Prostate cancer
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What is prostate cancer?
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Symptoms of prostate cancer
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Risk factors of prostate cancer
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Diagnosis of prostate cancer
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Staging and grading of prostate cancer
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Treatment of prostate cancer
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After prostate cancer treatment
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What is prostate cancer?
Consultant urologist, Jonathan Aning, talks you through what prostate cancer is, the main types, risk factors, stages and common treatments available to you.
Prostate cancer starts in the cells of the prostate. The prostate is a small gland that is just below the bladder and in front of the rectum (back passage).
Prostate cancer is a common cancer. In the UK about 48,600 men are diagnosed with it each year. Prostate cancer is more common over the age of 65. It can happen at a younger age but it is uncommon under 50. You have a higher risk of prostate cancer at a younger age if you are Black or have a strong family history of prostate cancer.
There are different types of prostate cancer
- early prostate cancer (or localised prostate cancer) – the cancer is only inside the prostate gland.
- locally-advanced prostate cancer – the cancer has spread through the capsule surrounding the prostate gland and may have started to spread into tissue or organs close by.
- advanced prostate cancer (or metastatic prostate cancer) – the cancer has spread to other parts of the body, such as the bones..
If you are a trans woman or are non-binary assigned male at birth, you also need to be aware of prostate cancer.
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Symptoms of prostate cancer
Prostate cancer symptoms only happen when the cancer is large enough to press on the tube that carries the urine from the bladder (urethra). If the cancer is in the early stage it may not cause any symptoms.
The prostate gland can also become enlarged due to a prostate condition called benign prostatic hyperplasia (BPH), which is non-cancerous.
The symptoms of benign (non-cancerous) prostate conditions and prostate cancer are similar. They can include:
- needing to pee more often than usual, especially at night
- difficulty peeing – for example, a weak flow or having to strain to start peeing
- feeling like you have not completely emptied your bladder
- an urgent need to pee
- blood in your urine or semen
- rarely, pain when peeing or ejaculating.
If you have any of these symptoms, it is important to have them checked by your doctor. Your GP can do tests (see Diagnosis of prostate cancer below) to find out if you need a referral to a specialist doctor.
If prostate cancer spreads, it usually goes to the bones. It may cause pain in the bones, such as in the back. This is called advanced prostate cancer (or metastatic prostate cancer).
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Risk factors of prostate cancer
Certain things called risk factors may increase the risk of developing prostate cancer. If you are black, you have a much higher risk of developing prostate cancer. You are also more likely to develop it at a younger age. Having a strong family history of prostate cancer is also a risk factor.
We have more information about the risk factors of prostate cancer.
Diagnosis of prostate cancer
You usually start by seeing your GP to have your symptoms checked. Your GP usually arranges some tests. The first tests used to diagnose prostate cancer are:
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Rectal Examination
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PSA test
If your PSA level is raised or your rectal examination is unusual your GP refers you to a specialist doctor (urologist). Your GP may test your PSA level again if it is raised but your prostate feels normal.
At the hospital
A specialist doctor or nurse asks about your symptoms and any other medical conditions. They check if you have any risk factors for prostate cancer. The doctor may do another rectal examination and arrange another PSA test. They will talk to you about further tests you may have. These may include:
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A multi-parametric MRI scan
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Trans-rectal ultrasound (TRUS) biopsy
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Trans-Perineal (TP) biopsy
Further tests after diagnosis
Whether you have any further tests will depend on the risk of the cancer growing quickly. Doctors work out your risk by looking at the PSA level, the stage, and the grade of the cancer.
To help diagnose or stage prostate cancer, you may have staging tests:
- an MRI (magnetic resonance imaging) scan
- a bone scan
- a CT scan
- more blood tests.
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Staging and grading of prostate cancer
Knowing the stage, grade and risk group of the cancer helps you and your doctor to decide on the best treatment for you.
The stage
The stage of prostate cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.
The grade
Your doctor decides the grade by how the prostate cancer cells (from your biopsy) look under the microscope. This tells them how quickly the cancer might grow or spread. Doctors use a combination of 2 systems to grade prostate cancer:
- Gleason score - examines the pattern of cells in the prostate tissues and grades them from 1 to 5. The most common and highest grades are added to give your Gleason score
- Grade Group - grades the cancer between 1 and 5 based on your Gleason score.
Risk group
Prostate cancer is also divided into risk groups. Your treatment options will depend on the risk group the cancer is in.
Your doctor looks at the stage of the cancer, your PSA level and your Gleason score to work out the risk group. They use a system called the Cambridge Prognostic Group (CPG). It divides prostate cancer risk into 5 different groups.
Treatment of prostate cancer
A team of specialists meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). There are different treatments. Your treatment will depend on:
- your general health
- your age
- the Gleason score, cancer grade
- the stage of the cancer
- the risk group of the cancer
- your preferences.
Your doctor and nurse will talk to you about the different things to think about when making treatment decisions. They will explain the different benefits and disadvantages of each treatment. You and your doctor can then decide on the best treatment for you.
Treatment for early or locally advanced prostate cancer may include one or more of the following:
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Radiotherapy
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Surgery or radical prostatectomy
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Monitoring
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Hormonal therapy
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Chemotherapy
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Other treatments
Advanced (metastatic) prostate cancer is usually treated with hormonal therapy and chemotherapy.
We have more information about prostate cancer treatments, including treatment options for early prostate cancer and locally advanced prostate cancer.
After prostate cancer treatment
You will have regular follow-up appointments after treatment for prostate cancer.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation such as Prostate Cancer UK.
Macmillan is also here to support you. If you would like to talk, you can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat online to our specialists online.
- Visit our prostate cancer forum to talk with people who have been affected by prostate cancer, share your experience, and ask an expert your questions.
Sex, relationships and fertility
Prostate cancer treatments can affect your sex life. They can reduce your sex drive (libido) and cause difficulties getting an erection. This is called erectile dysfunction or ED. This may be very worrying for you. There are different treatments and support available to improve sexual difficulties.
Talk to your doctor or nurse about sexual difficulties or concerns. They will be used to talking about these issues. You may want to involve a partner in these discussions.
Fertility
Prostate cancer treatments can affect your fertility. If this is a concern for you, talk to your doctor or nurse. You may be able to store sperm before treatment starts.
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.
Small changes to the way you live such as eating well and keeping active can improve your health and well-being and help your body recover.
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