• Approximately 1.5 million new cases of prostate cancer are diagnosed annually worldwide. Approximately 75% of cases are first detected when the cancer is still localized to the prostate. This early detection was associated with a five-year survival rate of nearly 100%.
  • Management includes active surveillance, prostatectomy surgical removal of the prostate, or radiation therapy, depending on risk of progression.
  • Approximately 10% of cases are diagnosed after the cancer has spread. This stage of prostate cancer has a five-year survival rate of 37%.
  • The most common prostate cancer is adenocarcinoma, a type that starts in gland cells, and the median age at diagnosis is 67 years.
  • More than 50% of prostate cancer risk is attributable to genetic factors and older age.
  • Source, University of Washington

In the UK as elsewhere, prostate cancer rates are increasing and expected to rise significantly in the next 10 years.

At this time ( 2025) there is no non-invasive cure for prostate cancer. You can’t take a pill or some magic treatment that doesn’t involve trauma to the prostate gland and/or surrounding organs.

Other pages here describe the various treatment options in more detail, radiation, surgery, ultrasound, cryotherapy and so on, but remember too that not all of these therapies are suitable for all cancers and/or anatomies. So here we describe the main effects on you.

It is common for clinicians to take an epidemiological approach when describing these effects; e.g. the percentage chance of this effect is this percent. These percentages are necessarily the result of clinical studies, but needed to be treated with caution, since they are general, perhaps not reflecting your genetic history, your ethnicity or your medical history.

Symptoms and Diagnosis

If you are lucky, your prostate will grumble to a point that you seek medical intervention, usually because you are having trouble peeing, either too often or with difficulty. If you are over the age of 50 you should be offered ( and if not, demand) a PSA test.

PSA stands for Prostate Specific Antigen, a marker in your blood that indicates over-activity in the Prostate Gland. This simple blood test yields results expressed in nanograms/ millilitre (Ng/ml) as a simple number. The resulting number indicates whether further investigation is warranted, although in the UK this is very hit and miss amongst GPS. In other countries, levels of 6 and above are considered significant. But the test is not definitive, and if it is in the low range, say between 6 and 12, you should be offered another test in 3 months to see if it has changed.

‘Normal’ PSA results vary with age and ethnicity, this page goes into this in more detail.

Please do not listen to those who say a PSA test proves nothing. High PSA means something . The PSA test may not be definitive for Cancer diagnosis but it’s the best indicator we have until something else is developed.

If a second test confirms a high PSA number, your GP should refer you to a Urologist consultant, who will determine if further action is necessary, and will discuss possible strategies for you (including doing nothing). If the consultant determines that further investigation is required, you should be offered a Magnetic Resonance Imaging (MRI) scan which may include the use of a contrast enhancing injection. This will show if there is significant possibility of a localised tumour, or cancer sites outside of the prostate.

Final investigation is by a biopsy of the prostate, as a day-procedure under local anaesthetic, when a surgeon will take 20 or so very small cell samples which are sent to a lab for inspection and grading.

If cancerous cells are detected, they will also be graded to determine how aggressive they are ( how quickly they may grow and spread) and how widespread within the gland they are.

After all this, the Urologist will be able to present you with treatment options if any are needed.

If you are unlucky, you may not have any symptoms at all, sometimes only picked up by some unrelated health investigation, or not at all until the cancer becomes evident and untreatable. This is why Prostate Cancer is known as the Silent Killer.

Treatments

Radical Prostatectomy

For many, the most effective and common treatment has been  Radical Prostatectomy, i.e. complete removal of the prostate gland. In most cases this ensures 100% cure frrm the cancer. This is also the most brutal treatment as far as your body is concerned, the surgery is difficult, surrounding tissues are greatly disrupted and overall recovery times are long. The advent of robot-assisted RP has greatly reduced recovery times and in many cases is virtually painless, or at least produces pain that is readily controlled.

The removal of the prostate involves cutting the urethra, then rejoining after prostate removal. Seminal vessels are also removed and perhaps lymph nodes since these can carry cancer or pre-cancerous cells. The prostate is very close to the nerves responsible for erection, so where possible nerve-sparing techniques are used. These are not always possible, or successful, and in all cases the nerves will be ‘bruised’ and will cease functioning. Nerve repair and regrowth is very slow, hence the several month timescale before erection recovery. It is not possible to know in advance how much damage nerves will suffer, or how long recovery may take (if ever).

Radical prostatectomy means

a) you can never have a fluid ejaculation, hence no children
b) you will experience a prolonged period of impotence
c) you will experience an extended period of incontinence.

Radiotherapy

Conventional External Beam Radiotherapy treatment takes place over many weeks requiring 35-40 treatments and means

a) your production of semen is likely to be lower
b) your libido (sex drive) may be lower if it includes hormone therapy
c) you may not be immediately impotent but this can develop over subsequent years
d) you will be infertile
e) you will have urinary and perhaps fecal incontinence for a while

Focussed stereotactic radiotherapy is a relatively new treatment that uses a precision Cyberknife device to deliver high intensity very small area radiation. This requires fewer treatments, typically 5 over 10 days and causes much less damage to surrounding tissue. But it is not suitable for all cancer types, especially if you have a large prostate. Nevertheless, it is reported to cause the least long-term harm to erectile and urinary functions and is probably the coming treatment of choice.

Androgen Deprivation Therapy (Hormone Therapy)

This is often used in late stage cancer and sometimes post operatively, to reduce the amount of testosterone in the body. For some versions of the cancer, testosterone is a natural driver of cancer aggression. Reducing or eliminating it can slow the progress, but it is not a cure. In some cases, removal of the testes is used, other times, testosterone suppressing drugs are used.

Active Surveillance

This is the ‘do-nothing’ treatment offered to those whose cancer is non-aggressive, small in size and not likely to spread quickly. In this mode, you have regular PSA tests and clinical reviews to keep an eye on things. Your hospital may run an active surveillance online program that automatically tracks your PSA results, and can trigger further action if it climbs above a certain level for you. If you can live with the thought of cancer inside you, this is certainly the best option for these types of cancer.

Things you can do to help yourself

Your clinician will do their best to help you, but there is no magic bullet and you have to take responsibility for your own therapy if you want the best outcome. So let’s discuss some of these.

You will hear this a lot in all forms of medical treatment and it’s not necessarily a well-received message but it doesn’t stop it being true. The best thing you can do to help your treatment is to be and stay fit. Being fit enough to withstand the rigours of surgery or radiotherapy before the event is the absolutely best thing you can do to speed your recovery.

So if you’re programmed for treatment, for even a few weeks before, work on your general fitness. This may be as simple as walking every day, eating a sensible diet and losing weight if you need to ( a fat belly really presses down hard after surgery) . You are going to experience trauma to your pelvic floor, so adopt Kegel exercises before treatment and carry them out. These are well-proven exercises for your pelvic floor muscles, which aid both urinary and erection control. |(Women are more used to using these than men especially after childbirth.)

If you lack the self-discipline to carry out Kegels regularly ( at least 3 times per day) invest £2.50 or so in the Squeezy app, available for Apple and Android devices. This both nags you to do the exercises, and times and logs them.

(N.B. Kegel pelvic floor exercises can be done any time, anywhere, and no-one need even know you’re doing them.)

After treatment, Kegel exercises are essential to control incontinence and help restore erections.

Making the decision

Choosing the type of treatment for you should be a joint decision between you and your clinician. Even so, it may be helpful to understand the long-term survival rates with no treatment at all, and this tool can help to inform you. It is based on a rigorous analysis of long-term studies, but should be used with caution. Since there is no 100% certainty of outcome, in the end, this is a gamble that tries to offset quality of life against length of life.

Prostate Cancer Recurrence

After a time, your cancer may return. This is known as recurrence. The options available to you depend on the treatments you have received so far. This article explains them.

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