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Health condition · Clinically reviewed

Prostate cancer, a modern, mpMRI-first patient guide.

The most common cancer in men in the UK. Modern diagnosis is mpMRI-first — before any biopsy — and treatment is tailored by risk group. Not every prostate cancer needs treating.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, EAU or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK guidance on mpMRI-first pathways, active surveillance and modern systemic therapy.

Key facts

Prostate cancer at a glance.

The essentials, in plain English — what it is, how common it is, how it’s diagnosed in the UK today, and how treatment is chosen.

  • What it is

    An adenocarcinoma of the prostate — cancer arising from the glandular cells of the prostate.

  • How common

    Around 52,000 new cases each year in the UK — the most common cancer in men.

  • How it is diagnosed

    Multiparametric MRI (Likert / PI-RADS) is now standard BEFORE any biopsy.

  • Low-risk disease

    Active surveillance is safe and preferred — many low-risk cancers never need treating.

  • Intermediate to high

    Modern radiotherapy or robotic prostatectomy, chosen with a uro-oncology MDT.

  • Advanced disease

    Systemic therapy — hormones, chemotherapy, PSMA-PET-guided treatment and PARP inhibitors.

Why this guide matters

Not every prostate cancer needs treating.

The pathway has changed. mpMRI comes first, active surveillance is safe for many, and treatment is chosen by risk group — not by a single number.

  • PSA is a trend, not a verdict

    One PSA reading rarely decides anything. The trend over time, in context, is what counts.

  • mpMRI before biopsy is now standard

    A pre-biopsy MRI spares many men an unnecessary biopsy and improves the ones that go ahead.

  • Risk group drives treatment

    Low-risk, intermediate and high-risk disease follow very different paths — from surveillance to combined modern therapy.

How the diagnosis is made

From first PSA to a clear plan.

The mpMRI-first pathway UK uro-oncology teams now follow, in order — so you know what to expect and why.

  1. 01

    Assessing

    PSA in context

    A PSA blood test is interpreted alongside your age, symptoms and family history — not in isolation.

  2. 02

    Assessing

    DRE only if symptomatic

    A digital rectal examination is offered when there are urinary symptoms or when it helps decision-making.

  3. 03

    Assessing

    Multiparametric MRI (mpMRI) FIRST

    A pre-biopsy mpMRI is now standard in the UK — reported using Likert or PI-RADS scoring.

  4. 04

    Confirming

    Targeted + systematic biopsy

    A transperineal biopsy targets any MRI-visible lesion, with systematic sampling of the rest of the gland.

  5. 05

    Confirming

    Gleason grading + risk group

    Biopsy tissue is graded (Gleason / ISUP), then combined with PSA and stage to give a risk group.

  6. 06

    Planning

    PSMA-PET for staging

    For intermediate and high-risk disease, PSMA-PET gives the most accurate picture of spread.

  7. 07

    Planning

    Uro-oncology MDT

    A specialist multi-disciplinary team recommends the treatment options that fit your risk group and preferences.

Typical timeline: 4–8 weeks from raised PSA to a treatment plan.

Symptoms

What prostate cancer actually shows up as.

Most cases are picked up on a PSA test with no symptoms at all. When symptoms do appear, they matter — here is what to watch for and when to act.

  • Asymptomatic

    Most prostate cancers are now picked up on a PSA blood test — with no symptoms at all.

  • LUTS (often unrelated)

    Lower urinary tract symptoms — hesitancy, weak stream, frequency — are usually from benign enlargement, not cancer.

  • Haematuria

    Visible blood in the urine or semen deserves prompt investigation.

  • Family history

    A father or brother with prostate cancer roughly doubles your own risk.

  • BRCA / Lynch mutation

    Inherited BRCA2 and Lynch syndrome mutations raise risk and change treatment options.

  • Rising PSA

    A PSA trend that rises over time matters more than any single reading.

  • Bone pain (advanced)

    New persistent back, hip or pelvic pain in a man with prostate cancer needs urgent assessment.

  • Red flag

    Suspected spinal cord compression, or urinary retention with known metastases — call 999.

Treatment

How prostate cancer is treated in the UK.

Treatment is chosen by risk group and personal preference — from active surveillance for low-risk disease, to modern surgery, radiotherapy and systemic therapy.

  • Active surveillance (low-risk)

    Regular PSA, MRI and repeat biopsy — safe for low-risk disease, avoiding treatment side effects.

  • Radical prostatectomy (robotic)

    Robot-assisted removal of the prostate — for localised disease in men fit for surgery.

  • External beam radiotherapy

    Precisely targeted radiotherapy, often with a short course of hormones, for localised disease.

  • Brachytherapy

    Radioactive seeds or a short high-dose implant placed inside the prostate itself.

  • Hormonal therapy (ADT)

    Androgen-deprivation therapy lowers testosterone — used with radiotherapy or for advanced disease.

  • Chemotherapy (docetaxel)

    Added to hormones for high-volume metastatic disease, and used again if the cancer becomes resistant.

  • Novel hormonal agents

    Abiraterone and enzalutamide extend life in advanced and metastatic prostate cancer.

  • PARP inhibitors

    For BRCA-mutated advanced disease — a targeted option after hormonal treatments.

What this guide is based on

The sources behind every number on this page.

UK and European guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or uro-oncology team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management (NG131).

  • European Association of Urology (EAU). Guidelines on prostate cancer.

  • Prostate Cancer UK. Patient information and treatment choices.

  • British Uro-oncology Group / UK Uro-oncology consensus statements.

Red flags

When prostate cancer becomes an emergency.

Most of the time, prostate cancer is a slow-moving condition. These are the situations where it stops being slow — and you should act today.

  • Metastatic cord compression

    New back pain with leg weakness, numbness or bladder/bowel change — call 999 or attend A&E immediately.

  • Acute urinary retention with cancer

    Sudden inability to pass urine in a man with known prostate cancer needs same-day assessment.

  • Skeletal pain

    Persistent bone pain — back, hips, ribs, pelvis — in known prostate cancer warrants imaging.

  • Hypercalcaemia

    Confusion, nausea, thirst and constipation in advanced disease — needs urgent bloods.

  • Anaemia

    Unexplained tiredness and pallor can signal marrow involvement or treatment effect.

  • Renal impairment (obstruction)

    Rising creatinine with reduced urine output may reflect ureteric obstruction — urgent scan needed.

  • Novel neurological signs

    New weakness, sensory change or incontinence must be treated as cord compression until proved otherwise.

  • Post-treatment complications

    Fever, severe pain, heavy bleeding or clot retention after surgery, biopsy or radiotherapy — seek urgent help.

  • BRCA family cascade

    A BRCA-mutated prostate cancer in the family should trigger genetic counselling for relatives.

Living with it

A long-term journey, with structured support.

Four things that make the biggest difference day to day — monitoring, side effects, bone health and specialist follow-up.

A quiet reminder

Ask about rehabilitation early.

Continence and erectile rehabilitation, bone-health checks and clear follow-up plans all work best when they’re set up from the start.

  1. 01 Monitoring

    PSA is a trend, not a moment

    Your PSA pattern over months matters far more than any single number in isolation.

  2. 02 Side effects

    Continence and erections

    After surgery or radiotherapy, both improve with time and specialist rehabilitation — ask for it early.

  3. 03 Bone health

    Bones matter on hormones

    Long-term ADT weakens bones — a DEXA scan and calcium / vitamin D advice are part of standard care.

  4. 04 Reviews

    Structured follow-up

    Regular uro-oncology follow-up with PSA and, when needed, MRI or PSMA-PET keeps things on track.

Frequently asked

Everything we get asked about prostate cancer.

Quick answers on PSA, mpMRI, biopsy, active surveillance and when to worry.

  • What is prostate cancer?

    An adenocarcinoma of the prostate — a cancer arising from the glandular cells of the prostate. It is the most common cancer in men in the UK, with around 52,000 new cases each year.

  • Do I need a biopsy if my PSA is raised?

    Not straight away. UK practice is now mpMRI-first — a multiparametric MRI is done before any biopsy, and the MRI result guides whether a biopsy is needed at all.

  • What is active surveillance?

    A monitoring pathway for low-risk prostate cancer, using regular PSA, MRI and repeat biopsy. It safely avoids the side effects of treatment for many men whose cancer would never have caused them harm.

  • What is PSMA-PET and when is it used?

    PSMA-PET is a highly sensitive scan that shows where prostate cancer cells are in the body. It is used for staging intermediate and high-risk disease and for looking for recurrence after treatment.

  • Is prostate cancer inherited?

    A father or brother with prostate cancer roughly doubles your risk. Inherited BRCA2 and Lynch syndrome mutations also raise risk and can change treatment options.

  • When should I worry about symptoms?

    New persistent back or hip pain, blood in the urine, or sudden inability to pass urine in a man with prostate cancer needs urgent assessment. New leg weakness or numbness — call 999 to exclude cord compression.

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