Symptoms of Prostate Cancer
Early prostate cancer often has NO symptoms — it's detected by PSA blood test. Later symptoms include:
- Needing to urinate more often, especially at night
- Difficulty starting to urinate or weak stream
- Urgency — needing to rush to the toilet
- Blood in urine or semen
- Erectile dysfunction
- Bone pain (late stage — suggests spread)
- Unexplained weight loss (late stage)
PSA Does Not Mean CancerA raised PSA has many causes: BPH (benign prostate enlargement), prostatitis (infection), recent ejaculation, vigorous exercise, or urinary catheter. A raised PSA requires further investigation — it does not confirm cancer.
PSA Levels — Reference by Age
| Age | Normal PSA (ng/mL) | Suggest Biopsy if |
|---|---|---|
| 40–49 | <2.5 | PSA >2.5 |
| 50–59 | <3.5 | PSA >3.5 |
| 60–69 | <4.5 | PSA >4.5 |
| 70–79 | <6.5 | PSA >6.5 |
Diagnostic Pathway
- PSA blood test
- If raised: prostate MRI (mpMRI — most important next step)
- If MRI suspicious: targeted biopsy (template or TRUS biopsy)
- Biopsy gives Gleason score (6 = lowest; 8–10 = most aggressive)
- Staging: bone scan, CT if high-grade disease
Treatment Options
| Option | Best For | Notes |
|---|---|---|
| Active surveillance | Gleason 6 (low risk) | PSA and repeat biopsies — no treatment unless progresses |
| Radical prostatectomy | Localised disease, younger men | Removes prostate — risk of incontinence, erectile dysfunction |
| External beam radiotherapy (EBRT) | Localised or locally advanced | 5–7 weeks of treatment |
| Brachytherapy | Low-risk localised | Radioactive seeds implanted in prostate |
| Hormone therapy (ADT) | Advanced / metastatic disease | Reduces testosterone; significant side effects |
| Chemotherapy | Metastatic, castration-resistant | Docetaxel as first-line |
Should all men over 50 have a PSA test?
PSA screening is controversial. In the UK, there is no NHS population screening programme. Men aged 50+ can request a PSA test if they wish after being counselled about benefits and harms. Black men and those with a family history should consider screening from 45.
What is the Gleason score?
Gleason score grades how abnormal the cancer cells look under a microscope. Score 6 (3+3) = low-grade; 7 (3+4 or 4+3) = intermediate; 8–10 = high-grade, aggressive. Higher score means more aggressive behaviour.
Does prostate cancer need treatment?
Not always. Many men with Gleason 6 (grade group 1) prostate cancer can safely have active surveillance for years without treatment. The aim is to avoid over-treating cancers that would never cause harm.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.