Prostate cancer

The commonest cancer in men in the UK. Some kill, many never would, and telling them apart is the whole difficulty.

What it is

Around 55,000 men are diagnosed with prostate cancer in the UK each year, and around 12,000 die of it.

Those two numbers contain the central problem. Many prostate cancers grow so slowly that a man will die with them rather than of them. Others are aggressive. Treating the first group causes harm, incontinence and erectile dysfunction, for no benefit; missing the second costs lives.

There is no national screening programme for that reason. What exists is informed choice: men over 50 can request a PSA blood test from their GP, and men at higher risk should consider it earlier.

Higher risk means: Black men, who have roughly double the lifetime risk and should consider testing from 45; men with a father or brother who had it; and men with certain inherited gene changes.

Signs you might notice

Often nothing at all in early disease, which is why symptoms are a poor guide.

Later: needing to urinate more often, particularly at night; difficulty starting; a weak flow; a feeling of not emptying.

Blood in urine or semen.

Bone pain, particularly in the back, hips or pelvis, which may mean spread.

New back pain with leg weakness or difficulty passing urine is spinal cord compression and is an emergency.

How it can affect day-to-day life

Active surveillance, monitoring rather than treating low-risk cancer, is now standard and it is psychologically difficult. Living with an untreated cancer takes support that is often not offered.

Treatment effects are long-lasting and under-discussed: incontinence, erectile dysfunction, and the effects of hormone therapy including fatigue, hot flushes, mood change and bone loss.

Men talk about this less than women talk about breast cancer, and the isolation is real.

Supporting someone well

Have the conversation about PSA testing rather than waiting for symptoms. Black men and men with a family history should have it earlier.

Understand that a raised PSA is not a diagnosis. It leads to an MRI and possibly a biopsy, and many raised results are not cancer.

On active surveillance, keep every monitoring appointment.

Ask about pelvic floor exercises before and after surgery. They substantially reduce incontinence and are frequently mentioned too late.

On hormone therapy, ask about bone protection, exercise and mood.

New back pain in a man with prostate cancer is not a muscle strain until proved otherwise.

Where to get help

Ask a GP about a PSA test. You are entitled to request one over 50 after a discussion.

Prostate Cancer UK have specialist nurses on 0800 074 8383, and a risk checker.

Back pain with leg weakness or bladder problems is an emergency: go to A and E.