Prostate Cancer Q&A

We asked four of our leading men's health urologists about prostate cancer, including early detection and symptoms. Find out what they have to say below.

Mr John Beatty
The prostate gland is positioned in front of the rectum at the base of the bladder and produces seminal fluid. The bladder outlet pipe or urethra passes through the prostate.  Prostate cancer occurs when normal prostate cells become abnormal and start to disrupt the structure of the prostate over time. Depending on how abnormal the cells are, the cancer may grow and cause problems in the region of the prostate or further away if it spreads.


Mr Alan Patrick Doherty
The prostate is a gland needed in fertility. With advancing age, it is prone to developing cancers. Usually, these start as small tumours that slowly grow and may spread to the bones.


Mr Steve Garnett
Prostate cancer is a cancerous growth arising from the prostate gland. Also called adenocarcinoma of the prostate, prostate cancer is the most common cancer in men. It can be difficult to detect because it may not cause any symptoms early on. Early prostate cancer may also cause similar symptoms to benign (non-cancerous) prostate enlargement, which is very common in men over 50.


Mr Tom Leslie
Prostate cancer is the most common cancer in men in the UK with approximately 40000 men a year diagnosed and more than 10000 men each year dying from the disease. The prostate is the organ in men that produces fluid during ejaculation to activate the sperm and helps with urinary continence as it sits below the bladder with the water pipe (urethra) running through the middle of it.

Mr John Beatty
Most early prostate cancers have no or few symptoms. Symptoms can be related to local growth and this may result in problems with passing urine, bleeding in the urine, bowel symptoms and erection problems. If the prostate cancer has spread to distant sites in the bones or lymph it may result in pain most commonly in the back.


Mr Alan Patrick Doherty
Early prostate cancers do not usually cause symptoms. More advanced cancers can cause blockage to the flow of urine with associated urgency, frequency and poor flow. Sometimes they can cause blood in the semen. When the cancer has spread to the bones, it can cause pain.

Currently, the only effective way of detecting an early prostate cancer is by having a PSA blood test, which gives an assessment of risk.


Mr Steve Garnett
Common symptoms of early prostate cancer include urinary symptoms such as getting up at night to pass urine, reduced urinary flow, difficulty getting started passing urine and frequent need to pass urine. Often early prostate cancer does not cause symptoms and can be picked up through a raised PSA blood test.


Mr Tom Leslie
Often there are no symptoms and men simply have a PSA test during a routine medical check up or a rectal examination. If the PSA is raised or the rectal examination is abnormal then their GP will refer them to a specialist for further investigations. Other symptoms could include trouble with the waterworks such as a slow flow, getting up often at night, or having to rush to the loo. Other signs include blood in the urine or ejaculate.

Mr John Beatty
It is a cancer of the ageing male and is the most common non-skin cancer in men over 70 but can occur at an earlier age. Men who have fathers, brothers or grandparents with prostate cancer may be at increased risk especially if they developed prostate cancer at a young age. Afro-Caribbean and black men may also have an increased risk.


Mr Alan Patrick Doherty
Older patients, afro-carribeans, and those with a family history of prostate cancer are most at risk.


Mr Steve Garnett
Men over the age of 50 are most at risk, particularly if there is a family history (father or brother) of prostate cancer.


Mr Tom Leslie
As men get older they are more at risk of prostate cancer, it is unusual to have prostate cancer under 50 years of age. However, men whose father or uncles had prostate cancer are at a higher risk of prostate cancer as it can run in families, the more men in the family who have had prostate cancer the higher the risk. Men of Afro-Caribbean origin also have a higher risk of prostate cancer.

Mr John Beatty
Prostate cancer is divided into low, intermediate and high risk. Risk stratification depends on PSA (prostate specific antigen), rectal examination, imaging and biopsies. Cancer confined to the prostate is known as localised prostate cancer.

If it is not confined to the prostate and has not spread to distant sites it is known as locally advanced prostate cancer. Prostate cancer that has spread to distant sites, most commonly lymph nodes or the bones, is called metastatic prostate cancer.


Mr Alan Patrick Doherty
In simple terms, the stages of prostate cancer are as follows: early (T1 or T2, N0, M0), locally advanced (T3 or T4, N0, M0) or metastatic (N1 or M1).


Mr Steve Garnett
Prostate cancer is best divided into early, locally advanced and metastatic cancer. Early prostate cancer is confined to the prostate & has the best chance of cure. Locally advanced prostate cancer has grown out of the prostate or affected local lymph nodes. More advanced prostate cancer has spread away from the prostate usually to more distant lymph nodes or bones.


Mr Tom Leslie
Prostate cancer is usually divided into low, intermediate or high risk cancer if it is confined to the prostate. If it has spread outside the prostate it is called advanced or metastatic cancer. Various factors help to work this out: the PSA blood test, the way the prostate feels on rectal examination, the Gleason score of the biopsies (6 is generally low risk and 10 is very high risk), most men should have a MRI prior to their biopsies and this will show how much cancer there is, and sometimes a bone scan, MRI or PET CT is needed to check for spread of the cancer.

Mr John Beatty
Perhaps the more important question is how clinically significant prostate cancer is detected? Most men are referred to specialists because of a raised PSA. However, this does not necessarily mean they have cancer. At an initial appointment further tests may include urine testing, blood tests, scans and biopsies. A rectal examination will be performed and the prostate examined for abnormal areas. The only way to definitively diagnose prostate cancer is by taking small samples of the prostate (prostate biopsy).

Recent trials have suggested that MRI scans in some instances may prevent unnecessary biopsies of very low risk (clinically insignificant) prostate cancers or lead to better targeting of lesions within the prostate.


Mr Alan Patrick Doherty
The diagnostic tests used frequently are PSA, urinary PCA3, MRI and prostate biopsies


Mr Steve Garnett
Prostate cancer is now picked up most commonly through a blood test (PSA – prostate specific antigen). Although the PSA test is raised by other things, such as infection, it can help detect early prostate cancer. Prostate cancer can also be found incidentally after prostate operations.


Mr Tom Leslie
Prostate cancer is diagnosed with a combination of PSA, rectal examination, a multiparametric MRI scan and then prostate biopsies.

Mr John Beatty
Treatments on the whole are individualised to patients depending on age, prostate size, medical problems, previous surgery and local expertise. Often there is a choice and your specialist will help in the decision-making.

As a general rule low risk patients have a very small risk of dying from prostate cancer 10 years from diagnosis and often a surveillance programme with regular PSA tests and examination is favoured. Curative treatment options are preferred for patients with intermediate and high-risk cancer with a good life expectancy. 

The most common curative treatment options available are radiation to the prostate or surgery. Radiation kills the cells in the prostate by burning them and can be given either from outside the body or directly into the prostate (brachytherapy). 

Surgery can be performed by an open or keyhole approach. Robotic surgery is the most recent advance in keyhole surgery and gives the surgeon improved vision and dexterity. Another potential curative approach is to try and target a specific area of cancer in the prostate with focal treatment using ultrasound (HIFU) or most recently laser light to destroy cancer cells. 

Focal prostate cancer treatment is still evolving and is currently not routinely available. 

If prostate cancer has spread, hormones with or without chemotherapy is the most common treatment. In men with shorter life expectancies and localised or locally advanced prostate cancer without symptoms, deferred hormonal treatment may be the best option.


Mr Alan Patrick Doherty
Monitoring, Hormone therapy, Radiotherapy ( including Brachytherapy and Cyberknife), Surgery (including Robotic, laparoscopic and open), or focal therapies (eg HIFU).


Mr Steve Garnett
There are a wide range of treatments depending on the stage of prostate cancer. Early prostate cancer can be cured with surgery to remove the prostate (robotic radical prostatectomy) or radiotherapy. More advanced cancer can be treated with hormone therapy, or chemotherapy or newer anti-androgen treatments.


Mr Tom Leslie
There are many treatments available and it does depend on what stage the cancer is. The options could include active surveillance, surgery (usually a robot assisted radical prostatectomy with the Da Vinci robot), radiotherapy, focal therapy (treating just part of the prostate using High Intensity Focused Ultrasound), light activated drugs (VTP), or freezing (cryotherapy).For more advanced disease, hormone therapy to hold the cancer back is the most common treatment.

Mr John Beatty
I introduced laparoscopic prostatectomy to Northampton in 2010. Since 2014 I perform robotic prostatectomy at Leicester General Hospital for the patients of Northampton, Kettering and Leicester.


Mr Alan Patrick Doherty
Being voted one of the top 10 prostate cancer surgeons in the UK.

Being involved and a co-author of the ProtecT study


Mr Steve Garnett
Performing the first Robotic Prostatectomy in Sussex & developing a regional prostate cancer treatment centre in Eastbourne, as well as introducing the UroLift procedure in Eastbourne.


Mr Tom Leslie
I became a Consultant Urological Surgeon in Oxford and Milton Keynes in 2013. Since then, I have developed my practice that means I can offer a state of the art diagnostic and therapeutic prostate cancer service including multiparametric MRI for my patients, targeted prostate biopsies, robotic surgery, focal therapy using HIFU, clinical trials and brachytherapy. I work closely with the oncologists to provide cutting edge radiotherapy in Oxford and Milton Keynes. 

I am Research lead for Urology in the region and Training Programme Director for junior doctors in the region. I am also an Honorary Senior Lecturer in the Nuffield Department of Surgical Sciences at the University of Oxford Hospital and run a number of clinical trials.

Prostate Cancer

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