Prostate cancer: symptoms, tests, treatment options and causes

Prostate cancer often has no symptoms at first. The NHS explains that it usually starts to grow on the outer part of the prostate, so it does not press on the tube that carries urine (the urethra) and cause symptoms until it has grown or spread.

When it does, the NHS lists changes to the way you pee. Other symptoms can also occur.

• Finding it difficult to start peeing or straining to pee.

• A weak flow of urine, or "stop start" peeing.

• Needing to pee urgently or often, or both.

• Feeling like you still need to pee just after finishing.

• Needing to pee during the night.

• Erectile dysfunction (being unable to get or keep an erection).

• Blood in your urine or semen.

• Lower back pain and losing weight without trying to, which may be symptoms of advanced prostate cancer.

The NHS says to see a GP if you are having trouble peeing or have other symptoms of prostate cancer, if you are over 40 and genetic tests have shown you have a faulty BRCA2 gene, or if you are worried about your risk.

These symptoms do not always mean cancer. The NHS says you can also get them with an enlarged prostate, a very common non-cancerous condition caused by the prostate getting larger as you get older. It stresses that it is important to be checked if your symptoms change, get worse or do not feel normal.

NICE CKS adds unexplained lower back or bone pain and lethargy to the list of symptoms that should raise suspicion.

The NHS says prostate cancer does not always need treatment. If the cancer has not spread, your care team may suggest monitoring it to see if it is growing, and when they know how it is behaving they can decide the best treatment. Treatments include surgery, radiotherapy and hormone therapy, and if the cancer has spread you may need chemotherapy.

For localised prostate cancer NICE guidance NG131 describes three options for people with Cambridge Prognostic Group 1, 2 and 3 cancer: active surveillance, radical prostatectomy and radical radiotherapy. It reports that the evidence from a large UK trial does not show a difference in the number of deaths from prostate cancer at 10 years between the three approaches.

NICE says active surveillance should not be offered for Cambridge Prognostic Group 4 and 5 cancers, for which radical prostatectomy or radical radiotherapy is offered when the cancer is likely to be controlled in the long term.

NICE also says people should be warned about the effects of treatment on urinary function, sexual function and fertility, and offered sperm storage before radical treatment. Side effects are central to the decision, so ask your specialist team what each option is likely to mean for you.

The prostate is a gland under the bladder that makes part of the fluid in semen. The NHS says prostate cancer usually happens to men over 50, and anyone with a prostate can get it.

NICE CKS describes prostate cancer as a malignant tumour of the prostate, with almost all (95%) being adenocarcinomas. It says it is multifocal, with different areas that can grow at very different rates. Most are indolent and slow growing, whereas a minority are aggressive and may spread, most often to the bones.

The NHS says your GP will ask about your health and family history, and may check your prostate with a rectal examination. They may suggest a PSA (prostate specific antigen) blood test after explaining its benefits and risks.

The NHS stresses a PSA test cannot tell you if you have prostate cancer, but it can show if there are problems affecting your prostate. A higher-than-normal result leads to other tests, because causes can also include an enlarged prostate or an infection (prostatitis). PSA results usually take 1 to 2 weeks.

You can ask a GP about a PSA test even without symptoms. The NHS says they will consider your risk, and PSA tests are not routinely offered if you have no symptoms or have not had genetic tests showing a faulty BRCA2 gene.

If you are referred because there is a chance of prostate cancer, the NHS says you will have an MRI scan, which gives a clearer view of the prostate and shows whether you need more tests. If more information is needed, a biopsy may be suggested, in which a small needle is put into the prostate to take a tissue sample.

NICE NG131 recommends multiparametric MRI as the first-line investigation for suspected localised prostate cancer, reported on a 5-point Likert scale, with MRI-influenced biopsy offered to people with a score of 3 or more. A biopsy may be omitted for a score of 1 or 2 after discussing the risks and benefits.

The NHS says it can take a few weeks to get your results. If your symptoms get worse, or you are still waiting after 2 weeks, you can call the hospital or contact your GP for an update.

The NHS says the risk increases with age. You may have a higher chance if you are over 50, are from a Black African or African Caribbean ethnic background, have a family history of prostate cancer, or a close relative has had pancreatic, breast or ovarian cancer, particularly at a young age, because they can be caused by the same inherited genes (BRCA2).

Cancer Research UK says prostate cancer is most common in men aged 75 to 79 in the UK and more common in Black men than White men. It says risk may be higher if you have more than one first-degree relative with it or a relative diagnosed before 60. It also lists inherited faults in BRCA2 and other genes, with research estimating a 2 to 5 times higher risk with a faulty BRCA2 gene.

Cancer Research UK says obesity or overweight may be linked to a higher risk of metastatic prostate cancer, and that it only includes risk factors supported by good-quality evidence. It reports there is no strong evidence that vasectomy or sexual activity changes your risk.

The NHS says that if you are told you have prostate cancer, a team of specialists will be available throughout, including a clinical nurse specialist who is your main point of contact. You can ask them any questions, and you do not need to wait for your next check-up if you have concerns.

If you are told the cancer cannot be cured, the NHS says treatment such as chemotherapy, hormone therapy or steroids may reduce symptoms and help you live longer, and a palliative or symptom control team can help you feel more comfortable. The NHS signposts Macmillan Cancer Support for emotional support.

On the NHS, your GP can arrange a PSA test and, if symptoms or results suggest cancer, an urgent referral. NICE CKS notes that treatment is started and managed in secondary care, with primary care sharing follow-up and monitoring.

Some people choose a private urologist or private MRI for faster assessment. Whichever route you take, the same national guidance applies to the pathway of PSA, MRI and biopsy, and your results and plan should be shared with your GP. Ask about the benefits and risks of each test before agreeing to it.