What is prostate cancer?
Prostate cancer is cancer that starts in the prostate gland, a small gland that sits just below the bladder and makes part of the fluid that forms semen. It is the biggest cause of cancer in men in the UK, with about 55,300 diagnoses and 12,200 deaths a year. It is the second most common form of cancer, after breast cancer. In many men, prostate cancer grows slowly, but in some it can grow and spread more quickly.
How many men get it?
The incidence of prostate cancer has risen by 55% since the early 1990s. That is mainly because of increased awareness, better detection and the ageing population. Cases are due to keep increasing to as many as 85,100 a year by 2038-40.
If I wee a lot at night, should I be worried?
Prostate cancer usually causes no symptoms in the early stages, which helps explain why so many men are diagnosed late. “But people should speak to their doctor if they notice changes to how often or easily they pee, [spot] blood in their pee or [have] difficulty getting or keeping an erection. These can be symptoms of prostate cancer but are often also signs of other health conditions or getting older,” says Naser Turabi, Cancer Research UK’s director of evidence. “If something has changed or doesn’t feel quite right, speak to your doctor. It probably won’t be cancer. But if it is, spotting it early could make all the difference.”
The signs of advanced prostate cancer are different: unexplained weight loss or tiredness and back or bone pain that does not go away.
Are some men more at risk than others?
Yes. While the risk of developing prostate cancer increases as you get older, some groups are much more likely to get it than others. Black men are around twice as likely as white men to develop and die from prostate cancer.
Having close family members with prostate, breast or ovarian cancer, or if you carry the BRCA1 or BRCA2 gene variant, also puts you at greater risk of prostate cancer. While rare, men with these BRCA faults are more likely to develop aggressive prostate cancer.
My dad had prostate cancer. Does that mean I’m more likely to get it?
Yes. Men whose father had it are twice as likely to develop it. If your brother had it, then that risk is three times higher, says Prostate Cancer Research.
Your risk is higher if your relative was diagnosed under the age of 60, more than one of your family members had it and if you are under 65 yourself. And if your mother or sister had either breast or ovarian cancer, that raises your risk of prostate cancer by 20%-30%, often owing to the BRCA1 or BRCA2 genes.
“If prostate, breast or ovarian cancer runs in your family, particularly at younger ages, it’s important to speak to your GP about your own risk,” says Dr Jayne Spink, the translational research director at Prostate Cancer Research.
How is prostate cancer diagnosed?
There is no single test that diagnoses prostate cancer. Any man or transwoman over 50 can request a prostate specific antigen (PSA) blood test from their GP on the NHS.
“The first step will be to take a careful medical and family history,” says Prof Kamila Hawthorne, the chair of the Royal College of GPs. “Often this conversation is the most important part of the consultation, where we can discuss why the patient is requesting a test, and the risks and benefits of conducting [a PSA test]. This is particularly the case if a patient is asymptomatic and without risk factors.”
The PSA test measures levels of prostate specific antigen in your blood, which can be higher in men with prostate cancer. GPs no longer need to assess a man’s prostate via a rectal exam but this does still sometimes happen.
However, PSA tests can show false positives and false negatives. So if a blood test shows high PSA levels, men will be referred for an MRI scan and, if needed, a biopsy to give a definite diagnosis. In a biopsy tiny samples of prostate tissue are taken and examined under a microscope. If one is done, it will often be a transperineal biopsy, which takes samples through the skin between the scrotum and anus. This method is far less invasive than how biopsies were previously carried out, which was via the rectum, and has a very low infection risk.
Do all men who may benefit from a PSA test request one?
No. “Too few men seek a PSA test. This is a major concern. Many men don’t come forward because prostate cancer often has no symptoms in the early stages and some don’t realise they are at higher risk,” says Spink.
“This means we are still diagnosing far too many men when their cancer is already advanced and becomes incurable.”
Poorer and less educated men as well as those from a minority ethnic background are less likely to seek a PSA test and so may be at higher risk.
This could be because of “a lack of understanding about prostate cancer symptoms and the health interventions to address them. But it could be that patients have other priorities than getting symptoms checked, if they are dealing with the pressures of poverty, poor housing and other social determinants of health,” says Hawthorne.
How many people have the BRCA gene variant?
About 1 in 300 to 400 people have a BRCA gene variant. Those with an Ashkenazi Jewish background have a higher risk – about 1 in 40 may carry the gene. Prostate Cancer UK estimates that up to 30,000 men with BRCA gene variants would be eligible for the 45 to 61 age group recommended for screening by the National Screening Committee.
I have a family history of breast and ovarian cancer, how do I know if I carry the gene?
Speak to your GP in the first instance, says Turabi. “Most people won’t have faulty BRCA genes, but if you’re worried about this, you can speak to your doctor. Currently we do not advise people get genetic tests without seeing a specialist.”
You may be able to get genetic tests such as BRCA testing on the NHS to check your cancer risk if one of your close relatives has been told they have a faulty gene that increases their risk of cancer, or several people in your family have had certain types of cancer.
On the NHS, men usually qualify for testing if: they have a first-degree relative (parent, sibling, child) with a confirmed BRCA mutation; they have a strong family history of prostate, breast or ovarian cancer; they themselves have been diagnosed with prostate cancer that appears high-risk or aggressive. If you fall outside these criteria, you can still get tested privately. The NHS also operates a Jewish BRCA testing programme. However, new registrations for this service closed at the end of October – though they are hopeful of future funding from 2026.
How does genetic testing for BRCA variants work?
The test is usually a blood test that looks for inherited changes in the BRCA1 and BRCA2 genes.
If you’re a black man over 50 with a history of prostate cancer in the family what should you do?
“We recommend all black men over 45 speak to their GP about regular PSA testing,” says Chiara De Biase, the director of health services, equity and improvement at Prostate Cancer UK.
If I get prostate cancer what is the treatment?
Treatment for prostate cancer depends on how early it is caught and how fast it is likely to grow. The main treatments are surgery, radiotherapy and hormone treatment. In England, 7% of men with low-risk localised prostate cancer and 69% of people with high risk, advanced disease have surgery.
Surgery is a radical prostatectomy, in which the prostate gland is removed. It is usually recommended when the cancer is contained to the prostate but looks like it may grow or spread. Surgery can lead to damaging side-effects, notably impotence and incontinence, which can have a huge impact on the man’s life.
“For many men with early stage, slow-growing prostate cancer, immediate treatment isn’t always needed,” says Holly Knight, a specialist nurse at Prostate Cancer UK. “Instead, they may be offered ‘active surveillance’, which means regular PSA blood tests, check-ups, and sometimes scans or biopsies. The aim is to monitor the cancer closely and only start treatment if it shows signs of growing.”
What are survival rates for prostate cancer?
“Survival has more than tripled since the 1970s. More than 80% of men diagnosed now survive their disease for 10 years or more, compared with just 22% 50 years ago,” says Turabi.
Survival is particularly high when the disease is caught early. According to Cancer Research UK, more than 85% of men diagnosed at stages 1 or 2 will live for at least 10 years after their diagnosis. At stage 3, the 10-year survival rate is about 80%. But once the cancer has spread more widely – to stage 4 – long-term survival drops sharply to about 19%.
“This gap shows just how important early diagnosis is,” says Spink. “Most prostate cancers grow slowly and are highly treatable when found early. But too many men in the UK are still diagnosed only once the cancer has already spread.”
What can I do to lessen the risk of getting prostate cancer?
Research shows that four in 10 cancers are preventable. Eating healthily, not smoking, reducing alcohol consumption and increasing exercise can help prevent cancer.