What is prostate cancer? 

Prostate cancer is a condition where cells within the prostate gland begin to grow and multiply uncontrollably, forming a malignant tumour. It is the most common cancer in men in the UK, with around 1 in 8 men being diagnosed in their lifetime. Unlike many other cancers, prostate cancer often grows very slowly and may not cause any symptoms or health problems for many years. However, in some cases, the cancer is more aggressive and can spread to other parts of the body, such as the bones or lymph nodes. Because early-stage prostate cancer is frequently ‘silent’, understanding your risk factors and monitoring for urinary changes is vital for early detection. 

What We Will Cover in This Article 

• The biological nature of malignant prostate growth 

• Why early-stage prostate cancer often has no symptoms 

• Common risk factors, including age, ethnicity, and family history 

• The difference between slow-growing and aggressive tumours 

• How the NHS uses the PSA blood test and MRI for diagnosis 

• Common treatments: Monitoring, surgery, and radiotherapy 

• The importance of the ‘Gleason Score’ in determining care 

How Prostate Cancer Develops 

Prostate cancer typically begins in the outer part of the gland (the peripheral zone). Because it starts away from the urethra, it usually does not cause urinary symptoms in its earliest stages. This is different from benign enlargement (BPH), which starts in the centre of the gland and causes symptoms much sooner. 

If the cancerous cells continue to divide, they can eventually form a lump that may press against the urethra or grow through the outer wall of the prostate (extraprostatic extension). In the UK, doctors categorise the cancer based on whether it is ‘localised’ (contained within the gland), ‘locally advanced’ (starting to spread just outside the gland), or ‘metastatic’ (spread to distant sites). 

Identifying Potential Symptoms 

In the early stages, most men with prostate cancer have no symptoms at all. When symptoms do occur, they are often similar to those of an enlarged prostate (BPH) because the tumour is physically obstructing the flow of urine. 

• Urinary Changes: A weak flow, difficulty starting to pee, or feeling like your bladder hasn’t emptied properly. 

• Increased Frequency: Needing to urinate more often, especially during the night (nocturia). 

• Urgency: A sudden, pressing need to use the toilet. 

• Blood in Urine or Semen: Known as haematuria or haematospermia; this should always be investigated by a GP. 

• Pain: New or persistent pain in the back, hips, or pelvis can sometimes be a sign of advanced prostate cancer. 

Risk Factors and Who is at Risk 

While we do not know exactly what causes prostate cancer, several factors significantly increase the likelihood of developing the condition. 

• ‘Age is the strongest risk factor for prostate cancer. It is rare in men under 50, but the risk increases as you get older. Most cases are diagnosed in men aged 65 and over.’ 

Other key risk factors in the UK include: 

• Ethnicity: Black men have a higher risk (about 1 in 4) and are often diagnosed at a younger age. 

• Family History: Having a father or brother who was diagnosed with prostate cancer (especially before age 60) increases your own risk. 

• Genetics: Some inherited gene changes, such as the BRCA2 gene (also linked to breast cancer), can increase the risk of aggressive prostate cancer. 

Differentiation: Prostate Cancer vs. BPH vs. Prostatitis 

It is important to remember that most prostate symptoms are caused by non-cancerous conditions. However, the symptoms can look very similar. 

Feature	Prostate Cancer	BPH (Enlargement)	Prostatitis (Inflammation)
Early Symptoms	Often none	Weak flow, frequent peeing	Pelvic or genital pain
Growth Speed	Usually very slow	Gradual (over years)	Can be sudden
Cancerous?	Yes	No	No
Pain	Usually painless in early stages	Usually painless	Often involves pain/stinging
PSA Level	Often elevated	Can be elevated	Can be elevated

Diagnosis and the ‘Gleason Score’ 

If a GP suspects a prostate issue, they will use a combination of tests. These typically include a PSA (Prostate-Specific Antigen) blood test, a physical exam of the gland (DRE), and often an MRI scan. If an MRI shows a suspicious area, a biopsy may be performed. 

The samples from a biopsy are given a Gleason Score. This is a grading system (ranging from 6 to 10) that tells doctors how ‘aggressive’ the cancer cells look under a microscope. A lower score (e.g., Gleason 6) suggests a slow-growing cancer that may never need treatment, while a higher score (e.g., Gleason 9) indicates a more aggressive cancer that requires immediate action. 

To Summarise 

Prostate cancer is a complex and common condition that primarily affects older men. While the majority of cases are slow-growing and may not require immediate treatment, early detection is vital for identifying more aggressive forms while they are still curable. In the UK, the focus of prostate care is on personalised management—using PSA tests, scans, and biopsies to ensure that men receive the right level of care, whether that is ‘active surveillance’ (monitoring) or active treatment like surgery or radiotherapy. 

If you experience new urinary symptoms or blood in your urine, speak to your GP. If you have a complete inability to pass urine, call 999 immediately. 

Authority Snapshot 

This article was reviewed by Dr. Stefan Petrov, a UK-trained physician with experience in general medicine, surgery, and emergency care. Dr. Petrov has worked in various hospital departments, including urology, where he assisted in the diagnosis and management of prostate conditions. The content is aligned with the latest clinical standards from the NHS, Prostate Cancer UK, and the British Association of Urological Surgeons (BAUS), ensuring the information is accurate and safe for the public.