Prostate cancer

What is it?

The prostate is a gland about the size of a walnut.¹ It sits under the bladder and makes a thick, white fluid that mixes with sperm to make semen.¹ Prostate cancer starts in the cells of this gland.⁴ Many prostate cancers grow slowly and may never cause serious harm, but some grow quickly and spread.^2,4

It mainly affects men over 50, and the risk rises with age. It is most often found between 65 and 74.^5,6 It is more likely if you are from a Black African or African Caribbean background, or if prostate cancer runs in your family.⁵ Close relatives with breast, ovarian or pancreatic cancer, especially at a young age, can point to an inherited faulty gene called BRCA2, which also raises the risk.^5,7

The first signs

Prostate cancer often has no signs at first, because it usually starts in the outer part of the gland, away from the tube that carries pee.⁷

• trouble starting to pee, straining, or a weak or stop-start flow;⁷
• needing to pee often or urgently, also at night;⁷
• feeling you still need to pee just after you finish;⁷
• problems getting or keeping an erection;⁷
• blood in your pee or semen.⁷

Lower back pain and losing weight without trying may be signs of advanced prostate cancer.⁷ These signs often have other causes, such as an enlarged prostate, which is common and not cancer.^4,7

How doctors find out

A doctor may feel the prostate through your back passage (rectal exam) and do a PSA blood test; a raised PSA can have many causes.^4,8 If you could have cancer, you are sent to a specialist and have an MRI scan.⁹ If more is needed, a thin needle takes small samples from the prostate (biopsy); only a biopsy can show for sure that it is cancer.^9,4,8

If you have prostate cancer, you may need more tests, such as a CT, MRI, PET or bone scan. These help your specialist team decide what treatment you need.⁹ Results can take a few weeks, and a specialist explains them; you can bring someone with you.⁹ A specialist nurse is your main contact.⁹

Current treatment

Small cancers without symptoms may be watched first; the main treatments are surgery, radiotherapy and hormone therapy, and chemotherapy may be used when the cancer has spread.Source: NHS

Will it get worse?

Prostate cancer often grows slowly.² Many prostate cancers grow slowly and may never cause problems, and most men who get prostate cancer do not die of it.^2,8 How it goes depends on the stage, which includes the PSA level and the Gleason score or Grade Group (how fast the cells look likely to grow), on your age, and on whether the cancer is new or has come back.⁸

When it spreads, it most often goes to the bones.^10,8 Advanced prostate cancer may not be curable, but treatment can slow it, ease the symptoms and help you live longer.² A palliative care team can help with symptoms and support you and your family.²

Medicines: what helps, and what to watch for

Prostate cancer needs the hormone testosterone to grow.² Hormone therapy, as injections or tablets, lowers testosterone or blocks it.^2,8 On its own it does not cure the cancer, but it can slow it and ease symptoms; together with radiotherapy it aims to cure early cancer.² Chemotherapy is a common treatment when the cancer has spread, and it may be used with hormone therapy and steroids.² Targeted medicines, immunotherapy and medicines that protect the bones are also used.^2,8

Good to know:

• Hormone therapy can cause hot flushes, less interest in sex, problems with sex, weaker bones, diarrhoea, feeling sick and itching;⁸
• You have regular check-ups during and after treatment;^2,8
• You can raise any worry with your care team at any time.²

Exercise and everyday tips help too

Tiredness is likely to be worse if you have hormone therapy, radiotherapy or chemotherapy, or more than one treatment at the same time.¹¹

• being physically active, which can ease tiredness and help you sleep better;¹¹
• planning your day, doing what matters most first and pacing yourself;¹¹
• keeping a regular sleep routine and having less caffeine in the evening;¹¹
• drinking about 1.5 to 2 litres of water a day, and asking your doctor to refer you to a dietitian if you have problems with your diet.¹¹
• telling your medical team before you start a complementary therapy such as yoga or massage.¹¹

Watching, surgery or radiotherapy

Not every prostate cancer needs treatment straight away.² If it is small and causes no signs, your team may first watch it: with check-ups and blood tests with your family doctor (watchful waiting) or regular tests and scans in hospital (active surveillance).² If it grows or causes symptoms, you talk about treatment.²

Surgery removes the whole prostate.² Afterwards you may leak pee, have problems with erections or orgasm, and you cannot father children through sex.² Radiotherapy uses high-energy rays to kill cancer cells; it can treat cancer that has not spread far, or slow cancer that has spread and ease symptoms.² Radiotherapy can cause erection problems and urinary problems.⁸ Some centres offer treatments that destroy the cancer with sound waves (HIFU) or freezing (cryotherapy).²

Is there a cure?

Yes, often, if it is found early.³ Advanced prostate cancer may not be curable, but treatment can slow its growth and spread.² Researchers are testing new treatments in clinical trials, such as freezing the cancer, focused ultrasound, proton beam radiotherapy and light-activated treatment.⁸ For some men, taking part in a trial may be the best choice.⁸

Median survival

Usually 1 to 3 years once it has spread to distant organsSource: NCI PDQ, 2025

Measured in: Men whose cancer has spread to distant organs

Sources

1. NHS: Prostate cancer – What is prostate cancer?
2. NHS: Prostate cancer – Treatment
3. NHS: Prostate cancer – Overview
4. MedlinePlus: Prostate Cancer
5. NHS: Prostate cancer – Causes
6. NCI SEER: Cancer Stat Facts: Prostate Cancer
7. NHS: Prostate cancer – Symptoms
8. NCI PDQ: Prostate Cancer Treatment (PDQ) – Patient Version
9. NHS: Prostate cancer – Tests and next steps
10. NCI PDQ: Prostate Cancer Treatment (PDQ) – Health Professional Version
11. Prostate Cancer UK (charity): Feeling tired