What is prostate cancer?

Prostate cancer grows in your prostate - a small walnut-sized gland just below your bladder, and in front of your rectum (back passage) that produces fluid which makes up part of your semen.

It’s the most commonly diagnosed cancer in men over 45 in the UK. ^{Footnote [1]}  

Prostate cancer happens when abnormal cells in your prostate start to grow out of control. These cells can then spread into surrounding tissues or organs. 

It’s not clear what causes prostate cancer but the risk increases as you get older. ^{Footnote [2]}  Some things that are known to increase the risk include:

• If your father or brother developed prostate cancer before the age of 60.
• If you’re obese (a balanced diet and regular exercise may reduce your risk).
• It’s more common if you’re over 50.

Prostate cancer symptoms ^{Footnote [3]} can be confused with those of an enlarged prostate.

You might be having some problems passing urine, such as:

• Urgently needing to go.
• Needing to go more often.
• Still trickling when you think you’ve finished peeing.
• Struggling to start peeing when you want to go.
• Just doing a trickle when your bladder feels full.
• Peeing more often at night-time. 

While these symptoms can be an enlarged prostate due to age, you need to be aware of these and any other symptoms such as:

• Blood in your urine.
• Pain as you’re peeing.
• Problems getting an erection.
• Pain in your back or pelvis.
• A urine infection.
• Tiredness.
• Weight loss with no explanation.

If something doesn’t seem normal for you, or your symptoms have increased, it’s important to visit a GP and get checked out.

If your GP thinks your symptoms might indicate prostate cancer, they’ll request some tests. 

Blood test

The first test is usually a test to check for high levels of prostate specific antigen (PSA). It’s a protein that men have in their blood made by both normal and cancerous prostate cells. High levels can indicate there’s a problem.

DRE test

Some GPs don’t like to rely on the PSA test, as PSA levels can be high for other reasons such as recent exercise and PSA levels may be normal in up to 1 in 7 cases of prostate cancer. They may ask to physically examine your prostate via a digital rectal examination (DRE). This involves gently putting a gloved finger into your bottom to feel for abnormalities. ^{Footnote [4]}

MRI scan

If your blood test shows a raised PSA level your GP may refer you to hospital for an MRI scan. ^{Footnote [5]} It’ll produce a detailed picture of your prostate for medical professionals to review and if it looks like there could be a problem, you’ll be referred for a biopsy.^{Footnote [5]}

Biopsy 

A biopsy is when tissue samples are removed from your prostate and examined under a microscope to check for cancer. 

This can be done by inserting a needle into your prostate through your back passage. As this can be uncomfortable, you’ll be given a local anaesthetic to numb the area. ^{Footnote [5]}  

The biopsy may also be performed by putting a needle into the prostate through your perineum. This is the area between your testicles and back passage. This is usually done under general anaesthetic.

The type of biopsy depends on where the abnormal cells are on your prostate.

Depending on your age, other illnesses and whether the cancer is likely to affect your lifespan, your medical team might suggest ‘watchful waiting’. This is recommended if your cancer is in its early stages, or if your general health isn’t good and the benefits of treatment are outweighed by the risks to your health.

You may be asked to undergo regular tests to keep an eye on its progression. If anything changes, your medical team will discuss treatment options.

Various treatments are available ^{Footnote [6]} including surgery, radiotherapy and drug treatments. A multidisciplinary team of doctors and surgeons will recommend the best option(s) for you. 

Surgery

Surgical removal of your prostate gland (‘radical prostatectomy’) to remove the cancer is usually offered if the cancer is confined to that local area.

As your prostate is being completely removed you may want to ask your doctor about storing some sperm, should you wish to retain fertility options for later. 

Radiotherapy

There are two types of radiotherapy that can be used for prostate cancer – these can be used on their own or alongside other treatments.

• External beam radiotherapy, where a beam of radiation is focused on the area of your body where the cancer cells are.
• Brachytherapy – internal radiotherapy. This is where small radioactive implants are placed inside your prostate gland and left there, or a radioactive substance is placed inside your prostate and then taken out.

Hormone therapy

Testosterone is a hormone made in your testicles that can help cancer cells grow. You may be offered a hormone treatment to block or lower the amount of testosterone in your body. 

This can be used alongside radiotherapy or on its own.

High-intensity focused ultrasound (HIFU)

HIFU destroys prostate cancer cells using high frequency sound waves via an ultrasound probe placed into your bottom. It is usually performed under general anaesthetic.

Chemotherapy

Chemotherapy may be offered when prostate cancer has spread beyond the area of the prostate (‘metastatic cancer’). These drugs kill cancer cells and can help to control pain and extend life.

All treatments carry some risks of complications. Your medical team will tell you what to expect:

Side effects of surgery

After having a radical prostatectomy, you’ll no longer be able to ejaculate during sex and won’t be able to father a child naturally.

You may also have erectile dysfunction (can’t get an erection), or urinary incontinence (a problem controlling your bladder to stay dry).

Side effects of radiotherapy

After having radiotherapy, you may experience some short-term problems such as:

• Diarrhoea 
• Tiredness
• Soreness around your bottom
• Cystitis (where your bladder is inflamed, and peeing is painful)
• Loss of pubic hair

In the long term though, you may get have problems getting an erection and find that you still have problems with your bottom such as diarrhoea and bleeding.

Side effects of hormone therapy

If you have hormone therapy you may have problems getting an erection, go off sex and have hot flushes.

Side effects of high-intensity focused ultrasound (HIFU)

You may have some erection problems and some pain and discomfort from the procedure. 

HIFU can cause the prostate to swell so you might need a bladder catheter (a thin tube with a bag attached to collect urine). 

Side effects of chemotherapy

These typically include fatigue, hair loss, nausea and vomiting, and infections.

You could use your health insurance cover to claim for treatment for prostate cancer. First, get a referral from your GP or through our Aviva Digital GP app^. Then you can make a claim through MyAviva, online, or call us. If we confirm your claim meets the terms of your policy, we’ll pay for the treatment directly. Just be sure to tell us if you need more tests or treatment, or if your hospital or specialist changes.

It’s good to have one less thing to worry about. It takes Aviva.

^ This service is non-contractual and can be withdrawn or amended by Aviva at any time.