Prostate cancer is the most common cancer in men in the UK, with approximately 52,000 new cases and 12,000 deaths each year. 1 in 8 men in the UK will be diagnosed with prostate cancer in their lifetime — rising to 1 in 4 for Black men. The majority of prostate cancers grow slowly and may never cause problems, but some are aggressive and require urgent treatment. Understanding risk, knowing when to get tested, and being aware of treatment options is essential for all men over 50 in the UK.
What Is the Prostate?
The prostate is a small walnut-sized gland in men, located beneath the bladder and in front of the rectum. It produces seminal fluid that nourishes and transports sperm. The prostate naturally grows with age — benign prostatic hyperplasia (BPH) is extremely common in older men and is not cancer, though it causes similar urinary symptoms.
Symptoms of Prostate Cancer
Early prostate cancer often causes no symptoms. When symptoms do occur, they are often related to the urethra (urine tube) being compressed by the growing prostate:
- Needing to urinate more frequently — especially at night (nocturia)
- Difficulty starting to urinate (hesitancy)
- Weak or interrupted urine flow
- A feeling the bladder hasn’t emptied fully
- Blood in urine or semen
- Discomfort in the pelvic area
These symptoms are more often caused by BPH (benign prostate enlargement) than cancer — but should always be assessed by a GP. Symptoms of metastatic prostate cancer include back, hip, or bone pain; unexplained weight loss; and fatigue.
Risk Factors
- Age — most cases occur in men over 50; risk increases significantly with age
- Ethnicity — Black African and Black Caribbean men have the highest risk in the UK (1 in 4 lifetime risk); men of Asian heritage have lower risk than White men
- Family history — first-degree relative with prostate cancer doubles risk; BRCA2 gene mutation significantly increases risk of aggressive prostate cancer
- Obesity — associated with more aggressive disease and worse outcomes
- Diet — high in red and processed meat; low in vegetables
The PSA Test: What You Need to Know
The PSA (Prostate-Specific Antigen) test is a blood test measuring a protein produced by both normal and cancerous prostate cells. In the UK, there is currently no routine NHS population-wide prostate cancer screening programme — unlike bowel or cervical cancer. This is because:
- PSA is not specific to cancer — it is also elevated by BPH, prostatitis, cycling, and recent ejaculation
- A significant proportion of detected prostate cancers would never have caused harm (overdiagnosis)
- Treatment side effects (erectile dysfunction, urinary incontinence) can be significant
The NHS Prostate Cancer Risk Management Programme (PCRMP)
Men aged 50 or over can request a PSA test from their GP after receiving information about its benefits and limitations. This is known as the PCRMP — it is not active screening, but informed choice. Men at higher risk (Black ethnicity, family history of prostate cancer or BRCA2 mutation) should discuss earlier testing:
- Black men are advised to discuss PSA testing from age 45
- Men with a first-degree relative diagnosed with prostate cancer under 60 from age 45
- Men with BRCA2 gene mutations from age 40
PSA Levels and What They Mean
- 0–3.0 ng/mL — generally considered normal for men under 60 (though some labs use age-specific ranges)
- 3.0–10.0 ng/mL — borderline; 1 in 4 chance of prostate cancer
- Above 10.0 ng/mL — high; greater than 50% chance of prostate cancer
A high PSA alone does not diagnose cancer — but triggers further investigation. PSA velocity (rate of rise) and PSA density (PSA adjusted for prostate volume) are also used in risk assessment.
Diagnosis: MRI-First Pathway
NICE guideline DG17 transformed UK prostate cancer diagnosis in 2019 by establishing an MRI-first pathway:
- Multiparametric MRI (mpMRI) — performed before biopsy in all men with elevated PSA and suspected prostate cancer; classifies suspicion using the PI-RADS scoring system (1–5)
- Targeted biopsy — only biopsies areas identified as suspicious on MRI; significantly reduces unnecessary biopsies of insignificant cancers while improving detection of clinically significant cancer
- Template/transperineal biopsy — replacing older transrectal ultrasound (TRUS) biopsy due to lower infection risk; now standard in NHS centres
NHS Treatment for Prostate Cancer
Active Surveillance (Low-Risk Cancer)
For low-risk, localised prostate cancer (Gleason score 6/Grade Group 1), NICE recommends active surveillance rather than immediate treatment — regular PSA tests, MRI scans, and repeat biopsies to monitor the cancer. Treatment is initiated only if the cancer shows signs of progression. This approach avoids the side effects of unnecessary treatment for cancers that may never cause harm.
Radical Prostatectomy (Surgery)
Surgical removal of the prostate. Increasingly performed laparoscopically with robotic assistance (robot-assisted radical prostatectomy — RARP) in NHS specialist centres. The da Vinci robotic system is now widely available in UK urology centres. Potential side effects: erectile dysfunction (varies widely by surgical technique and pre-operative function) and urinary incontinence (usually temporary).
Radiotherapy
- External beam radiotherapy (EBRT) — modern techniques including IMRT and VMAT allow high-dose precise treatment with minimal normal tissue damage
- Stereotactic body radiotherapy (SBRT/CyberKnife) — 5 sessions over 2 weeks; equivalent outcomes to conventional radiotherapy; increasingly available on NHS
- Brachytherapy — radioactive seeds or temporary wires placed directly in the prostate; excellent outcomes for localised disease
- Proton beam therapy — available at The Christie (Manchester) and University College London Hospital (UCLH) on NHS for selected cases
Hormone Therapy (ADT)
Androgen deprivation therapy (ADT) — reducing testosterone to near-zero levels — is the cornerstone of metastatic prostate cancer treatment and is used alongside radiotherapy for high-risk localised disease:
- LHRH agonists — monthly or 3-monthly injections (goserelin/Zoladex, leuprorelin/Prostap)
- LHRH antagonists — degarelix (Firmagon), relugolix (Orgovyx — oral, once daily)
- Anti-androgens — bicalutamide, enzalutamide (Xtandi), darolutamide, apalutamide — newer agents significantly improve survival in castration-resistant disease; NICE approved
- Abiraterone (Zytiga) — blocks androgen production; NICE approved for metastatic prostate cancer
Focal Therapy
Focal treatments — treating only the cancer-bearing portion of the prostate — are available at specialist NHS centres for carefully selected patients. Options include high-intensity focused ultrasound (HIFU) and focal cryotherapy. NICE recommends these only within clinical trials or with special arrangements for data collection (IPG424, IPG424).
Living With and After Prostate Cancer Treatment
- Erectile dysfunction — affects most men after prostatectomy; penile rehabilitation (vacuum devices, PDE5 inhibitors, injections) is effective and should be started early post-surgery
- Urinary incontinence — pelvic floor exercises (Kegel exercises) should begin before and after surgery; specialist continence physiotherapy is available on NHS
- Bone health on ADT — long-term ADT causes bone loss; DEXA scans and bone protection therapy (bisphosphonates or denosumab) are NICE-recommended for men on long-term ADT
- Cardiovascular risk on ADT — ADT increases metabolic syndrome risk; exercise, diet, and cardiovascular monitoring are essential
- Hot flushes on ADT — affect up to 80% of men; venlafaxine or cyproterone acetate can help
UK Support and Resources
- Prostate Cancer UK — prostatecanceruk.org | Specialist nurse helpline: 0800 074 8383 | UK’s leading prostate cancer charity
- Prostate Cancer Research — prostate-cancer-research.org.uk | Research and patient advocacy
- Orchid Cancer — orchid-cancer.org.uk | Support for all male cancers
- Macmillan Cancer Support — macmillan.org.uk | 0808 808 0000
- PCRMP (NHS Prostate Cancer Risk Management) — gov.uk — information about the PSA test
What Major Health Sites Often Miss About Prostate Cancer
1. The UK’s MRI-First Biopsy Pathway — A World-Leading Innovation
The UK’s adoption of multiparametric MRI before prostate biopsy (NICE DG17, 2019) is a world-leading diagnostic advance. The PROMIS and PRECISION trials (both UK-led) provided the evidence base. This approach reduces unnecessary biopsies by 28% and improves detection of clinically significant cancers. Many US men still undergo TRUS biopsy without prior MRI — the UK pathway is significantly superior and patients in the UK should expect mpMRI before any biopsy in NHS centres.
2. Black Men’s Substantially Higher Risk — an NHS Priority
1 in 4 Black African and Black Caribbean men in the UK will develop prostate cancer — twice the rate of White men — and their cancers tend to occur at younger ages and be more aggressive. The NHS Equality and Diversity agenda has identified this as a priority, and Prostate Cancer UK runs specific campaigns to reach Black men in the UK. NICE and NHS England recommend Black men discuss PSA testing from age 45. This is a UK-specific context rarely addressed in depth by international health sites.
3. No Routine Screening Programme — But You Can Request a PSA Test
Unlike the US (where PSA screening is widely offered), the UK does not have a national prostate cancer screening programme — a deliberate policy decision based on harms from overdiagnosis. However, men aged 50+ can request a PSA test from their GP under the PCRMP, after receiving balanced information. This distinction creates confusion among UK patients who read US health sites suggesting routine annual PSA testing from age 50. The UK evidence-based approach involves a different conversation about individual risk and informed choice.
Related Health Guides on YourHealthXpert
- Bowel Cancer — the UK’s second most common cancer cause of death; NHS screening from age 50
- Osteoporosis — long-term ADT for prostate cancer significantly increases bone loss risk
- Anxiety and Depression — a prostate cancer diagnosis and its treatments frequently impact mental health
- High Blood Pressure — cardiovascular risk increases on long-term ADT therapy