Understanding prostate cancer, diagnosis and treatment options
Prostate cancer is the most common cancer affecting men in the UK. It is particularly common as men get older, although some men have a higher risk because of their family history, genetic factors or ethnic background.
Prostate cancer does not always cause symptoms in its early stages. It is often identified following an elevated or rising PSA blood test, an abnormal prostate examination or investigation prompted by urinary or other symptoms.
An important part of managing prostate cancer is establishing the correct diagnosis and understanding exactly how significant the cancer is. Not every prostate cancer requires immediate treatment, and treatment decisions depend on factors including the cancer’s grade, stage, extent, your overall health and your personal priorities.
Mr Gidon Ellis is a Consultant Urological Surgeon who frequently assesses men at the earlier stages of prostate cancer diagnosis. He provides specialist assessment of raised PSA, arranges appropriate investigations including prostate MRI and, where required, refers patients to experienced specialist colleagues for prostate biopsy.
Mr Ellis does not provide treatment for prostate cancer himself. Where prostate cancer is diagnosed, he works closely within a network of experienced prostate cancer specialists, including cancer surgeons, focal therapy specialists, clinical oncologists and medical oncologists. This allows patients to be directed towards the most appropriate treatment team for their specific diagnosis, circumstances and preferences.
What is prostate cancer?
The prostate is a small gland located below the bladder and surrounding part of the urethra. Prostate cancer develops when cells within the prostate begin to grow in an abnormal and uncontrolled way.
Prostate cancers vary considerably. Some grow very slowly and may never cause significant problems, while others can be more aggressive and have the potential to spread outside the prostate. Understanding the behaviour of an individual cancer is therefore essential before deciding whether treatment is required.
What are the symptoms of prostate cancer?
Early prostate cancer often causes no symptoms.
When symptoms do occur, they can include:
- Difficulty starting urination
- A weak or slow urinary stream
- A stop-start urinary flow
- A feeling that the bladder has not emptied completely
- Passing urine more frequently
- Urinary urgency
- Waking during the night to pass urine
- Blood in the urine or semen
- Erectile difficulties
These symptoms are not specific to prostate cancer and are much more commonly caused by conditions such as benign prostate enlargement.
More advanced prostate cancer can sometimes cause:
- Persistent pain in the back, hips or pelvis
- Unexplained weight loss
- Increasing difficulty passing urine
The absence of symptoms does not exclude prostate cancer.
Who is at increased risk of prostate cancer?
The risk of prostate cancer increases with age.
Other factors associated with increased risk include:
Family history
Having a close relative with prostate cancer can increase your risk, particularly if the relative was diagnosed at a younger age. A family history of breast, ovarian or pancreatic cancer may also be relevant because some inherited genetic changes can increase the risk of prostate cancer.
Genetic factors
Inherited genetic changes, including alterations in genes such as BRCA1 and BRCA2, can increase prostate cancer risk. Men with a significant family history or known genetic risk may therefore benefit from earlier or more intensive assessment.
Ethnic background
Prostate cancer is more common in men of Black African or Black Caribbean ancestry. This is an important consideration when assessing individual risk.
How is prostate cancer diagnosed?
There is no single test that can diagnose prostate cancer in every man. Diagnosis usually involves a combination of clinical assessment, PSA testing, prostate examination, MRI and, where appropriate, biopsy.
PSA blood test
PSA (prostate-specific antigen) is a protein produced by the prostate. A raised PSA can be associated with prostate cancer, but it can also occur with benign prostate enlargement, prostatitis, urinary infection, urinary retention and other prostate conditions. PSA therefore provides an indication that further assessment may be required rather than providing a diagnosis by itself.
Related: Raised PSA
Prostate examination
A digital rectal examination (DRE) may be performed as part of the assessment. This allows the prostate to be assessed for enlargement, asymmetry, hardness or other abnormalities.
Prostate MRI
If there is concern about prostate cancer, multiparametric MRI (mpMRI) is an important part of the diagnostic pathway. MRI provides detailed images of the prostate and can identify areas that may be suspicious for clinically significant cancer. It also helps determine whether a biopsy is appropriate and can guide the areas that need to be sampled.
Prostate biopsy
If MRI or the overall clinical assessment suggests that cancer may be present, a prostate biopsy may be recommended. A biopsy involves taking small tissue samples from the prostate which are examined under a microscope.
Mr Ellis does not perform prostate biopsies himself. Where biopsy is indicated, he refers patients to an experienced specialist colleague with expertise in prostate cancer diagnostics. This ensures that the biopsy is performed by an appropriate specialist and that the results can be integrated into the wider diagnostic pathway.
What does the biopsy tell us?
If prostate cancer is identified, the biopsy provides important information about the characteristics of the cancer.
Grade
The grade describes how abnormal the cancer cells appear under the microscope and provides information about how aggressively the cancer is likely to behave. The Gleason grading system is used to describe the appearance of prostate cancer cells, with the results contributing to the overall assessment of cancer risk.
Stage
Staging describes how far the cancer has spread.
The cancer may be:
- Localised – confined to the prostate
- Locally advanced – extending outside the prostate or involving nearby structures
- Advanced or metastatic – spread to distant parts of the body
Additional imaging may be recommended when there is concern that cancer has spread beyond the prostate. This can include CT, bone imaging or PSMA PET-CT, depending on the individual circumstances.
Does every prostate cancer need treatment?
No. Some prostate cancers are small, slow-growing and unlikely to cause problems during a man’s lifetime. For selected men with low-risk or otherwise suitable localised prostate cancer, active surveillance may be recommended. This involves regular monitoring rather than immediate treatment, usually including PSA testing, clinical assessment, MRI and sometimes repeat biopsy.
The purpose is to identify any evidence that the cancer is becoming more significant while avoiding unnecessary treatment and its potential side effects. Other men may require treatment because the cancer is more aggressive, has progressed or is considered likely to cause problems if left untreated.
What treatments are available for prostate cancer?
The most appropriate treatment depends on the individual diagnosis.
Treatment options can include:
Active surveillance
For selected men with low-risk or favourable-risk prostate cancer, active surveillance allows the cancer to be monitored closely while avoiding immediate treatment. If there is evidence of progression, definitive treatment can then be considered.
Radical prostatectomy
Radical prostatectomy involves surgically removing the prostate and, in some circumstances, nearby lymph nodes. It can be a potentially curative treatment for selected men whose cancer is confined to the prostate or has only limited local extension. Surgery can affect urinary continence and sexual function, and these potential consequences form an important part of treatment decision-making.
Radiotherapy
Radiotherapy uses high-energy radiation to destroy prostate cancer cells. It can be used with curative intent for selected localised or locally advanced cancers and may be combined with hormone therapy depending on the risk and stage of the cancer.
Focal therapy
Focal therapy aims to treat the area of clinically significant cancer while preserving as much of the surrounding prostate as possible. Different technologies are available, including treatments such as high-intensity focused ultrasound (HIFU) and cryotherapy. Focal therapy is only suitable for carefully selected patients, and its role depends on the location, size, grade and extent of the cancer.
Hormone therapy
Hormone therapy reduces the effect of testosterone on prostate cancer cells. It may be used alongside radiotherapy for some localised or locally advanced cancers and is also an important treatment for advanced or metastatic disease.
Chemotherapy and other systemic treatments
For more advanced prostate cancer, systemic treatments may include chemotherapy and newer hormone-targeted or other systemic therapies. Treatment is increasingly individualised according to the biology and extent of the cancer.
How does Mr Ellis help if he does not treat prostate cancer?
The diagnosis of prostate cancer can be an overwhelming experience, particularly when there are several possible treatment options. Mr Ellis’s role is primarily in the earlier stages of diagnosis and assessment.
This may include:
- Assessing a raised or rising PSA
- Reviewing previous PSA results and risk factors
- Performing a prostate examination where appropriate
- Arranging prostate MRI
- Assessing MRI findings
- Arranging referral for prostate biopsy where indicated
- Reviewing the biopsy and diagnostic results
- Helping you understand the significance of the diagnosis
- Discussing the different treatment pathways available
If prostate cancer is diagnosed, Mr Ellis works closely with a network of experienced specialists, including:
- Urological cancer surgeons
- Focal therapy specialists
- Clinical oncologists
- Medical oncologists
The aim is to ensure that each patient is directed towards the specialist and treatment approach most appropriate for their specific diagnosis, cancer risk, overall health and personal preferences. This allows treatment recommendations to be genuinely individual rather than assuming that the same approach is right for every man.
Choosing the right treatment
There is no single treatment that is best for every man with prostate cancer.
The decision may depend on:
- PSA level and pattern over time
- MRI findings
- Biopsy results
- Gleason grade and Grade Group
- Cancer stage
- Number and location of cancer-containing biopsy samples
- Age and overall health
- Urinary and sexual function
- Personal priorities and preferences
For some men, avoiding treatment initially and remaining on active surveillance may be the best option. For others, surgery, radiotherapy or focal therapy may be more appropriate.
Where cancer has spread beyond the prostate, systemic treatment may become the mainstay of care. The most important thing is to understand the diagnosis accurately before deciding how to proceed.
When should I seek medical advice?
You should arrange an assessment if:
- Your PSA is raised or rising
- You have an abnormal prostate examination
- You have a strong family history of prostate cancer
- You have been advised that you are at increased genetic risk
- You have persistent or unexplained urinary symptoms
- You have blood in your urine or semen
- You have unexplained persistent pain in your back, hips or pelvis
Many of these symptoms have causes other than prostate cancer, but they should be assessed appropriately.
Frequently asked questions
Does a raised PSA mean I have prostate cancer?
No. A raised PSA can occur with benign prostate enlargement, prostatitis, urinary infection, urinary retention and other prostate conditions. Further assessment, usually including MRI and sometimes biopsy, is needed to establish whether prostate cancer is present.
Does prostate cancer cause urinary symptoms?
It can, but early prostate cancer often causes no symptoms. Urinary symptoms are more commonly caused by benign prostate enlargement or other lower urinary tract conditions.
Will I need a prostate biopsy?
Not necessarily. MRI and the wider clinical assessment help determine whether biopsy is appropriate. Some men with a raised PSA and reassuring MRI may be monitored rather than proceeding directly to biopsy.
Can prostate cancer be cured?
Some prostate cancers can be cured, particularly when they are diagnosed before they have spread significantly. Other cancers are better managed as a long-term condition, particularly when they have spread beyond the prostate. The outlook depends on the stage, grade and biology of the cancer.
Do you treat prostate cancer?
Mr Ellis does not provide treatment for prostate cancer. His role is primarily in the assessment and diagnosis of men with suspected prostate cancer, including raised PSA and MRI assessment. Where cancer is diagnosed, he works closely with a network of experienced prostate cancer specialists to ensure that patients are referred to the most appropriate expert for treatment.
Will you help me decide which treatment is right?
Yes. Mr Ellis can explain the diagnosis, discuss the available treatment pathways and help you understand the factors that influence the decision. Where treatment is required, he works with appropriate specialist colleagues in surgery, focal therapy, clinical oncology and medical oncology.
Prostate cancer at a glance
| Medical term | Prostate cancer |
|---|---|
| Commonest early finding | Raised or rising PSA, although early cancer may have no symptoms |
| Diagnosis | PSA, prostate examination, MRI and biopsy where appropriate |
| Staging | MRI and additional imaging where indicated |
| Treatment options | Active surveillance, surgery, radiotherapy, focal therapy and systemic treatments depending on the diagnosis |
| Mr Ellis’s role | Assessment, diagnosis and guidance through the treatment pathway; cancer treatment is provided by specialist colleagues |
Arrange a consultation
If you have a raised PSA, an abnormal prostate examination, concerning MRI findings or have recently been diagnosed with prostate cancer and would like to understand what happens next, Mr Gidon Ellis offers specialist assessment in London. A consultation provides an opportunity to review your results, clarify your diagnosis and discuss the most appropriate next steps.
Where treatment is required, Mr Ellis can help you navigate the available options and arrange referral within his network of experienced prostate cancer specialists.
