What is prostate cancer?

Prostate cancer is the most common cancer in men in the UK. About 55,100 people are diagnosed with it each year. It is more common over the age of 65. It can happen at a younger age, but it is uncommon under the age of 50. There is a higher risk of getting prostate cancer at a younger age if you are Black or have a strong family history of prostate cancer.

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).

There are different types of prostate cancer:

Early (localised) prostate cancer – the cancer cells are only inside the prostate
Locally advanced prostate cancer – the cancer has grown through the capsule surrounding the prostate. It may have started to spread into tissue or organs close by.
Advanced prostate cancer – the cancer cells have spread from the prostate gland and nearby area to other parts of the body.

If you are a trans (transgender) woman or are non-binary assigned male at birth, you still need to be aware of prostate cancer. Trans women can develop prostate cancer, but there is not enough evidence to know how common this is.

This video explains prostate cancer. Consultant urologist Jonathan Aning talks abut what it is, the different types and the treatments that may be offered to you.

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Booklets and resources

Symptoms of prostate cancer

Prostate cancer often grows slowly. Symptoms may not develop for many years. Symptoms usually happen when the cancer is large enough to press on the tube you pee (pass urine) through. This is called the urethra.

The prostate can also become enlarged due to a condition called benign prostatic hyperplasia (BPH). Benign means non-cancerous. BPH can develop as you get older.

The symptoms of benign prostate conditions and prostate cancer are similar. Some people will have both BPH and prostate cancer. If you have any of these symptoms, it is important to have them checked by your GP:

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
blood in your semen
pain when peeing or ejaculating – this is rare.

Sometimes blood in the urine cannot be seen. It can only be detected by a urine test.

Sometimes prostate cancer can cause other symptoms, such as problems getting or keeping an erection (erectile dysfunction). It can also cause loss of appetite and weight loss.

When prostate cancer spreads, it usually goes to the bones. This is called advanced (metastatic) prostate cancer It may cause pain in the bones, such as in the back.

It is important to tell your GP if you have any of these symptoms.

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Do I have cancer?

Causes of prostate cancer

Doctors do not know the exact causes of prostate cancer. But there are risk factors that can increase your chance of developing it. 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 causes and risk factors of prostate cancer.

Diagnosis of prostate cancer

If you have symptoms, you will usually begin by seeing your GP, who will examine you. They may do the following tests:

Digital rectal examination (DRE)

During a digital rectal examination (DRE), the doctor lubricates a gloved finger with gel. Then they gently insert it through the anus and into the rectum to feel the prostate. As the rectum sits behind the prostate, your doctor can feel for any abnormalities. DRE can detect other conditions, such as inflammation of the prostate (prostatitis) and BPH, as well as a possible prostate cancer.

DRE may feel uncomfortable, but it is quick and should not be painful. Tell the doctor or nurse if you feel pain.

If you are worried or feel uncomfortable about having a DRE, tell your GP or urologist. There are other tests for prostate cancer so they may decide not to do a DRE if you feel this way.
PSA test

The PSA test is a blood test. It can be used with other tests to help diagnose prostate cancer.

Prostate-specific antigen (PSA) is a protein made in the prostate. Some PSA leaks into the blood and can be measured in the PSA test.

Prostate cancer often causes a raised level of PSA. But the test is not always reliable. A raised level of PSA does not mean you have prostate cancer.

Naturally, as you get older, the level of PSA in the blood slowly rises. Your doctor can tell you what they think the normal level of PSA should be for you.

If they think that your symptoms could be caused by cancer, they will refer you to a specialist doctor.

At the hospital

At the hospital, you will meet with a urologist or a urology specialist nurse. The urologist may want to do another PSA test or digital rectal examination.

They will ask about your symptoms, your medications and any other medical conditions you have. They will ask questions to find out whether you have any risk factors for prostate cancer. After this, they will talk to you about having further tests. These may include:

Multi-parametric MRI scan (mpMRI)

An MRI scan use magnetic fields to build up a detailed picture of certain areas of the body. A multi-parametric MRI (mpMRI) scan is a specialised type of MRI scan. It gives a more detailed picture of the prostate and surrounding area than a standard MRI scan. Your doctor might recommend you have a mpMRI scan if they think you could have prostate cancer.
Prostate biopsy

If your test results show that you may have cancer, your doctor may advise you to have a biopsy. This involves a doctor removing samples of prostate tissue with a fine needle. A pathologist is a doctor who is an expert in studying cells. They look at the samples under the microscope to check for cancer.

A prostate biopsy is usually done as an outpatient. But sometimes people go into hospital and have the biopsy under a general anaesthetic, which means they are not awake when they have it. Or they may have a spinal anaesthetic, which is an injection of anaesthetic around the spine. This numbs them from the waist down to have the biopsy.

There are 2 different types of prostate biopsy:

Transperineal (TP) biopsy

During a TP biopsy, samples of the prostate are taken through the perineum. This is the area between the scrotum and the back passage (anus). The doctor will do a digital rectal examination before they gently pass a small ultrasound probe into the rectum using lubricating gel. The doctor injects the area with local anaesthetic. They place a special grid called a template on the perineum. The doctor then passes a needle through the grid into the skin of the perineum to take small tissue samples. They can take many small tissue samples from different areas of the prostate.
Transrectal ultrasound scan (TRUS) biopsy

Before a TRUS biopsy, you will change into a hospital gown. The doctor will do a rectal examination before they gently pass a small ultrasound probe into the rectum using lubricating gel. This helps the doctor guide a needle along the probe and into the prostate to take the biopsy. The doctor usually takes 10 to 18 small samples of tissue.

Further tests after diagnosis

Your specialist may arrange further tests to find out more about the cancer or to check whether it has spread:

MRI scan

An MRI scan can show if the cancer has spread outside the prostate to areas nearby. The procedure is the same as for a multi-parametric multi-parametric MRI (mpMRI) scan.
CT scan

A CT scan makes a 3D picture of the inside of the body using x-rays taken by the CT scanner. You may have a CT scan if you are unable to have an MRI due to the magnet.
Bone scan

The bones are the most common place for prostate cancer to spread to beyond the lymph nodes. A bone scan can show abnormal areas of bone.

Waiting for test results can be a difficult time. We have more information that can help.

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Just been diagnosed?

Booklets and resources

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.

Staging

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

The grade

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. Grade Groups are a system to describe the grade of a prostate cancer. They are based on the Gleason score.

The Gleason Score looks at the pattern of cancer cells in the prostate tissue, and how different they are to normal prostate cells.

There are 5 different patterns, graded from 1 to 5:

Grades 1 and 2, look like normal prostate tissue.
Prostate cancer is Gleason grade 3, 4 and 5.
Grade 5 is very different to normal tissue.

There may be more than 1 grade present in the biopsy.

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 will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your treatment will depend on:

your general health
your age
the stage of the cancer
the Grade group
the risk group
your preferences.

Your doctor or cancer specialist or nurse will explain the different treatments and their side effects. Treatment side effects can include erection difficulties (ED), urinary or bowel problems. Your doctor or cancer specialist nurse will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.

Your cancer team may also give you advice about preparing for your treatment. This is sometimes called prehabilitation. It helps to improve your fitness and diet and to get you ready mentally before treatment.

Monitoring

Monitoring is where you do not start treatment straight away. If you have early prostate cancer, your doctor may offer you active surveillance. This involves having a PSA test every few months, and a multiparametric MRI scan (mpMRI scan) every 1 or 2 years. If the cancer starts to grow you can be given treatment which aims to cure the cancer.

In some situations, doctors may offer monitoring with watchful waiting. You will not have so many tests. You can have treatment, usually with hormonal therapy, if there are signs the cancer is growing, or if it is starting to cause symptoms. The aim of watchful waiting is to control the symptoms of prostate cancer rather than cure it.
Surgery to remove the prostate or help with symptoms

Surgery to remove the prostate is called a radical prostatectomy. It is usually done with keyhole surgery (laparoscopic surgery) or robot-assisted surgery, which means you usually recover quickly.

A radical prostatectomy is not commonly done to treat locally advanced prostate cancer. Sometimes, it may be done to try to prevent the cancer spreading. You may need to have radiotherapy afterwards.

Some people with locally advanced prostate cancer may have a transurethral resection of the prostate (TURP) if they are having difficulty passing urine (peeing).
Radiotherapy

Radiotherapy uses high-energy rays to treat cancer. It destroys cancer cells in the area where the radiotherapy is given. It may be given as external beam radiotherapy, which you usually have over a few weeks as an outpatient. Depending on the risk group of the cancer, you may have hormonal therapy as well.

Some people may have internal radiotherapy. This is called brachytherapy. Brachytherapy gives high doses of radiation directly to the prostate. It may be given with external beam radiotherapy. For some people with early prostate cancer, it may be given on its own.
Hormonal therapy
Hormonal therapy treats prostate cancer by reducing the amount of testosterone naturally produced in the body. Or by stopping testosterone from reaching the prostate cancer cells.

You may have hormonal therapy:

with radiotherapy

on its own if you are older or are on watchful waiting and the cancer starts to change

if you do not want other treatments or have health problems that would make other treatments difficult.

There are other treatments used to treat early prostate cancer, including cryotherapy and high-intensity focused ultrasound (HIFU).

If you have advanced prostate cancer, your doctors may offer you treatment with hormonal therapy and chemotherapy. Some people may be able to have targeted therapy.

Although advanced prostate cancer cannot be cured, you can still have treatments that will help. Treatments may control the cancer, sometimes for many years. They can also help relieve any symptoms caused by the cancer and improve your quality of life.

You may have some treatments as part of a clinical trial.

We have more information about prostate cancer treatment, and treatment for advanced prostate cancer.

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After prostate cancer treatment

You will have regular check-ups during and after your treatment. Follow-up appointments are a good time to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments.

We have more information about follow-up care after treatment.

Sexual wellbeing

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

Most treatments for prostate cancer are likely to cause infertility. This means you will no longer be able to get someone pregnant naturally.

If fertility is a concern for you, talk to your specialist before treatment. It is usually possible to store sperm before treatment starts, but you may need to pay for this. The sperm may then be used later as part of fertility treatment.

Well-being and recovery

Taking good care of yourself can help speed up your recovery after prostate cancer treatment. Even small lifestyle changes may improve your wellbeing.

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.

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More information and advice

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

Support after prostate cancer

People often have many different feelings during and after prostate cancer treatment. If you have finished treatment, you may feel relieved it has ended but worried about what might happen in the future.

It is important to know where to get support or information if you need it. People often need support even some time after prostate cancer treatment. But sometimes it is difficult to know who to ask for help.

To find support:

ask your GP or someone from your cancer team for advice about support in your area
find cancer support services near you
call the Macmillan Support Line free on 0808 808 0000
chat to our cancer information specialists online
visit our Online Community prostate cancer forum to talk to people who have been affected by prostate cancer, share your experience, and ask questions.

The HOPE programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer.

Topics include goal setting, fatigue management, and wellbeing. You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk

Other organisations who offer information and support

Prostate Cancer UK

Prostate Cancer UK provides information and support to men with prostate cancer and their families. Has office in London, the Midlands, Scotland, Wales and Northern Ireland.
Tackle Prostate Cancer

Tackle Prostate Cancer is an organisation of UK patient-led prostate cancer support groups.

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References

Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk

National Institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management. NICE Guideline [NG131]. Published: 09 May 2019. Last updated: 15 December 2021. Available from: www.nice.org.uk/guidance/ng131 [accessed March 2024].

Castro E, Fizazi K, Heidenreich A, Ost P, Parker C, Procopio G, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2020; 31(9): 1119–1134. Available from: www.annalsofoncology.org/article/S0923-7534(20)39898-7/fulltext [accessed March 2024].

Cancer Information Development team

Author

Dr Ursula McGovern

Reviewer

Consultant Medical Oncologist & Honorary Associate Professor

University College Hospitals, London

Date reviewed

Reviewed: 01 October 2025

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Next review: 01 October 2028

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