What is prostate cancer?

Prostate cancer develops when cells in the prostate gland grow abnormally and uncontrollably. The prostate is a walnut-sized gland that sits below the bladder and produces the fluid that nourishes sperm. Prostate cancer most commonly develops in the outer zone of the gland — which is why it typically causes no urinary symptoms in its early stages.

Prostate cancer varies enormously in behaviour. Some tumours are slow-growing, low-grade, and unlikely to cause harm in a man's lifetime. Others are aggressive and require prompt treatment. The critical question — and the reason for thorough investigation — is identifying which type you have.

Key fact: Prostate cancer is not one disease. A Gleason 3+3 cancer behaves very differently from a Gleason 4+5 cancer. Treatment decisions are made based on Gleason grade, PSA, stage, age, and personal preference — not on the diagnosis alone. BAUS patient resources →

Symptoms of prostate cancer

Early prostate cancer typically causes no symptoms at all. This is why PSA testing is the primary method of early detection — and why men with no symptoms should still consider a PSA discussion with their GP.

When symptoms do appear, they are often related to urinary function — but these same symptoms overlap completely with benign enlargement (BPH):

  • Difficulty starting urination or a weak urine stream
  • Needing to urinate more frequently, especially at night
  • A feeling that the bladder hasn't emptied fully
  • Blood in the urine (haematuria) or semen (haematospermia)

Advanced prostate cancer — which has spread beyond the gland — can cause bone pain (particularly in the lower back, hips or pelvis), unexplained weight loss, or fatigue. If you have these symptoms alongside urinary changes, seek an urgent urology review.

How prostate cancer is diagnosed

01
PSA blood test
A simple blood test measuring prostate-specific antigen. A raised PSA (adjusted for age) prompts specialist review. PSA alone cannot diagnose cancer — it is the starting point for investigation. Understanding your PSA result →
02
Specialist consultation and DRE
A consultant urologist assesses your full history, performs a digital rectal examination (DRE) of the prostate, and reviews all PSA data. This guides the need for further investigation.
03
Multiparametric MRI (mpMRI)
A detailed prostate MRI assigns a PIRADS score (1–5) to suspicious areas. NICE recommends MRI before biopsy, as it identifies where to target the biopsy needle and reduces unnecessary procedures. About MRI-targeted biopsy →
04
Targeted transperineal biopsy
If MRI identifies suspicious areas (PIRADS 3–5), an MRI-fusion biopsy targets the precise location. Transperineal biopsy (needle through the perineum rather than the rectum) has a much lower infection risk and is now the preferred approach in UK specialist centres.
05
Staging scans if needed
For higher-grade cancers, CT scan of the chest/abdomen/pelvis and bone scan (or PSMA PET scan) assess whether cancer has spread to lymph nodes or distant sites. Staging determines whether treatment is curative or palliative in intent.

Understanding your Gleason score and Grade Group

The Gleason score describes how the cancer cells appear under a microscope — specifically, how different they look from normal prostate cells. The score is the sum of the two most common patterns seen in the biopsy, each graded 1–5. Modern practice uses Grade Groups (1–5), which map to Gleason scores:

GG1
Gleason 6 (3+3)
Low risk. Slow-growing. Active surveillance is often the preferred approach. May not require treatment in many men.
GG2
Gleason 7 (3+4)
Intermediate risk. Usually treated with surgery or radiotherapy, though surveillance is sometimes appropriate in older men with small-volume disease.
GG3
Gleason 7 (4+3)
Intermediate-high risk. The predominant Gleason 4 pattern indicates more aggressive disease. Treatment usually recommended.
GG4
Gleason 8 (4+4/3+5)
High risk. Prompt treatment strongly recommended. Multimodal treatment (surgery or radiotherapy plus hormone therapy) often indicated.
GG5
Gleason 9–10
Very high risk. Aggressive disease requiring prompt, often multimodal treatment. Staging scans essential.
N/A
No cancer found
Biopsy negative. Ongoing PSA monitoring with repeat MRI-guided biopsy if PSA continues to rise.

Treatment options for prostate cancer

The main curative treatments for localised prostate cancer are robotic radical prostatectomy and radiotherapy. Active surveillance is appropriate for low-risk disease. The right choice depends on your Grade Group, PSA, staging, age, overall health, and personal priorities.

Surgical treatment Robotic Radical Prostatectomy Surgical removal of the prostate using the da Vinci robotic system. Mr Ameen's Retzius-sparing technique minimises continence disruption. Over 500 cases performed — top 25% European outcomes. Full procedure guide → Non-surgical management Active Surveillance Structured monitoring for low-risk, slow-growing cancer. Regular PSA, MRI and biopsy track disease without treating it immediately. Curative treatment remains available if needed later. About active surveillance → Diagnosis first Understanding Your PSA Not sure what your PSA result means? Our comprehensive PSA guide covers age-related ranges, causes of raised PSA, velocity, and what happens next — before any diagnosis is made. PSA testing guide →
Radiotherapy (external beam radiotherapy and brachytherapy) is an equally effective alternative to surgery for localised prostate cancer and is delivered by clinical oncologists. Mr Ameen works closely with oncology colleagues and will discuss radiotherapy as a treatment option at consultation, referring appropriately if surgery is not the preferred choice.

Frequently asked questions

Early prostate cancer usually causes no symptoms. When symptoms do occur, they typically involve urinary flow — difficulty starting, weak stream, frequent urination at night, or blood in urine or semen. Advanced cancer can cause bone pain in the back or hips. Because these symptoms overlap with benign prostate conditions, only investigation (PSA and MRI) can differentiate. Many men are diagnosed through a routine PSA test with no symptoms at all.

Yes — having a first-degree relative (father or brother) with prostate cancer approximately doubles your lifetime risk. Men with BRCA2 gene mutations have a significantly higher risk of aggressive prostate cancer. Men of Black African or Caribbean ethnicity have approximately double the population risk, independent of family history. If you have a family history of prostate cancer, BRCA status, or relevant ethnicity, earlier PSA testing (from age 40–45) should be discussed with your GP or a urologist.

Cancer control outcomes are equivalent between robotic prostatectomy and radiotherapy for localised prostate cancer — neither is clearly superior. The choice comes down to side effect profiles, personal preference, and practical considerations. Surgery offers the clearest post-treatment monitoring (PSA should be undetectable); radiotherapy avoids surgery and general anaesthetic. Both affect sexual function, though differently and with different timescales. A multidisciplinary discussion — including both a urologist and an oncologist's perspectives — is the best approach for anyone facing this decision.

Prostate cancer has an excellent prognosis when caught early. 5-year survival for stage 1–2 is approximately 98–100%. For stage 3 (locally advanced), 5-year survival is around 95%. Even stage 4 (metastatic) disease is increasingly manageable with modern systemic therapies — many men live well for many years. Survival has improved dramatically over the past 30 years due to earlier detection and better treatments.

Yes — biochemical recurrence (a detectable or rising PSA after primary treatment) occurs in approximately 20–30% of men after prostatectomy and a similar proportion after radiotherapy. This does not necessarily mean the cancer has spread. After surgery, salvage radiotherapy to the prostate bed is highly effective. After radiotherapy, further treatment options include hormone therapy and focal salvage treatments. Recurrence is detected early through regular PSA monitoring — which is why lifelong follow-up matters.

Recently diagnosed, or concerned about your prostate?

Mr Ameen sees patients at every stage — from a raised PSA with no biopsy yet, to a confirmed diagnosis requiring treatment planning. Every consultation includes a clear, written care plan so you know exactly where you stand and what the options are. No referral needed privately.

Book a Consultation Call 0204 558 6750 Robotic prostatectomy →