Diagnosis and treatment

A healthcare team, including different treatment specialists, will advise you on your options and help you decide what to do. 

There's not always a clear medical reason for choosing one type of treatment over another, so your decision may be based on your personal needs and preferences.

"The patient's preferences are very important," says Mike Kirby, a GP and visiting professor at the Faculty of Health and Human Sciences, University of Hertfordshire.

"We can't always be certain which treatment is the best choice. Individual specialists may favour one method of treatment over another because of their personal experience and expertise.

"Sharing experiences in a multidisciplinary team gives a much more balanced approach. That said, all this information can be confusing to the patient and may not make reaching a decision any easier."

If your doctor thinks you may have a prostate problem, you'll be asked about your symptoms and a urine sample will be taken to rule out infection.

You will also be asked to have some additional tests, including:

• PSA test - if there's a problem in the prostate, the levels of prostate-specific antigen (PSA) in the blood can go up. The PSA test doesn't test specifically for cancer but can show if there's a problem with the prostate gland.
• DRE - a digital rectal examination (DRE) is a quick and simple test done by your GP. Your GP will insert a gloved, lubricated finger into your rectum (back passage) to feel your prostate. They are looking for enlargement or any hard areas on the gland that may be a sign of cancer.

If your GP has concerns because of the DRE or PSA result, you will be referred to a urologist in hospital for further tests. If cancer is suspected, you will be seen by the urologist within a fortnight.

You may be offered a biopsy of the prostate. This is a 30-minute examination that involves taking a number of small tissue samples from the gland.

It may be done by the urologist, a specially trained nurse or a radiologist (an expert in ultrasound).

A transrectal ultrasound scan (TRUS) will be used to look at the prostate, measure its size and guide the biopsy needles.

A lubricated probe is passed into your anus and images of the prostate are shown on a screen. A small amount of tissue is removed from different parts of the prostate with the needles. Some men find this uncomfortable, but pain is minimised with the use of local anaesthetic.

"A negative biopsy result doesn't always mean you don't have cancer as it's possible to miss a small area of tumour, so you still need to be followed up," says Professor Kirby.

With positive results, the spread of the cancer and its speed of growth will be presented to you using a scale of numbers called the Gleason score. The scale usually runs from two to 10, with two being the least aggressive and 10 being the most aggressive form of cancer.

How aggressive your cancer is will be one factor that determines your choice of treatment. If the cancer is aggressive, you will be offered some further tests to check if it has spread outside the prostate gland. These may include:

• CT scan - a computerised tomography (CT) scan is a series of X-ray pictures of the body taken from different angles, enabling the doctor to see the prostate and its surrounding tissues
• MRI - magnetic resonance imaging (MRI) produces images of the body using powerful magnets instead of X-rays
• bone scan - if the prostate cancer has spread to other parts of the body, bone is one of the most likely places for it to go

Prostate cancer can be treated in several different ways. The treatment that is advised will depend on how fast the cancer is growing, whether it has spread outside the prostate gland, your age and your general health.

You will be looked after by a team of cancer specialists called a multidisciplinary team, which may include a urologist, a radiologist, an oncologist (a cancer specialist) and a specialist nurse.

The main types of treatment are:

• Watchful waiting - if the cancer is in its early stages and causing no symptoms, you may decide to delay any treatment and then wait to see if any symptoms of progressive cancer develop. This is often recommended for older men when it is unlikely that the cancer will impact on their natural life span.
• Active surveillance - this is also a treatment option for the early stages of prostate cancer. It is normally recommended for younger men, where there is a chance that the cancer will impact on their natural life span. Active surveillance involves having regular PSA tests and biopsies to closely monitor the progression of the cancer. If these tests reveal that the cancer is likely to spread beyond the prostate, you can then make a decision about further treatment. 
• Prostatectomy - this involves the surgical removal of the prostate gland. This treatment is an option for curing localised prostate cancer and locally advanced prostate cancer.
• Radiotherapy - X-rays are delivered to the prostate either through the skin from the outside (external beam) or by placing small radioactive seeds directly in the prostate (brachytherapy) to kill cancer cells. Sometimes the two techniques are combined.
• Hormone therapy - drugs are used to lower your level of testosterone, a hormone that encourages prostate cancer to grow. Hormone therapy doesn't cure the cancer but slows down its spread and growth.
• Chemotherapy - drugs are available to manage advanced prostate cancer and have been shown to prolong life. Research is continuing into new drugs for this indication.

Some new treatments for advanced prostate cancer are only available on the NHS in some areas or as part of a clinical trial. Your specialist should be able to discuss your options and the risks and benefits of any particular treatment.  

Being diagnosed with prostate cancer can cause anxiety. Asking questions is one way of regaining control.

It may help to take a list of questions with you when you see your doctor.

Remember, there are some very good treatments available that can both cure and control the disease.

It may also help to speak to someone who has been in the same situation as you.

There are many regional prostate cancer support groups that you can find on the internet.

Several prostate cancer charities have helplines manned by men and their families who have been affected by prostate cancer and can share their experiences with you.