Prostate Cancer

Prostate cancer symptoms only happen when the cancer is large enough to press on the tube that carries the urine from the bladder (urethra). If the cancer is in the early stage it may not cause any symptoms.

The prostate gland can also become enlarged due to a prostate condition called benign prostatic hyperplasia (BPH), which is non-cancerous.

The symptoms of benign (non-cancerous) prostate conditions and prostate cancer are similar. They can include:

• 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 or semen
• rarely, pain when peeing or ejaculating.

If you have any of these symptoms, it is important to have them checked by your doctor. Your GP can do tests (see Diagnosis of prostate cancer below) to find out if you need a referral to a specialist doctor. If prostate cancer spreads, it usually goes to the bones, it may cause pain in the bones, such as in the back. This is called advanced prostate cancer (or metastatic prostate cancer).

Age

This is the strongest risk factor for prostate cancer and your risk increases from the age of 50. It is uncommon under the age of 50 and more common over the age of 65. Risk factors like ethnicity and family history are linked with getting prostate cancer at a younger age.

Ethnicity

If you are Black, you have a much higher risk of developing prostate cancer. The reason for this is not clear, but it may be because of genetic factors. You are also more likely to develop prostate cancer at a younger age. If you are Black and aged 45 or over, Prostate Cancer UK has more information about your risk. It gives advice on talking to your GP about your risk of getting prostate cancer and helps you to make  decisions about having a PSA test. If you are Asian, your risk of prostate cancer is much lower. We do not know why this is.

Family history

Sometimes there may be a possible family link (inherited). The risk of prostate cancer is higher if you have: 

• either a father or brother who had prostate cancer – the risk is greater if they were diagnosed under the age of 60
• 2 or more close relatives (father, brother, grandfather, half-brother, uncle) on the same side of the family who had prostate cancer
• a mother who had breast cancer
• inherited certain cancer gene changes (mutations).

We get a copy of each of our genes from both parents. Genes are the instructions that tell our cells what to do. Doctors think 5 to 10 out of 100 prostate cancers (5% to 10%) are linked to inherited gene changes. Rarely, prostate cancer may be linked to changes in certain genes. They are called BRCA1 and BRCA2. These altered genes increase the risk of breast and ovarian cancer in some families. If you have inherited the BRCA2 gene change, your risk of prostate cancer is 5 times higher. The BRCA1 gene may also increase your risk, but this is not as clear. If you have a family history of cancer and are worried about your risk of prostate cancer, always speak to your GP 

Body weight and diet

Being very overweight (obese) may increase the risk of having a more advanced prostate cancer. It may also increase the risk of having a faster-growing type of prostate cancer. Eating a balanced diet and doing regular physical activity will keep you at a healthy weight.

The PSA (Prostate-specific antigen) test is a blood test. Used with other tests it can help doctors diagnose prostate cancer. PSA is a protein made in the prostate gland. Some PSA leaks into the blood and can be measured in a test. A small amount of PSA in the blood is normal. If the prostate becomes enlarged, inflamed, or infected, larger amounts of PSA get into the blood. The amount of PSA in the blood may also increase if there is cancer in the prostate. A raised PSA level may be a sign of prostate cancer, but it can also be caused by other things, such as non-cancerous prostate conditions.

Who can have the PSA test?
If you are over 50, you can ask your GP for a PSA test. GPs do not routinely offer PSA testing as part 
of a general health check, or if you do not have any symptoms.If you ask for a PSA test, your GP will advise you to think carefully about the benefits and disadvantages. If you have a higher risk of prostate cancer, it is important to talk to your GP about your personal risk. This is even if you do not have any symptoms. Early prostate cancer does not usually cause symptoms. Talking to your GP can help you to make an informed decision about having a PSA test.
 

If you are transgender
People who have a prostate include men, transgender (trans) women and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you will still have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have any symptoms and want to have the PSA test.

Is there a national screening programme for prostate cancer?
Screening is a way to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel, and cervical cancer, but no UK national screening programme for prostate cancer. The PSA test on its own is not  accurate enough to be used in a screening programme to diagnose early prostate cancer. It may falsely diagnose prostate cancer and may also miss some cancers. Some studies show that lives may be saved by PSA screening because it may lead to prostate cancer being diagnosed at an early stage. But they also show that screening may lead to:

• more invasive tests, such as a prostate biopsy, which can cause complications
• more treatment of slow growing prostate cancers that would never have caused serious harm.

Treatment side effects include:

• urinary incontinence
• bowel problems
• or difficulty getting an erection.

For a screening programme to be effective, the benefits need to outweigh the disadvantages.

Why a PSA test is done
The PSA test may help to diagnose very early prostate cancer before any symptoms develop. There are benefits and disadvantages of having treatment for early prostate cancer. Sometimes a PSA test can lead to an earlier diagnosis of prostate cancer, when treatment to cure the cancer could be more effective. This is particularly the case if you have higher risk factors of prostate cancer.Some prostate cancers grow very slowly. With early prostate cancer, you are not likely to die from it within the next 10 years. For some people, the possible side effects of treatment may be worse than the effects of the cancer itself. You may decide you do not want to know if you have prostate cancer because of the anxiety or uncertainty it might cause you. You may not want further tests, or to make difficult decisions about treatment. Or you may have concerns about the side effects of treatment. Some treatment for prostate cancer may cause urinary incontinence or bowel problems, or affect your ability to get an erection.

Having the PSA test
If you decide to have the PSA test, your GP or nurse will take a blood sample which is then sent to a laboratory for testing. You can ask how long the result will take. If you are having the PSA test, you usually have a rectal examination as well. The doctor gently inserts a gloved finger, using lubricating gel, into your back passage (rectum) to feel the prostate. It may be uncomfortable, but it is quick and should not be painful.

PSA test results
There is not one normal PSA level for everyone. The PSA level naturally gets higher as you get older 
and varies depending on the size of your prostate. The size of the prostate is different for everyone and 
the prostate also gets bigger with age. There are different things that can affect the PSA level, for 
example, non-cancerous prostate problems or a urine infection. Hospitals may have normal ranges for PSA testing based on age, but they do not consider all these other factors.

What is a normal PSA level?
Your GP will think about different things when assessing the results of your PSA test. They will tell you if they think your PSA result is higher than it should be for your age and situation. PSA is usually measured in nanograms per millilitre of blood (ng/ml). If your PSA level is, for example, 3 ng/ml or higher (depending on your age and situation), you may be referred to see a specialist.  Or your GP may recommend repeating your PSA test in a few weeks. A continuous rise in PSA level over time may also be a sign of prostate cancer. A normal PSA level does not mean you will never get prostate cancer. Sometimes prostate cancer can be present even when PSA levels are lower.

Prostate conditions that can affect PSA levels
Different things other than prostate cancer can also raise PSA levels, these includes common prostate conditions, such as:

• benign prostatic hyperplasia (or hypertrophy) called BPH for short
• prostatitis (inflammation of the prostate). 

BPH and prostatitis can both cause a raised level of PSA in the blood, but they are not prostate cancer.

• benign prostatic hyperplasia (BPH)
• prostatitis

Other reasons for a raised PSA

There are some situations where PSA levels can be raised for a short while. These may affect how accurate the test result is. If you decide to have the PSA test, your doctor may suggest you wait for a while if any of the following apply to you:

• urine infections
• recent ejaculation (within the last 48 hours)
• having a tube in your bladder to drain pee (urinary catheter)
• recent prostate biopsies
• prostate or bladder surgery
• exercising energetically 48 hours before the test (some doctors include cycling in this advice)
• receiving anal sex or prostate stimulation during sex (best to avoid for 1 week before the PSA test).

If you have the PSA test, always tell your GP/nurse about any medicines you are taking. This includes ones you buy over the counter, complementary therapies or drugs made from herb and plant extracts.

Seeing a specialist
You will usually be seen within 2 weeks of your GP making a referral. The specialist will talk to you about having a specialised scan called a multi-parametric MRI scan. Depending on the results of your scan your doctor may:

• explain that you do not need any further tests
• ask you to think about having a prostate biopsy.

Before a biopsy your specialist doctor will explain the risks and benefits to help you to decide. If you have prostate cancer, your specialist will talk to you about your options. 

Questions to think about 
Deciding whether to have the PSA test can be hard. Thinking about what is important to you can help you make the best decision. You could think about the following questions:

• What would you do if your PSA level is raised?
• What would you do if further tests find that you have early prostate cancer?
• What difference will it make for you to know about an early prostate cancer?         

We understand that it is important you feel prepared and informed regarding treatment for your prostate cancer. You may have lots of questions regarding the treatment and potential side effects of treatment. Your clinical consultant & their team will be able to answer any specific questions regarding your treatment.