Frequently asked questions about prostate cancer

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.

You may not get all these symptoms, and some men with an enlarged prostate don’t get any symptoms at all. These symptoms can be caused by other things, such as cold weather, anxiety, other health problems, lifestyle factors, and some medicine.

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 January 2018
To be reviewed January 2020

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 January 2018
To be reviewed January 2020

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

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

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 in most hospitals, you will now have an MRI scan at an earlier stage.

There are two main ways that an mpMRI scan may be useful before having a prostate 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

Research 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 was published in January 2017. mpMRI scans before biopsy are now available in most UK 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: January 2019
To be reviewed: January 2021

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 prostate 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 aren't included on pathology reports as they are similar to normal cells. If you have prostate cancer, you will have Gleason grades of 3, 4 and 5. 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. Your 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. When these 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 your Gleason score is made of two of the same Gleason grades, such as 3+3, this means that no other Gleason grade was seen in the samples. 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 newer and simpler system for showing how aggressive your prostate cancer is likely to be. Your grade group will be a number between 1 and 5.

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 out of the prostate.

Read more about Gleason scores and grade groups, and what they mean.

Last updated May 2019
To be updated May 2021

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:

• localised prostate cancer – it's contained inside the prostate.
• locally advanced prostate cancer – it’s started to break out of the prostate or has spread to the area just outside it
• advanced prostate cancer – it’s spread from the prostate to other parts of the body.

Last updated May 2019
To be updated May 2021

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

This is a urine test that 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 May 2019
To be reviewed May 2021

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

A specialist nurse: A nurse who specialises in a particular medical condition or group of conditions. They may have another name, such as a clinical nurse specialist (CNS) or urology nurse specialist.

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 radiographer: A person who takes X-rays and scans of the body.

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.

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.

Some MDTs may be larger than this and include other health professionals, such as a dietitian, counsellor, physiotherapist or a palliative care nurse.

Last updated April 2019

To be reviewed November 2020

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’re very overweight
• you’ve had bowel or prostate surgery in the past
• you’ve had bladder, bowel or erection problems in the past.

Last updated: December 2018
To be reviewed: February 2021

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 January 2017
To be reviewed March 2020

Urinary or bowel problems after prostate cancer treatment can 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.

• Pack enough pads and medicine and a few extra in case of delays to your trip.
• Plan ahead to help you manage urinary or bowel problems. For example, book an aisle seat close to the toilets and find out where the nearest public toilets are in advance.
• Try using a toilet whenever you have the chance, whether you need to go or not.
• 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.
• Find out how you can have your clothes washed if needed at your destination.
• Use our Urgent toilet card to help you get to a toilet quickly. If you are visiting a non-English speaking country, you can buy an international travel version from the IBS network.
• 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.

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.

Find out more about preparing for your trip.

Last updated April 2019

To be reviewed January 2022

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 June 2017
To be reviewed June 2020

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.

Hormone therapy can also reduce your desire for sex (libido), which may also make it difficult to get and keep an erection.

There are a number of treatments available which work in different ways. Treatments include:

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

How well each treatment works and whether your erections recover varies from man to man. Your overall health, your ability to get erections before cancer treatment, the treatments you try and your age can all play a role. Try different things and stick with them for a while to find the best option for you.

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 relationships to find out more about treatments for erection problems.

Last updated June 2017
To be reviewed June 2020

If you’re on life-long hormone therapy and having problems with side effects, you might be able to have intermittent hormone therapy. This is where you stop hormone therapy when your PSA level is low and steady, and start it again if your symptoms get worse or your PSA starts to rise. It may help to give you a break from some of the side effects, such as hot flushes and sexual problems, and you may feel better in yourself. But it can take several months for side effects to improve, and some men never notice any 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 choose surgery (orchidectomy).

There is a risk 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 will need to have your PSA level checked every three months while you’re having a break from treatment. 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. This will normally be when your PSA rises to 10 ng/ml, or if your symptoms start to get worse. If you do need to start hormone therapy again, you will usually have the same type as before, for at least three to six months.

Read more about hormone therapy side effects and what can help.

Last updated June 2019
To be reviewed December 2021

Hormone therapy can affect your mood. You may feel more emotional than usual or just ‘different’ to how you felt before. Some men find they cry a lot or get mood swings, such as getting tearful and then angry.

Some men experience low moods, anxiety or depression. This could be directly caused by the hormone therapy itself, or because you’ve been diagnosed with prostate cancer. It could also be due to the impact that treatment is having on you and your family.

Read more about how hormone therapy might affect your mood and things that may help.

Last updated June 2019
To be reviewed December 2021

Hot flushes are a common side effect of hormone therapy and can affect men on LHRH agonists or anti-androgens.

If your hot flushes are mild or don’t bother you, you may not need treatment. But speak to your doctor or nurse if you find them disruptive or difficult to deal with.

Ways to manage hot flushes can include lifestyle changes, medicines, and complementary therapies.

Read more about how to manage hot flushes.

Last updated June 2019
To be reviewed December 2021

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 March 2017
To be reviewed August 2019