Prostate Cancer FAQs

• Difficulty or pain when passing urine^6,8
• Erectile problems^6,8
• Seeing blood in the urine or semen^6,8

• Losing weight without good reason⁶
• Feeling very tired all the time⁶
• Having low iron levels in the blood⁶
• Feeling pain in your lower back or pelvic area⁶

As well as asking about your medical and family history, there are several tests that can help your doctor determine if you have prostate cancer, see how far it has spread, and help you both decide what to do next.⁶

Tests can be used to screen for, diagnose and stage, or monitor prostate cancer, and include:⁶

• A digital rectal examination or DRE
• A prostate-specific antigen or PSA blood test
• A biopsy
• Prostate cancer imaging
• Genetic testing in some cases

Types and stages of prostate cancer are two different things. Type usually refers to the cell type involved, and stages generally refers to how far the cancer has spread within the body. 

In terms of types, most prostate cancers are adenocarcinomas. These are so-called because they arise in the glandular tissue of the prostate. Other types of prostate cancer include small cell carcinomas, neuroendocrine tumors (NETs), transitional cell carcinomas and sarcomas.⁶ 

In terms of stages, prostate cancer can be very broadly separated into:⁶

• Localized prostate cancer
• Locally-advanced prostate cancer
• Advanced or metastatic prostate cancer

Localized prostate cancer means that the cancer is only seen in the prostate.⁹

This form of prostate cancer may not need any treatment at first, but if it does it is often very amenable to surgical removal or radiotherapy.⁹

Locally-advanced prostate cancer means that the cancer is no longer only found in the prostate, but that it has moved to areas that directly surround the prostate, such as neighboring lymph nodes.¹⁰

Advanced or metastatic prostate cancer means that the cancer has moved away from the prostate and spread into other areas of the body.¹¹

Metastasis is the process by which cancer moves and spreads around the body. The first place prostate cancer tends to move or metastasize to is the lymph nodes and bones, but it can also move to nearby organs such as the liver and even reach the brain.¹¹ 

When cancer occurs in several other places these are called metastases; you may also hear them referred to as ‘lesions’ or ‘mets.’¹¹

PSA testing is important because it can be an early indicator of prostate cancer, especially as there aren’t often any other signs or symptoms of prostate cancer. 

Getting a PSA test is one of the simplest things you can do to check your prostate’s health.

Prior to definitive therapy a PSA of 4 (ng/mL) is considered to be within the normal range.⁶

PSA can be raised for many reasons, not just because prostate cancer is present. 

Although a PSA above 10 (ng/mL) is a strong indicator that there could be prostate cancer it is not always the case.⁶

A single raised PSA result does not mean that you have cancer. Additional PSA or other tests such as imaging may be needed to confirm a diagnosis.

The Gleason grading system was developed in the 1960s and can sometimes be misleading. Doctors have therefore revised how they use the Gleason score by referring to Grade Groups instead.⁶

There are five Gleason Grade Groups which give an indication of how quickly the prostate cancer may grow and spread, with the lower numbers suggesting slower growth and spread and the higher numbers indicating faster growth and spread.⁶ 

Using this approach Gleason scores of 6 and under fall into Gleason Grade Group 1 and Gleason scores of 9–10 fall into Gleason Grade Group 5.⁶

The Gleason score gives a measure of the severity of prostate cancer. It is determined by looking at samples of the prostate taken from biopsies, under the microscope.⁶ 

To get a Gleason score, the cells are first graded using a scale that goes from 1 to 5 to indicate how similar to normal cells the cells in the prostate sample look.⁶ 

The more normal the cells look, the lower the score (e.g., Gleason grade 1 or 2), but the less normal the cells look, the higher the score (e.g., Gleason grade 3, 4, or 5).⁶ 

To calculate the Gleason score at least two areas of prostate tissue needs to be looked at. Each area is individually graded and then the grades are added together.⁶

For example, if one area of cells is graded as 3 and another area is graded as 5, the score will by 8. This may be written down as 3 + 5 or 5 + 3. The first number indicates the grade of the most common cell type in the sample.⁶

The Gleason score may be used to categorize prostate cancer into one of three groups:⁶ 

1. Low-grade, well differentiated prostate cancer (Gleason score 6 and lower)
2. Intermediate-grade, moderately differentiated prostate cancer (Gleason score 7)
3. High-grade, poorly differentiated prostate cancer (Gleason score 8–10)

Differentiated means how easy it is to identify or recognise prostate cells as prostate cells. So well differentiated means that you can make out that it is a prostate cell, poorly differentiated means that it is hard to tell if the cell is normal.

Prostate cancer is a very treatable type of cancer. If caught early enough, and before the cancer has spread to other parts of the body, it can also be highly ‘curable.’ ¹² 

Rather than the word ‘cure,’ however, doctors tend to call the successful treatment of cancer as being in remission. This is because there is always a chance that the cancer can come back, which is called recurrence.¹³ 

The longer you are ‘cancer free,’ the greater the chances that your cancer may not return.¹³ 

Your doctor is the best person to ask about your long term outlook or prognosis, as this depends on many things including the type of prostate cancer you have, the Gleason score or grade, your PSA level, what your treatment options are, and also your general health.¹⁴ 

Even if you have metastatic disease, your prostate cancer can often be treated, and sometimes for a long period of time.⁶

Your doctor will discuss your treatment options with you.

Prostate cancer is generally not a fast-growing form of cancer, so you may not need to be treated immediately.⁶ If this is the case then your doctor is likely to suggest that you are still monitored regularly. This is called active surveillance.⁶

There are many options for treating prostate cancer. Very generally, these include:⁶

• Surgery
• Radiation therapy which is also called radiotherapy 
• Cryotherapy
• Hormone therapy 
• Chemotherapy
• Immunotherapy
• Targeted drug therapy 

Which is most suitable in your case will depend on where your cancer is located, how ‘active’ or ‘aggressive’ your prostate cancer is, whether this is your first experience of having prostate cancer or if you are experiencing a recurrence, and what your wishes are regarding your care. 

Localized prostate cancer may be treated with surgery and radiotherapy, if it needs any treatment at all.⁹

Locally-advanced prostate cancer may be treated with radiotherapy, with or without additional hormone therapy. Surgery may also be an option for some men.¹⁰

Metastatic prostate cancer is generally treated with hormone therapy, which may be combined with chemotherapy.¹¹ 

There may also be the opportunity to receive investigational new treatments for metastatic prostate cancer by enrolling in a clinical trial.¹¹

Keeping yourself as healthy as possible is important whether or not you have been diagnosed with prostate cancer:

• Keep active 
• Eat well 
• Limit alcohol 
• Quit smoking 
• Get enough sleep 
• Manage stress
• Know your PSA level