, and
    • the highest grade of any other cancer seen is grade 4, then
    • the Gleason score will be 7 (3+4).

    If you have prostate cancer, your Gleason score will be between 6 (3+3) and 10 (5+5).

    Grade group

    Your doctor might also talk about your "grade group". This is a new system for showing how aggressive your prostate cancer is likely to be. Your grade group will be a number between 1 and 5 (see table).

    What does the Gleason score or grade group mean?

    The higher your Gleason score or grade group, the more aggressive the cancer and the more likely it is to grow and spread outside the prostate. Read more about different Gleason scores and what they mean.

    Last updated July 2016
    To be updated July 2018

  • What is the 'stage' of my cancer and what does this mean?  

    TNM staging

    Your doctor will use your scan results to work out the stage of your cancer – in other words, how far it has spread. This is usually recorded using the TNM (Tumour-Nodes-Metastases) system.

    • The T stage shows how far the cancer has spread in and around the prostate.
    • The N stage shows whether the cancer has spread to the lymph nodes.
    • The M stage shows whether the cancer has spread (metastasised) to other parts of the body.

    Read more about TNM staging.

    Localised, locally advanced, and advanced prostate cancer

    Your TNM stage is used to work out if your cancer is localised, locally advanced or advanced.

    Depending on the results, your cancer may be treated as:

    Last updated July 2016
    To be updated July 2018

  • Where can prostate cancer spread to?  

    If prostate cancer spreads outside the prostate, it can spread to the area just outside the prostate (locally advanced prostate cancer) or to other parts of the body (advanced prostate cancer).

    Locally advanced prostate cancer

    Locally advanced prostate cancer is cancer that has started to break out of the prostate, or has spread to the area just outside the prostate. It may have spread to your:

    • prostate capsule, which is the outer layer of the prostate
    • seminal vesicles, which are two glands that sit behind your prostate and store some of the fluid in semen (the fluid that carries sperm)
    • pelvic lymph nodes, which are part of your immune system and are found near your prostate
    • bladder, which is the part of the body where urine (pee) is stored
    • back passage (rectum).

    Read more about locally advanced prostate cancer.

    Advanced prostate cancer

    This is cancer that has spread from the prostate to other parts of the body. It develops when tiny prostate cancer cells move from the prostate to other parts of the body through the blood stream or lymphatic system.

    Prostate cancer can spread to any part of the body, but most commonly to the bones. Another common place for prostate cancer to spread to is the lymph nodes (sometimes called lymph glands). Lymph nodes are part of your lymphatic system. They are found throughout your body and some of the lymph nodes are in the pelvic area, near the prostate.

    Read more about advanced prostate cancer.

    Staging

    Staging is a way of recording how far the cancer has spread. The most common method is the TNM (Tumour-Nodes-Metastases) system. The T stage shows how far the cancer has spread in and around the prostate. The N stage shows whether the cancer has spread to the lymph nodes. The M stage shows whether the cancer has spread (metastasised) to other parts of the body. Read more about TNM staging.

    Last updated September 2016
    To be reviewed September 2018

  • What is the PCA3 test?  

    This is a urine test measures the activity of a gene called PCA3, which is unusually active in prostate cancer cells.

    Your doctor or nurse will use a finger to massage your prostate through the wall of the back passage. They will then ask you to give a urine sample. Cells from the prostate pass into the urine where they can be looked at with a special test that looks at your genes.

    This test might be useful for monitoring men who’ve already had a biopsy, or it might help specialists decide which men should have a biopsy.

    At the moment the PCA3 test is only available in a few private hospitals and clinics, as we still need more research about how well it works.  Read more about the tests to diagnose prostate cancer.

    Last updated July 2016
    To be reviewed July 2018

  • What is a multi-disciplinary team (MDT)?  

    This is the team of health professionals involved in your care. The team may include:

    • A urologist: A doctor who specialises in conditions affecting the urinary and reproductive systems, including prostate cancer. Urologists are surgeons and carry out prostate surgery.
    • An oncologist: A doctor who specialises in cancer treatments other than surgery, such as radiotherapy or chemotherapy.
    • A radiologist: A doctor who specialises in diagnosing medical conditions using X-rays and scans. 
    • A pathologist: A doctor who specialises in studying cells and tissues under a microscope to identify diseases. A pathologist examines prostate biopsy samples to see if there is any cancer in your prostate. 
    • Clinical Nurse Specialist: A nurse who specialises in a particular medical condition or group of conditions.
    • Key worker: This is your main point of contact. This is usually your clinical nurse specialist but might be someone else. They help to coordinate your care and can guide you to the right team member or sources of information.

    Last updated January 2015
    To be reviewed January 2017

Treatments

  • How will I know if my cancer is spreading if I am on active surveillance?  

    Active surveillance involves monitoring your prostate cancer with regular tests, rather than treating it straight away. This means you can avoid unnecessary treatment, or delay treatment and the possible side effects.

    The tests aim to find any changes that suggest the cancer is growing. The tests used vary from hospital to hospital, but you may have the following:

    Repeat biopsies aren't done by every hospital – some will only do them if an MRI scan suggests the cancer is growing.

    If the results of the tests show your cancer has grown, you’ll be offered treatment which aims to cure the cancer – for example, surgery or radiotherapy.

    Last updated June 2014
    To be reviewed June 2016

  • How can I find out if my consultant is a good surgeon?  

    Research suggests that surgeons who perform a lot of prostatectomies each year get better results and fewer side effects. Your surgeon should be able to tell you how many operations they have done, as well as the results of these operations and the rates of side effects.

    You can look at information on surgeons and centres that do radical prostatectomies online. This includes the number of operations they’ve done, and whether they were open, keyhole or robot-assisted. It also includes rates of complications (such as the risks of surgery above) but not side effects.

    It’s important to remember that some surgeons operate on ‘higher risk’ patients who could be more likely to have complications (for example, if they are overweight) or do more difficult operations, which can affect their results. You can see the information at www.baus.org.uk

    Last updated May 2017
    To be reviewed May 2019

  • Is robot-assisted surgery better than keyhole surgery by hand?  

    There are several ways of removing the prostate:

    •    open surgery
    •    keyhole surgery by hand
    •    robot-assisted keyhole surgery.


    Although robot-assisted keyhole surgery is the newest way of doing surgery, the most recent research suggests all three techniques are as good as each other for treating prostate cancer. They also have similar rates of side effects such as urinary problems and problems getting an erection.


    The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.


    Robot-assisted surgery is not available in all hospitals in the UK because it uses specialist equipment that isn’t available everywhere. The type of operation you have will depend on lots of things, including what’s available at your hospital or where you are prepared to travel to, and what your surgeon recommends.


    Last updated May 2017
    To be reviewed May 2019

  • Should I have surgery or radiotherapy?  

    If you have cancer that contained inside the prostate, you may be offered:

    • Surgery: This involves having an operation to remove the prostate and the cancer inside it. The seminal vesicles are also removed.
    • External beam radiotherapy: This uses high energy X-ray beams directed at the prostate from outside the body to kill cancer cells.
    • Brachytherapy: A type of internal radiotherapy. It involves putting a source of radiation directly inside the prostate.

    There may be more than one treatment that is suitable for you. Your choice of treatment will depend on several things, including:

    • How far the cancer has spread and how quickly it may be growing.
    • Your age and general health.
    • What the treatment involves and the possible side effects.
    • How you feel about different treatments – some men prefer to have their prostate removed others may not.
    • How the treatment you choose will affect any future treatment options if the cancer comes back or spreads – for example, you may not be able to have surgery if you’ve already had radiotherapy.

    There’s no overall best treatment, and each one has its own pros and cons. All treatments have side effects, such as leaking urine and erection problems. Treatments will affect each man differently, and you might not get all the possible side effects. But it’s important to think about how you would cope with them when choosing a treatment.

    Your doctor or nurse will explain all your treatment options, and help you to choose the right treatment for you. You can also speak to our Specialist Nurses.

    Last updated September 2014
    To be reviewed November 2016

  • How do oestrogens treat prostate cancer?  

    Oestrogens are a type of hormone therapy that can be used to treat prostate cancer that is no longer responding to other types of hormone therapy. Oestrogen is a hormone found in both men and women, but women usually produce more.

    Oestrogens are used less often than other treatments. They can be given as a tablet called diethylstilbestrol (Stilboestrol®). They can also be given through a patch that sticks to your skin like a plaster.

    Like all treatments, oestrogens can cause side effects. These can be similar to the side effects of other types of hormone therapy, and can include breast swelling and tenderness. A low dose of radiotherapy to the breast area can prevent this. Read more about this and other side effects in our booklet, Living with hormone therapy: A guide for men with prostate cancer.

    Diethylstilbestrol can also increase your risk of circulation problems, such as blood clots. You will usually take drugs such as aspirin or warfarin to make this less likely. You may not be able to take diethylstilbestrol if you have a history of high blood pressure, heart disease or strokes. Your doctor or nurse will discuss this with you.

    Last updated June 2015
    To be reviewed June 2017

  • Will I have to have chemotherapy?  

    You will only be offered chemotherapy if your cancer has spread out of the prostate to other parts of the body (advanced or metastatic prostate cancer).

    Chemotherapy does not get rid of prostate cancer, but aims to shrink it and slow down its growth. This helps some men to live longer, and can help to control or delay symptoms such as pain.

    Chemotherapy isn't used to treat prostate cancer that is contained within the prostate (early or localised prostate cancer) because there are other treatments that are more effective, such as surgery and radiotherapy.

    If you would like to know more about treating prostate cancer with chemotherapy, read our page about chemotherapy. Or, if you are unsure about the stage of your cancer and your treatment options, read our treatment pages.

    Last updated January 2016
    To be reviewed January 2018

Side effects

  • Can I have side effects from radiotherapy several years after treatment?  

    Like all treatments, radiotherapy can cause side effects.

    Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy. Most healthy cells recover, so side effects may only last a few weeks or months. But some side effects can start much later – several months, or even years after finishing treatment. If this happens, these side effects can last a long time.

    These side effects might be similar to problems you had during treatment, such as urinary problems or bowel problems. They may also include problems getting or keeping an erection.

    Talk to your doctor or nurse about your own risk of late side effects. You might be more likely to get them if:

    • you’re older
    • you have diabetes
    • you’ve had bowel or prostate surgery in the past
    • you’ve had bladder, bowel or erection problems in the past.

    Last updated: June 2016
    To be reviewed: June 2018

  • When will I stop leaking urine after surgery?  

    Surgery to remove the prostate can damage the muscles and nerves that control when you urinate. These include the pelvic floor muscles, which stretch below the bladder and help support it. This can cause you to leak urine.

    You might just leak a few drops if you exercise, cough or sneeze (stress incontinence). Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.

    Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. But some men leak urine for a year or more and others never fully recover. This can be hard to deal with, but there are things that can help, and things you can do yourself.

    There are treatments available that can help manage urinary problems, as well as things that you can do yourself. Your doctor or nurse may suggest you do pelvic floor muscle exercises for a few weeks before the operation. These might help you recover more quickly from any urinary problems after surgery.

    Last updated May 2017
    To be reviewed May 2019

  • How can I manage incontinence when travelling abroad?  

    Incontinence after prostate cancer treatment could affect your travel plans. This should not stop you from travelling but it might affect where you go and what sort of things you do while you're away. Here are some tips for planning your trip.

    If you have urinary problems and use pads, make sure you pack enough for your trip and a few extra in case of delays.

    •  Pack extra pads and medicine in your hand luggage in case your suitcase gets lost.

    If you use a catheter:

    • take a spare catheter with you
    • take plenty of extra drainage bags and catheter valves
    • speak to your specialist nurse about caring for your catheter while you are away
    • ask your doctor for a letter that explains what your equipment is for. This is called a medical validation certificate and it might make things easier if customs officials decide to search your bag.

    Tell your travel company about any special needs you have. They may be able to help or give you a seat close to the toilet.

    If you're visiting an English speaking country, use our toilet card to help you access a toilet quickly if you have urinary problems.

    Find out how you can have your clothes washed if needed at your destination.

    If you are worried about leaking during the night, ask your hotel or accommodation if they can provide a protective sheet for the bed.

    Drink a little less while you are on holiday but take care to stay hydrated, especially if it is hot weather. Read more about travelling with prostate cancer.

    Last updated June 2015
    To be reviewed June 2017

  • Is there anything I can do before and after surgery to help keep my erections?  

    If you have surgery to remove the prostate there is a risk that you will have problems getting an erection afterwards, but there are things that can help.

    There are two bundles of nerves attached to the prostate that help you get erections. If you have surgery these nerves may need to be removed or they could be affected. This often causes problems getting or keeping an erection after surgery (erectile dysfunction).

    Your surgeon will try to save these nerves if it’s possible. This is called nerve-sparing surgery. Speak to your surgeon about this before the operation.

    There are treatments available to help with erection problems. These include

    •    tablets called PDE5 inhibitors (brand names: Viagra®, Cialis®, Levitra® or Spedra®)
    •    vacuum pumps
    •    injections
    •    pellets or cream
    •    implants.

    Your doctor may suggest starting treatment for erection problems before surgery or in the first few weeks afterwards, even if you aren’t ready to have sex yet. Starting treatment soon after surgery may improve your chances of getting erections later on. This is known as penile rehabilitation. If you had nerve-sparing surgery this may include tablets, and if you didn’t it may involve a vacuum pump.

    Even with nerve-sparing surgery it can take anything from a few months to three years for erections to return and they may not be as strong as before. Some men will always need medical help to get erections, and some men might not be able to get erections even with medical help.

    How likely you are to have erection problems will depend on several things, such as:

    • your age and weight
    • the strength of your erections before surgery
    • other health problems such as high blood pressure or diabetes
    • any medicines you take
    • whether you smoke.

    Last updated May 2017
    To be reviewed May 2019

  • How can I get an erection after treatment?  

    Some treatments for prostate cancer can damage the nerves and blood vessels that are needed for an erection. Treatments that can have this effect include surgery, radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) and cryotherapy.

    All types of hormone therapy can cause erection problems because it reduces your desire for sex (libido).

    Many of the treatments for erection problems work by improving the flow of blood to the penis. Treatments include:

    • tablets
    • injections, pellets or cream
    • vacuum pump
    • implant
    • testosterone therapy.

    Because getting an erection also relies on your thoughts and feelings, tackling any worries or relationship issues as well as having medical treatment for erection problems often works well. There are lots of ways to do this, so pick what works best for you. It may be talking to someone close to you, speaking to your nurse or getting some counselling or sex therapy.

    Read our information about sex and prostate cancer to find out more about treatments for erection problems.

    Last updated January 2015
    To be reviewed January 2017

  • Does stopping hormone therapy from time to time help to reduce the side effects?  

    Stopping hormone therapy from time to time is called intermittent hormone therapy. You might be able to stop treatment when your PSA level is low and steady, and start it again when your PSA starts to rise. This may help to give you a break from side effects while you're not having treatment, but it can take several months before you may notice an improvement.

    For some men, intermittent hormone therapy can be just as effective at treating prostate cancer as continuous treatment. But it isn't suitable for everyone. And it isn't an option if you decide to have surgery to remove your testicles (orchidectomy).

    There is a chance that having a break from treatment may mean your cancer might grow. Speak to your doctor or nurse about the advantages and disadvantages of intermittent hormone therapy and whether it might be an option for you.

    You can have intermittent hormone therapy for as long as it continues to work. Your doctor or nurse will tell you when you need to start treatment again.

    Last updated September 2015
    To be reviewed September 2017

  • Why do I feel so low now that I'm having hormone therapy?  

    Hormone therapy itself can affect your mood. You may find that you feel more emotional than usual or just 'different' to how you felt before. Some men find that they cry a lot. Others get mood swings, such as getting tearful and then angry. Just knowing that these feelings are caused by hormone therapy can help.

    Some of the other side effects of hormone therapy can be hard to come to terms with. Physical changes, such as putting on weight, or changes to your sex life might make you feel different about yourself. Or you might be too tired to do some of the things you used to enjoy.

    Some men experience low moods, anxiety or depression. This could be a direct effect of hormone therapy, a response to being diagnosed with prostate cancer, or the impact of cancer and its treatment on your life.

    If your mood is often very low, you are losing interest in things, or your sleep pattern or appetite has changed a lot, speak to your GP or doctor or nurse at the hospital. These can be signs of depression and there are treatments available for this.

    You may find it helps to talk to your family or friends. Or you could speak in confidence to our Specialist Nurses, or your GP, doctor or nurse. It might also help to talk to someone who’s been there. We have volunteers on our One-to-one support service who have had hormone therapy and can understand what you’re going through.

    There are also support groups across the country where you and your family can meet others affected by prostate cancer. Or you could join our online community where you can talk to other men with prostate cancer and their families.

    If you need to speak to someone immediately, you could call the Samaritans on 08457 90 90 90.

    Read more about the side effects of hormone therapy and how it affects your mood.

    Last updated September 2015
    To be reviewed September 2017

  • How can I manage hot flushes?  

    Hot flushes are a common side effect of hormone therapy. They can affect men on LHRH agonists, GnRH antagonists or anti-androgens. They are similar to the hot flushes women get when they're going through the menopause.

    Hot flushes can vary from a few seconds of feeling overheated to a few hours of sweating.

    If hot flushes disrupt your everyday life, there are a number of things you can do to help manage them. These include lifestyle changes, medicines and complementary therapies. Read more about managing hot flushes in our booklet, Living with hormone therapy: A guide for men with prostate cancer.

    Last updated September 2015
    To be reviewed September 2017

  • What causes lymphoedema and how can I stop the swelling?  

    If the cancer spreads to the lymph nodes it could lead to a condition called lymphoedema – caused by a blockage in the lymphatic system. The lymphatic system is part of your body’s immune system, carrying fluid called lymph, around your body.  If it is blocked, the fluid can build up and cause swelling (lymphoedema). Cancer itself can cause the blockage, but so can some treatments such as surgery or radiotherapy.

    Lymphoedema in prostate cancer usually affects the legs, but it can affect other areas, including the penis or scrotum (which contains the testicles).

    Symptoms in the affected area can include swelling, pain, discomfort or heaviness.

    Lymphoedema can affect your daily life. You might find that you are less able to move around and it’s harder to carry out everyday tasks.

    What can help?
    Speak to your nurse or GP if you have any symptoms. Treatments can help reduce or stop the swelling and make you more comfortable and are most effective if started early. You may be referred to a specialist lymphoedema nurse.

    There are a variety of treatments which might help such as having a special massage, or wearing compression bandages or stockings to help encourage the fluid to drain from the affected area.

    Read more about lymphoedema and ways to manage it in our booklet, Advanced prostate cancer: Managing symptoms and getting support.

    Last updated February 2015
    To be reviewed February 2017