Prostate Cancer
Most common cancer in men — often slow-growing and curable when localised.
Overview
Prostate cancer affects 1 in 8 UK men. Most cases are adenocarcinomas arising in the peripheral zone. Many are indolent and never cause harm; a minority are aggressive and life-threatening. Risk stratification (PSA, Gleason/ISUP grade, MRI) guides management from active surveillance to radical treatment.
Symptoms
- • Often asymptomatic — detected on PSA testing
- • Lower urinary tract symptoms: hesitancy, weak stream, nocturia (usually benign hyperplasia, sometimes cancer)
- • Haematuria or haematospermia
- • Bone pain, weight loss or unexplained fatigue (advanced)
Risk factors
- • Age >50 (>45 in Black men or with family history)
- • Black ethnicity (1 in 4 lifetime risk)
- • First-degree relative with prostate cancer
- • BRCA2 mutation — earlier onset and more aggressive disease
Causes
- • Genetic: BRCA2, HOXB13, Lynch syndrome
- • Androgen-driven proliferation
- • Age-related epithelial change
🚨 Red flags — seek urgent care
- • Bone pain, especially spinal — possible metastasis
- • Lower limb weakness or saddle anaesthesia — spinal cord compression (emergency)
- • Rapid PSA rise on surveillance
When to seek care
- • Urinary symptoms over 50, or any haematuria
- • Family history — discuss baseline PSA from age 45
- • Symptoms suggestive of bone or cord involvement — urgent same-day assessment
Diagnosis
- • Age-adjusted PSA + digital rectal examination
- • Multiparametric MRI of prostate before biopsy
- • Transperineal targeted + systematic biopsy if MRI Likert ≥3
- • Staging: bone scan, CT, PSMA-PET for intermediate/high risk
- • Risk stratification: PSA, ISUP grade group, clinical T stage
Treatment
- • Active surveillance for low/favourable intermediate-risk disease (PSA, MRI, repeat biopsy)
- • Radical prostatectomy (open, laparoscopic or robotic)
- • External beam radiotherapy ± brachytherapy boost; commonly with androgen deprivation
- • Androgen deprivation therapy (LHRH agonists/antagonists)
- • Advanced disease: docetaxel, abiraterone, enzalutamide, apalutamide, PARP inhibitors (BRCA), Lu-PSMA radioligand therapy
- • Bone-protective therapy (zoledronate, denosumab) in metastatic disease
Prevention
- • No proven primary prevention; healthy weight, exercise and Mediterranean-style diet may help
- • Discuss informed PSA testing from age 50 (45 if higher risk)
Complications
- • Urinary incontinence and erectile dysfunction after radical treatment
- • Radiation cystitis or proctitis
- • Bone metastases — pathological fracture, hypercalcaemia, cord compression
- • Androgen deprivation: hot flushes, osteoporosis, cardiometabolic risk
Prognosis
5-year survival ~100% for localised disease; ~50% for metastatic disease and improving with novel hormonal and targeted therapies.
Education & self-care
Prostate cancer is highly treatable when caught early. Knowing your risk and discussing PSA testing matters more than waiting for symptoms.
Frequently asked questions
Should I have a PSA test?
It is an informed choice. Discuss benefits and risks with your GP, especially if you are Black or have a family history.
Will treatment make me incontinent?
Some men have temporary urinary or erectile problems; modern surgery and radiotherapy minimise long-term effects.
Is active surveillance safe?
Yes — for carefully selected low-risk disease, with structured PSA, MRI and biopsy follow-up.