Clinically reviewed by
Mr Paul Cathcart
Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
About Prostate Cancer
Prostate cancer is the most common cancer in men in the UK, with more than 64,000 new cases diagnosed each year. It remains a leading cause of cancer-related mortality in men, with around 12,000 lives lost annually — underscoring the importance of early detection and timely treatment. The majority of cases are detected in men over the age of 50. While many prostate cancers grow slowly and may never cause significant harm, others are more aggressive and require prompt treatment. Early detection provides the best opportunity for curative management.
Source: Prostate Cancer UK
Should you consider a PSA test?
There is no national screening programme for prostate cancer in the UK, but you can request a PSA blood test from your GP. You should consider asking about testing if you:
Age 50+
All men regardless of symptoms
Age 45+ (Black men)
1 in 4 Black men will develop prostate cancer in their lifetime
Age 45+ (Family history)
Father or brother diagnosed with prostate cancer
Your Prostate Cancer Specialists
Mr Bijan Khoubehi
Chairman & Consultant Urological Surgeon
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Mr Paul Cathcart
Consultant Urological Surgeon
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Professor Mark Emberton
Consultant Urological Surgeon
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Professor Clément Orczyk
Consultant Urological Surgeon
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Mr Joseph Gabriel
Consultant Urological Surgeon
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Risk Factors
Three well-established risk factors for prostate cancer are:
Increasing Age
Prostate cancer is uncommon under the age of 50, and risk rises significantly thereafter.
Ethnic Origin
Black men are at higher risk and may develop prostate cancer at a younger age. Men of East Asian origin have a lower risk.
Family History
A first-degree relative (father or brother) with prostate cancer increases risk. BRCA2 gene mutations are also associated with a higher risk of more aggressive disease.
Other potential risk factors may exist, but these are less clearly understood.
Symptoms of Prostate Cancer
Early-stage prostate cancer is often asymptomatic and may be detected incidentally through PSA testing or imaging. Symptoms, when present, typically relate to urinary function — though these are more commonly caused by benign conditions such as BPH. The following symptoms should prompt clinical evaluation:
Urinary Symptoms
- Increased urinary frequency (including nocturia)
- Hesitancy or difficulty starting urination
- Weak or interrupted urinary stream
- Dysuria (discomfort when passing urine)
- Urinary retention
- Erectile dysfunction
- Haematuria
Advanced Disease
- Persistent pain in the lower back, pelvis, or thighs
- Unintentional weight loss
These symptoms warrant clinical assessment. A raised PSA or abnormal examination finding may prompt further investigation with MRI and, if indicated, prostate biopsy.
Diagnosis
Non-invasive Investigations
The diagnostic pathway combines blood testing, clinical examination, and imaging before any biopsy is considered. Multiparametric MRI (mpMRI) is now used as the first-line imaging investigation and has significantly improved our ability to detect clinically significant cancer while avoiding unnecessary procedures.
- PSA testing (total and free/total ratio)
- Digital rectal examination (DRE)
- Multiparametric MRI (mpMRI) — first-line imaging
Invasive Investigation
Prostate biopsy remains the gold standard for diagnosis. The traditional method of prostate biopsy was the transrectal approach — biopsy via the back passage. However, this approach has largely been surpassed by the transperineal route, where the biopsy needles are passed through the perineum (the area behind the scrotum and anterior to the anus). The transperineal route is preferred due to its lower risk of sepsis and infection, and because it is more accurate at detecting prostate cancer than the transrectal approach. In addition, MRI-targeted transperineal biopsy is now often recommended to improve diagnostic accuracy even further.
PSMA PET-CT — Advanced Staging & Recurrence Detection
PSMA (Prostate-Specific Membrane Antigen) PET-CT is a highly sensitive nuclear medicine scan that detects prostate cancer cells throughout the body. It is now the gold-standard investigation for staging intermediate and high-risk disease before treatment, and for localising recurrence after a rise in PSA following surgery or radiotherapy — often detecting disease that conventional CT and bone scans would miss.
Understanding Your Grade
If a biopsy confirms prostate cancer, the tissue is graded to indicate how aggressive the cancer appears under the microscope. The Gleason score was the traditional system; this has largely been replaced by the ISUP Grade Group system (1–5), which is easier to interpret and more closely reflects prognosis.
Grade Group alone does not determine treatment. Stage (how far the cancer has spread), PSA level, and your overall health are all considered together to guide decision-making in a specialist MDT.
Treatment of Prostate Cancer
Prostate cancer often grows slowly, and not all patients require immediate treatment. Management is highly individualised, depending on cancer stage, grade (Gleason/ISUP), patient fitness, and preference.
Treatments we offer at LUS
Active Surveillance
Radical Prostatectomy
Focal Therapies (selected cases)
Other treatments
Radiotherapy (EBRT)
Brachytherapy
Hormone Therapy
Chemotherapy
Comparing Your Options at a Glance
A simplified overview to help guide your conversation with your specialist.
| Treatment | Suitable for | Urinary impact | Erectile function | Curative intent |
|---|---|---|---|---|
| Active Surveillance | Low / favourable-intermediate risk | None | None | Monitoring |
| Radical Prostatectomy | Localised to locally advanced, all risk groups | Moderate | Moderate | Yes |
| Focal Therapy | Selected localised disease | Low risk | Low risk | Yes |
| Radiotherapy | Localised to locally advanced, all risk groups | Low–moderate | Moderate | Yes |
| Hormone Therapy | Advanced, metastatic and used with radiotherapy | Minimal | Significant | Control |
| Chemotherapy | Metastatic / castration-resistant | Minimal | Minimal | Control |
Side effect profiles vary by individual. This table is a guide only — your specialist will discuss expected outcomes based on your specific circumstances.
Active Surveillance
Active surveillance is an appropriate strategy for carefully selected men with low-risk or favourable intermediate-risk prostate cancer. It aims to avoid or defer treatment-related side effects while preserving the option for curative intervention if the disease progresses. Patients are monitored through a structured programme and should be counselled that active surveillance requires ongoing commitment to follow-up.
Active surveillance typically includes:
Radical Prostatectomy
Radical prostatectomy — the surgical removal of the prostate and seminal vesicles — is an established curative treatment for localised prostate cancer. It can be performed via open, laparoscopic, or robotic-assisted approaches. Robotic-assisted (da Vinci) surgery has become the most widely adopted technique in the UK, offering greater precision, reduced blood loss, and faster recovery.
At London Urology Specialists, robotic prostatectomy is performed by highly experienced surgeons with an extensive case volume in minimally invasive prostate surgery. Learn more about our robotic prostatectomy service →
Advantages of Robotic Surgery
- 3D magnified vision and articulated instruments enabling precise dissection
- Reduced blood loss and lower transfusion rates
- Shorter hospital stay (typically 1–2 days)
- Faster return to normal activity
Oncological Outcomes
- Enables accurate pathological staging
- PSA should fall to undetectable levels post-operatively
- Facilitates early detection of recurrence via PSA monitoring
- Preserves the option for adjuvant or salvage radiotherapy if required
Outcomes in oncological control, continence, and erectile function are closely related to surgeon experience and case volume. Patients should discuss expected functional outcomes with their surgeon prior to making a treatment decision.
Focal Therapies for Prostate Cancer
Focal therapy is an emerging treatment approach that aims to target and treat only the cancerous area within the prostate, while preserving the surrounding healthy tissue. This contrasts with whole-gland treatments such as surgery or radiotherapy, which treat the entire prostate.
Focal therapy is typically considered in selected patients with localised, clinically significant prostate cancer, particularly where the disease is confined to a specific area of the gland.
Principles of Focal Therapy
- Treatment directed at the index lesion (dominant tumour focus)
- Aims to achieve cancer control while reducing side effects
- Structures responsible for urinary continence and erectile function may be better preserved
Patient Selection
Careful patient selection is essential, usually involving:
- Multiparametric MRI
- Targeted prostate biopsy
- Multidisciplinary team (MDT) discussion
Types of Focal Therapy
High-Intensity Focused Ultrasound (HIFU)
HIFU uses focused ultrasound waves to generate heat and destroy cancer cells within the prostate.
- Delivered via a probe placed in the rectum
- Typically performed under general or spinal anaesthetic
- Minimally invasive, with no surgical incisions
Irreversible Electroporation (Nanoknife)
IRE uses short electrical pulses to disrupt cancer cell membranes, leading to cell death. It does not rely on heat, which may help preserve surrounding structures.
- Performed using needles inserted through the perineum
- Conducted under image guidance
Cryotherapy (Cryoablation)
Cryotherapy destroys cancer cells by freezing the targeted tissue using cycles of freezing and thawing.
- Thin probes inserted into the prostate under imaging guidance
- Freeze-thaw cycles used to ablate the tumour
Advantages
- Minimally invasive
- Shorter recovery time compared to surgery
- Reduced risk of urinary incontinence
- Lower rates of erectile dysfunction in selected patients
- Can be repeated or followed by other treatments if required
Limitations & Considerations
- Not suitable for all patients (e.g. multifocal or high-risk disease)
- Long-term cancer control data still evolving vs. established treatments
- Requires careful follow-up: PSA monitoring, repeat MRI, follow-up biopsies in some cases
- Prior focal treatment can make subsequent surgery (salvage prostatectomy) more complex; surgery after focal treatment should only be undertaken by surgeons with extensive experience of salvage surgery
Other Treatments
The following treatments are not provided directly at London Urology Specialists but form an important part of the prostate cancer treatment pathway. We work closely with NHS and private oncology teams to ensure a seamless referral when these treatments are appropriate.
Radical Radiotherapy
Radiotherapy is an effective alternative to surgery for localised and locally advanced prostate cancer, and may also be used adjuvantly or as salvage treatment following surgery. It is typically delivered in one of two forms:
External Beam Radiotherapy (EBRT)
High-energy X-rays are directed at the prostate from outside the body, usually delivered over several weeks using modern techniques such as IMRT or VMAT. Treatment is commonly combined with a short course of hormone therapy to enhance efficacy.
Suitable for:
- Localised and locally advanced disease
- Patients who prefer to avoid surgery
- Post-operative PSA recurrence
Brachytherapy
Radioactive seeds or wires are placed directly into the prostate, delivering a high radiation dose locally while limiting exposure to surrounding structures. Low-dose-rate (LDR) seeds are most commonly used for low-risk disease.
Most suitable for:
- Low-risk, organ-confined disease
- Good urinary flow (IPSS assessment required)
Prior radiotherapy to the prostate significantly increases the technical complexity and risk of any subsequent surgical intervention. Treatment sequencing should be discussed carefully with a specialist.
Hormone Therapy
Prostate cancer cells rely on male hormones (androgens), primarily testosterone, to grow. Hormone therapy — also known as androgen deprivation therapy (ADT) — works by reducing testosterone levels or blocking its effects, slowing or stopping cancer growth.
Hormone therapy does not cure prostate cancer on its own but plays an important role in several treatment settings.
When it is used
- Combined with radiotherapy for intermediate and high-risk localised or locally advanced disease
- Primary treatment for advanced or metastatic disease
- Salvage treatment following PSA recurrence after surgery or radiotherapy
- Occasionally used before (neoadjuvant) radiotherapy to reduce tumour volume
Types of Hormone Therapy
- LHRH agonists / antagonists — injections that suppress testosterone production (e.g. goserelin, degarelix)
- Anti-androgens — tablets that block testosterone from acting on cancer cells (e.g. bicalutamide, enzalutamide)
- Surgical castration (orchidectomy) — rarely used but permanently reduces testosterone
Hormone therapy has side effects including hot flushes, fatigue, reduced libido, bone thinning, and metabolic changes. These should be discussed with your specialist before starting treatment, and bone protection and cardiovascular monitoring may be recommended.
Chemotherapy
Chemotherapy is used when prostate cancer has spread beyond the gland and is no longer responding adequately to hormone therapy alone. It is not a first-line treatment for localised disease but plays an important role in the management of advanced and castration-resistant prostate cancer (CRPC).
Docetaxel
The most commonly used chemotherapy agent in prostate cancer. Given intravenously every three weeks, usually for six cycles.
- Used alongside hormone therapy for metastatic castration-sensitive prostate cancer (mCSPC)
- First-line chemotherapy for castration-resistant disease
- Has been shown to improve survival in high-volume metastatic disease
Cabazitaxel
A second-generation taxane used when docetaxel is no longer effective.
- Used in castration-resistant prostate cancer after docetaxel failure
- Can be combined with hormone therapy agents
- Administered in a specialist oncology setting
Chemotherapy carries side effects including fatigue, hair loss, increased infection risk, and peripheral neuropathy. It is administered by a medical oncologist and requires careful monitoring throughout treatment. Decisions about chemotherapy are made within a multidisciplinary team and will depend on overall fitness and disease stage.
Follow-Up & PSA Monitoring
PSA monitoring is the cornerstone of follow-up after treatment for prostate cancer. What your PSA should do — and how quickly — depends on the treatment you have had. Regular review with your specialist allows early detection of any recurrence, when further treatment options are most effective.
After Radical Prostatectomy
- PSA should fall to undetectable (<0.1 ng/mL) within 4–6 weeks
- Checked at 8 weeks, 3-monthly for the first year, 6-monthly for 5 years, then annually thereafter
- Biochemical recurrence (recurrent prostate cancer after surgery) is defined as a PSA ≥ 0.2 ng/mL on two consecutive readings
After Radiotherapy
- PSA falls gradually over months, reaching a nadir (lowest point)
- Checked every 3–6 months initially, then annually once stable
- Biochemical recurrence (Phoenix criteria): PSA rise of 2 ng/mL above nadir
After Focal Therapy
- PSA monitoring combined with serial MRI surveillance
- Repeat biopsy considered if PSA or MRI findings raise concern
- Residual or recurrent disease can be re-treated or managed with alternative therapy
Contact your specialist promptly if you notice:
A rising PSA on consecutive tests, new or worsening urinary symptoms, bone pain, or any unexplained change in your health between scheduled reviews. Early assessment allows the widest range of treatment options.
Emotional Wellbeing & Support
A prostate cancer diagnosis — and the treatments that follow — can have a significant impact beyond the physical. Changes to sexual function, urinary control, and the ongoing need for PSA monitoring can all affect quality of life, relationships, and emotional wellbeing.
Sexual Health & Relationships
Many treatments for prostate cancer can affect erectile function, libido, and intimacy. These changes can place strain on relationships and self-image. Specialist support — including erectile rehabilitation — is available and should be discussed early.
Living with Uncertainty
Ongoing PSA monitoring can provoke anxiety around each test. It is common to feel heightened worry in the run-up to results. Acknowledging this is normal — and learning strategies to manage it — is an important part of long-term wellbeing.
Talking & Professional Support
Sharing concerns with a partner, family, or trusted friend is valuable. Prostate Cancer UK offers dedicated support lines and peer networks. Psychological counselling can also be arranged through your specialist team if needed.
Please speak to your specialist if you are experiencing significant distress — emotional wellbeing is an integral part of your overall care, not a secondary concern.
Prostate cancer is common but often highly treatable, particularly when detected early. Management should be individualised and guided by specialist multidisciplinary assessment.
Further Reading — Patient Information
Frequently Asked Questions About Prostate Cancer
Concerned About Symptoms?
Early assessment is key. Our specialist team offers rapid appointments for assessment, diagnosis, and treatment of prostate cancer.