Prostate and prostate cancer FAQs

Our Specialist Nurses receive thousands of emails and phone calls each year from men, their families and friends and health professionals asking for information about prostate cancer. The following pages give answers to some of the most common questions we receive.

If you would like to speak to our Specialist Nurses, in confidence, call 0800 074 8383 or fill in our email contact form.

Please note responses are based on UK practice. We hope this information will add to the medical advice you have had. Please do continue to talk to your doctor if you are worried about any medical issues.

Contents

Prostate problems:

Risk factors:

Diagnosis:

Treatments:

Side effects:

 

Prostate problems

 

What does 'benign enlargement of the prostate' mean?

Benign prostatic enlargement (BPE) is the medical term used to describe an enlarged prostate. It means a non-cancerous enlargement of the prostate gland.

You might also hear it called benign prostatic hyperplasia (BPH). Hyperplasia means an increase in the number of cells. It's this increase in cells that causes the prostate to grow.

An enlarged prostate is common for men after the age of about 50. About 4 out of every 10 men (40 per cent)1 over the age of 50 and 3 out of 4 men (75 per cent)2 in their 70s have urinary symptoms that are caused by an enlarged prostate.

Normal And Enlarged Prostate

Having an enlarged prostate is not the same as having cancer. Read more about the symptoms, diagnosis and treatment of an enlarged prostate.

Last updated January 2013

To be reviewed January 2015

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Risk factors

 

Am I more likely to get prostate cancer if my father had it?

Inside every cell of our body is a set of instructions called genes. These are inherited from our parents. Genes control how the body grows, works and what it looks like. Researchers have found some characteristics in genes that might be passed on through your parents and could increase your risk of developing prostate cancer.1  Only 5 to 10 per cent of prostate cancers are thought to be strongly linked to an inherited risk.2

  • You are two and a half times more likely to get prostate cancer if your father or brother has been diagnosed with it, compared with a man who has no affected relatives.3
  • There may be a higher chance of you developing prostate cancer if your relative was under 60 when he was diagnosed or if you have more than one close relative with prostate cancer.3

Last updated January 2013

To be reviewed January 2015

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Is it true that Black men are more likely to get prostate cancer?

Black men are more likely to get prostate cancer than men of other ethnic backgrounds. In the UK, about 1 in 4 Black men will get prostate cancer at some point in their lives. The reasons are not yet clear but it could be because of genetic changes passed down through generations2-8.

You can read more about the risk in Black men or download our leaflet, What do you know about your prostate? Information for African Caribbean men.

Last updated October 2013

To be reviewed May 2015

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Does masturbating increase my risk of prostate cancer

Some research suggests that masturbation and sexual activity probably don't increase your risk of prostate cancer, and might even lower it. 1,2,3 But we don't know for certain how masturbation affects your risk because there isn't much research in this area. It is a normal, healthy and enjoyable activity for many men. Read more about who is at risk.

Last updated December 2013

To be reviewed December 2015

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 Does drinking alcohol increase my risk of getting prostate cancer?

We don't know if alcohol has any specific effects on men with prostate cancer. But we do know that drinking too much alcohol can make you put on weight and causes health problems such as heart disease and some other cancers.1 The government advises that men should not regularly drink more than three to four units of alcohol a day.2

How many units are in a drink?

  • A pint of lager, beer or cider contains 2.8 units
  • A 175ml glass of wine contains 2.1 units
  • A 25ml measure of 40 per cent single spirit with mixer contains 1 unit

 Your doctor or nurse can tell you whether alcohol will affect your prostate cancer treatment. If you have urinary problems after treatment, try to cut down on alcohol as it can irritate the bladder and make the problems worse. You can find out more about managing how much you drink from NHS Choices.

Last updated December 2012

To be reviewed December 2014

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Is there anything I can do to prevent getting prostate cancer?

We don't know how to prevent prostate cancer for certain, but a healthy diet and lifestyle may be important. Eating healthily and being active can help you stay a healthy weight. This may mean that you are less likely to be diagnosed with aggressive1  or advanced2-4 prostate cancer. A healthy lifestyle can also improve your general wellbeing and reduce your risk of other health problems such as diabetes, heart disease and some other cancers.5 Read our pages on diet and your risk of prostate cancer for more information.

Last updated December 2012

To be reviewed December 2014

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Does red wine help to prevent prostate cancer?

Red wine contains natural compounds called antioxidants that may help prevent damage to cells. Antioxidants are found in the skin and seeds of grapes as well as other fruits and vegetables. Red wine contains more antioxidants than white wine because it is made with grape skin but white wine is not.

In 2005, one small study found that red wine may help to lower a man's risk of prostate cancer1. However, since then larger studies have not found this to be true2,3. Therefore there is not enough evidence at present to say that red wine helps to prevent prostate cancer.

Drinking a lot alcohol might increase your risk of prostate cancer4,5. Drinking alcohol also increases your risk of some other cancers and health problems such as high blood pressure and stroke6-8. If you are drinking alcohol, you should aim to stay within the recommended limits for your general health6-8. If you would like to know more about how diet may affect your risk of prostate cancer, read our pages about healthy living.

Last updated December 2012

To be reviewed December 2014

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Do vitamin E and selenium protect against prostate cancer?

Vitamin E

Previous research suggested that vitamin E supplements might help prevent prostate cancer and help protect against advanced cancer. More recent research has shown that it does not have this effect and might even be harmful1.  You do need vitamin E in your diet; like all vitamins it is vital for good health. The best way to get enough vitamin E is through a balanced diet, without taking supplements.

Selenium

There is evidence to suggest that selenium helps to protect against prostate cancer2,3 and advanced prostate cancer.2 Most of us in the UK don't have much selenium in our diet, but some foods are a good source of it. These include Brazil nuts, fish, seafood, liver, kidney and poultry. Taking selenium supplements doesn't appear to have any benefit in protecting against prostate cancer.2,3

Please visit our pages diet and prostate cancer for more information on improving your diet.

Last updated December 2012

To be reviewed December 2014

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Diagnosis

 

Why is there no screening programme for prostate cancer?

Screening programmes aim to spot the early signs of cancers in people who do not have any symptoms. In the UK there are screening programmes for breast, cervical and bowel cancer.

There is currently no screening programme for prostate cancer. One reason for this is that the PSA test is not reliable enough to be used as part of a screening programme. Read about the advantages and disadvantages of the PSA test.

Some studies show that screening using the PSA test could reduce the number of deaths from agressive prostate cancer but it could also increase the number of men having unnecessary treatment for slow growing prostate cancer.

In most cases prostate cancer is slow growing and may not cause any problems in a man's lifetime.1  However, some men will have fast growing cancer that needs treatment to delay or prevent it spreading outside of the prostate gland.

At the moment, if you are diagnosed with prostate cancer, there is no way to tell whether it will be fast or slow growing, so many men will have treatment. Treatment can cause significant side effects such as erectile dysfunction and urinary problems. So, screening could lead to many men having worse side effects from treatment than they would have had from the cancer itself.

Although there is currently no screening programme for all men, research is looking into how screening could be used to target men who have a higher risk of prostate cancer due to genes passed down in their families. Early results suggest that regular PSA tests could be helpful for these men, but we still need more information.2  Only a small number of prostate cancers are thought to be linked to genes. But if you have a strong family history you may want to discuss this with your GP. Read more on family history and prostate cancer.

If you are concerned about prostate cancer, you can talk to your GP about your individual risk and talk through the advantages and disadvantages of the PSA test. If you then decide that you want a PSA test, you can ask your GP for one.

Researchers have been looking at other tests that may be more helpful in diagnosing prostate cancer. These tests are not widely available but they include the following. Find out more here.

Last updated July 2012

To be reviewed July 2014

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What does 'Gleason score' mean?

If your biopsy samples contain cancer, it is graded to show how aggresive the cancer is – which means how likely it is to grow and spread outside the prostate.

Cancer cells have different patterns, depending on how quickly they are likely to grow. The pattern is given a grade from 1 to 5. This is called the Gleason grade.

Gleason score

There may be more than one grade of cancer in the biopsy samples. An overall Gleason score is worked out by adding together two Gleason grades.

The first is the most common grade in all the samples. The second is the highest grade of what’s left. When the most common and the highest grade are added together, the total is called the Gleason score.

For example, if the biopsy samples show that:

  • most of the cancer seen is grade 3 and
  • the highest grade of any other cancer seen is grade 4, then
  • the Gleason score will be 7 (3+4).

The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread. Your doctor or nurse will talk you through what your results mean. Read more about Gleason scoring.

Last updated February 2014

To be updated February 2016

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What is the 'stage' of my cancer and what does this mean?

Staging is a way of recording how far the cancer has spread. The most common method is the TNM (Tumour Nodes Metastases) system.

  • The T stage measures the tumour
  • The N stage measures whether the cancer has spread to the lymph nodes
  • The M stage measures whether the cancer has spread (metastasised) to other parts of the body.

Read more about staging.

Last updated February 2014

To be reviewed February 2016

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Where does prostate cancer spread to?

If prostate cancer spreads outside of the prostate it can spread to the area just outside of the prostate or to other parts of the body, such as the bones.

Locally advanced prostate cancer

The seminal vesicles are two glands situated behind the prostate which produce some of the fluid in semen. The lymph nodes are part of the immune system. There are lymph nodes in the groin and pelvic area, near the prostate called the pelvic lymph nodes.

For more information, read our pages about locally advanced prostate cancer.

Advanced prostate cancer

Advanced prostate cancer is cancer that has spread from the prostate gland to other parts of the body. It is also called metastatic prostate cancer. This is when tiny prostate cancer cells move from the prostate to other parts of the body through the blood stream or lymphatic system.

Prostate cancer can spread to any part of the body but it most commonly spreads to the bones and the lymph nodes (sometimes called lymph glands). More than four out of five men (80 per cent) with advanced prostate cancer will have cancer that has spread to the bones.  The lymph nodes are part of the body's immune system and carry fluid called lymph around the body. There are lymph nodes throughout the body, including in the groin and pelvic area, near the prostate.

For more information, read our pages about advanced prostate cancer.

Staging

Staging is a way of recording how far the cancer may have spread. The most common method is the TNM (Tumour-Nodes-Metastases) system. This looks at the tumour (T), lymph nodes (N) and whether the cancer has spread to other parts of the body or metastasised (M).

Read more about:

Last updated July 2012

To be reviewed July 2014

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What is the PCA3 test?

Researchers have been looking at other tests that might help to diagnose prostate cancer. These tests are not widely available and more research is needed before we can be sure how useful they are.

The PCA3 test is a urine test. Your doctor or nurse will massage your prostate and then ask you to give a urine sample. Cells from the prostate pass into the urine where they can be looked at with a special test that looks at your genes. This test might help specialists decide which men should have a biopsy, or it might be useful for monitoring men who've already had a biopsy.

At the moment the PCA3 test is only available in a few private hospitals and clinics, as we still need more research about how good it is. Read more about the tests to diagnose prostate cancer.

Last updated February 2014

To be reviewed February 2016

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What is a multi-disciplinary team (MDT)?

This is the team of health professionals or specialists involved in your care. The team may include:

  • A consultant urologist: This is a doctor who specialised in the urinary and reproductive systems. Urologists are also surgeons.
  • A consultant oncologist: This is a doctor who specialised in cancer treatments other than surgery, for example radiotherapy.
  • A consultant radiologist: This is a doctor who specialises in diagnosing medical conditions using X-rays and scans.
  • A consultant pathologist (also known as a histopathologist): This is a doctor who specialised in studying cells and tissues under the microscope to identify diseases. A pathologist will examine biopsy samples to diagnose prostate cancer.
  • A clinical nurse specialist:This is a nurse who specialises in a particular medical condition. They are also sometimes known as key workers.
  • A key worker: This is your main point of contact: This is usually your specialist nurse but may be another member of the multi-disciplinary team. They help to coordinate your care and can guide you to the appropriate team member or sources of information.

Last updated July 2012

To be reviewed July 2014

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Treatments

 

How will I know my cancer is spreading if I am on active surveillance?

Active surveillance involves monitoring your prostate cancer with regular tests, rather than treating it straight away. This means you can avoid unnecessary treatment, or delay treatment and the possible side effects.

The tests aim to find any changes that suggest the cancer is growing. The tests used vary from hospital to hospital, but you may have the following:

  • a prostate specific antigen (PSA) blood test every three to six months
  • a digital rectal examination (DRE) every six to 12 months
  • a prostate biopsy about a year after you were diagnosed, and then every few years
  • an MRI scan if your PSA test or DRE results suggest the cancer is growing.

Repeat biopsies aren’t done by every hospital – some will only do them if an MRI scan suggests the cancer is growing.

If the results of the tests show your cancer has grown, you’ll be offered treatment which aims to cure the cancer – for example, surgery or radiotherapy.For further information, please read our page on active surveillance.

Last updated June 2014

To be reviewed June 2016

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How can I find out if my consultant is a good surgeon?

The most common side effects of surgery for prostate cancer are difficulty getting and keeping an erection (erectile dysfunction) and leaking urine (urinary incontinence). The risk of getting these side effects depends on your overall health, the stage and grade of your cancer and also your surgeon's skill and experience.

Your surgeon should be able to give you information about how many operations they have done, the outcomes of these and the rate of side effects. Research suggests that surgeons who do at least 20 radical prostatectomies each year, and ideally more than 35 a year, have better results, including lower rates of side effects.1   Hospitals should carry out more than 50 radical operations for prostate or bladder cancer in a year.2

If you are worried, ask your surgeon how many of these operations they have done and how many do they do each year. For more information please read our pages about surgery.

Last updated September 2012

To be reviewed September 2014

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Is robotic surgery better than surgery by hand?

Robot-assisted surgery to remove your prostate is relatively new and is only available in some hospitals in the UK. If your hospital does not carry out robot-assisted surgery, they may be able to refer you to one that does.

All types of surgery appear to be as good as each other in treating prostate cancer1  and have similar side effects. Your doctor or nurse can tell you which types of operation are available in your area. For further information please read our pages about surgery.

Last updated August 2012

To be reviewed August 2014

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Should I have surgery or radiotherapy?

There may be more than one treatment that is suitable for you. Your choice of treatment will depend on your test results, personal preferences and a number of other factors.

Surgery (radical prostatectomy)

  • This is an operation to remove the whole prostate gland. There are several types of operation: laparoscopic (keyhole) surgery
  • traditional open surgery, and
  • robotic-assisted keyhole surgery.

You can read more about radical prostatectomy, the different types of operation and possible side effects in our pages about surgery.

External beam radiotherapy (EBRT)

This treatment uses high energy X-ray beams to destroy the cancer cells. The X-ray beams are directed at the prostate from outside the body.

You may be offered hormone therapy for several months before starting radiotherapy. This is to shrink the prostate and help make the treatment more effective. In some cases you may continue hormone therapy for two to three years after radiotherapy.

For more information about EBRT, including the possible side effects, read our pages about external beam radiotherapy.

Last updated July 2012

To be reviewed July 2014

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What is abiraterone?

Abiraterone (Zytiga®) is a new type of hormone therapy for men with advanced prostate cancer that has stopped responding to other hormone therapy. It is suitable for men who have already had docetaxel chemotherapy and whose cancer has started to grow again. Abiraterone may help some men to live longer.1  It can also help control symptoms.

Abiraterone is taken as a tablet and works by stopping the production of testosterone. You will also take a steroid called prednisone to reduce the risk of side effects. Side effects of abiraterone include fluid retention, high blood pressure, liver problems and a lower than normal level of potassium in the blood.2  This could make you feel tired and you may be a risk of a fast irregular heartbeat. You should contact your doctor if you experience this. You will have your blood pressure checked regularly, and have blood tests to check how well your liver is working.

Abiraterone is also effective in men who have stopped responding to other types of hormone therapy but have not yet had chemotherapy.3  However it is not widely available in the UK for these men. If your doctor thinks it is suitable for you, they may be able to apply for you to get it.

Last updated October 2012

To be reviewed October 2014

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How do oestrogens treat prostate cancer?

You may be given oestrogen to treat your prostate cancer if your original hormone therapy stops working. Diethylstilbestrol (Stilboestrol®) is a tablet that is similar to the hormone oestrogen. Oestrogen is a hormone found in both men and women, but women usually produce more. Diethylstilbestrol can be used to treat prostate cancer that is no longer responding to other types of hormone therapy.

Diethylstilbestrol can cause similar side effects to other types of hormone therapy, such as breast swelling and tenderness. A low dose of radiotherapy to the breast area can prevent this. You can read more about this and other side effects in our booklet, Living with hormone therapy: A guide for men with prostate cancer.

Diethylstilbestrol can also increase your risk of circulation problems, such as blood clots.1  You will usually take drugs such as aspirin or warfarin to reduce the risk of blood clots.2  You may not be able to take diesthylstilbestrol if you have a history

of high blood pressure, heart disease or strokes. Your doctor or nurse will discuss this with you and can explain the risks and benefits.

Last updated October 2012

To be reviewed October 2014

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Will I have to have chemotherapy?

You will only be offered chemotherapy if your cancer has spread out of the prostate to other parts of the body (advanced or metastatic prostate cancer) and is no longer responding to another treatment called hormone therapy.

Chemotherapy does not get rid of prostate cancer, but aims to shrink it and slow down its growth. This helps some men to live longer, and can help to control or delay symptoms such as pain.

Chemotherapy isn't used to treat prostate cancer that is contained within the prostate (early or localised prostate cancer) because there are other treatments that are more effective, such as surgery and radiotherapy.

If you would like to know more about treating prostate cancer with chemotherapy, read our page about chemotherapy. Or, if you are unsure about the stage of your cancer and your treatment options, read our treatment pages.

Last updated January 2014

To be reviewed January 2016

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Side effects

 

Can I have side effects from radiotherapy four years after treatment?

Like all treatments, radiotherapy has side effects. Most short term side effects will settle down after your radiotherapy treatment has finished. But you can have later side effects that develop several months, or even years, after you finish your treatment. These side effects can be long term. They include loose stools, pain around the abdomen and bleeding from the back passage. For a full list of symptoms, read our pages about radiotherapy.


Older age, diabetes, previous bowel or prostate surgery, and previous bladder and bowel problems can all increase your risk of getting long term side effects. Speak to your doctor or nurse about your own risk.

Last updated July 2012

To be reviewed July 2014

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When will I stop leaking urine after surgery?

Surgery may weaken some of the muscles and damage nerves that help you control passing urine. This can cause you to leak urine. You may leak a few drops when you exercise, cough or sneeze (stress incontinence). Some men may leak larger amounts of urine and need to wear absorbent pads or pants, especially in the weeks after the operation. The risk of urinary problems will also depend on other factors such as your age.

You may continue to leak urine for several months after surgery.1 This is usual. Pelvic floor muscle exercises may help you regain control of your bladder more quickly after surgery. 2,3   You may need to practise the exercises for up to three to six months after your operation before you see an improvement in your symptoms.  And you may find it helps to continue doing pelvic floor muscle exercises regularly. For more information about pelvic floor muscle exercises and how to do them, read our Tool Kit fact sheet, Pelvic floor muscle exercises [PDF].

Urinary symptoms should improve with time and most men will notice an improvement three to six months after surgery. However, some men may still have problems with leaking urine a year after having surgery.

There are treatments available that can help manage urinary problems, as well as things that you can do yourself. You can read more about these in our Tool Kit fact sheet, Urinary problems and prostate cancer. You can also call our Specialist Nurses on our confidential helpline.

Last updated August 2012

To be reviewed August 2014

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How can I manage incontinence when travelling abroad?

Incontinence after prostate cancer treatment could affect your travel plans. This should not stop you from travelling but it might affect where you go and what sort of things you do while you're away. Here are some tips for planning your trip.

If you have urinary problems and use pads, make sure you pack enough for your trip and a few extra in case of delays.

  •  Pack extra pads and medicine in your hand luggage in case your suitcase gets lost.

If you use a catheter:

  • take a spare catheter with you
  • take plenty of extra drainage bags or catheter valves
  • speak to your specialist nurse about caring for your catheter while you are away
  • ask your doctor for a letter that explains what your equipment is for. This is called a medical validation certificate and it might make things easier if customs officials decide to search your bag.

Tell your travel company about any special needs you have. They may be able to help or give you a seat close to the toilet.

Find out how you can have your clothes washed if needed at your destination.

If you are worried about leaking during the night, ask your hotel or accommodation if they can provide a protective sheet for the bed.

Drink a little less while you are on holiday but take care to stay hydrated, especially if it is hot weather. Read more about travelling with prostate cancer.

Last updated January 2013

To be reviewed January 2015

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Is there anything I can do before and after surgery to help keep my erections?

If you have surgery to remove the prostate (radical prostatectomy) there is a risk that you may have problems getting an erection after your treatment. There are things you can do before and after surgery to help avoid this:

Ask your surgeon if they will be able to do a nerve-sparing prostatectomy. There are two bundles of nerves that control erections on either side of the prostate. Saving these nerves during surgery increases the chances of keeping erections afterwards. However, nerve-sparing surgery is only suitable if your cancer has not spread outside of the prostate. And, sometimes the nerves can only be saved on one side. Even if your surgeon does save the nerves, you may still have problems getting an erection.

The likelihood of having erection problems depends on several things such as your age, the strength of your erections before surgery, other medical conditions such as high blood pressure or diabetes, and whether you smoke.1,2

At first, most men find it difficult to get an erection strong enough for sexual intercourse and it can take anything from a few months to three years for erections to return.3 Erections are often not as good as they were before surgery and some men will never get back the ability to maintain an erection without the help of artificial methods such as vacuum pumps or tablets.4

There are treatments available to help with erection problems. These include tablets called PDE5 inhibitors (brand names: Viagra®, Cialis® or Levitra®), vacuum pumps, injections and pellets. You will not be prescribed PDE5 inhibitors if you are taking medicines called nitrates for a heart problem. Your doctor may refer you to an erectile dysfunction clinic for treatment and advice for erection problems.

Your doctor may suggest that you start treatments for erection problems in the first few weeks after surgery. Even if you are not ready to start any sexual activity yet, some research suggests that starting treatment soon after surgery may improve your chances of getting erections later on.5,6 You may hear this called penile rehabilitation.

If you are able to get erections you will not be able to ejaculate. This is because the prostate gland and seminal vesicles, which produce the fluid in the semen, are removed during the operation. Instead you may have a 'dry orgasm' where you feel the sensations of orgasm, but do not release any semen from the penis. This may feel different to orgasms you are used to.

You can read more about erection problems following surgery and ways to manage these in our pages about sex and prostate cancer.

Last updated August 2012

To be reviewed August 2014

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How can I get an erection after treatment?

Some treatments for prostate cancer can damage the nerves and blood vessels that are needed for an erection. Treatments that can have this effect include surgery, external beam radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) and cryotherapy.

All types of hormone therapy can cause erection problems because hormone therapy can reduce your desire for sex (libido).1 

Many of the treatments for erection problems work by improving the flow of blood to the penis.

The treatments are:

  • tablets
  • injections
  • pellets
  • vacuum pump
  • surgical implant
  • sex therapy.

Because getting an erection also relies on your thoughts and feelings, a combined approach to erection problems often works well.2-4 Try getting some medical treatment as well as tackling any worries or relationship issues you may have. There are lots of ways to do this, so pick what works best for you. It may be talking to someone close to you, seeing your nurse or getting some counselling or sex therapy.

Read our information about sex and prostate cancer to find out more about treatments for erections problems.

Last updated December 2012

To be reviewed December 2014

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Does stopping hormone therapy from time to time help to reduce the side effects?

Stopping hormone therapy from time to time is called intermittent hormone therapy. You might be able to stop treatment when your PSA level is low and steady, and start it again when your PSA starts to rise. You might avoid side effects while you're not having treatment, but it can take several months for the side effects to wear off.

You can have intermittent hormone therapy for as long as it continues to work. Your doctor or nurse will tell you when you should stop treatment, and when to start again.

Intermittent hormone therapy may be just as effective at treating prostate cancer as continuous treatment, but we need more research into this.1,2 It might not be suitable for all men.3 Speak to your doctor or nurse about whether it might be an option for you.

Last updated May 2013

To be reviewed May 2015

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Why do I feel so low now that I'm having hormone therapy?

Hormone therapy itself can affect your mood. Some men find that they feel more emotional than usual or just feel ‘different’ to how they felt before. Some men find that they cry a lot. Others experience mood swings, anxiety or depression. Just knowing that these feelings are caused by hormone therapy can help.

Some of the side effects of hormone therapy can also be difficult to come to terms with. Physical changes, such as putting on weight, or changes to your sex life might make you feel different about yourself.

Things in your day-to-day life may change because of the hormone therapy. Your role in your relationships with your partner, family and friends might change. Or you might be too tired to do some of the things you used to do.

If you often feel tearful or low, or you find you get angry more easily, start drinking more or stop taking care of yourself, you may be depressed. If you recognise these kinds of changes in yourself, there are things that can help. Speak to your GP or doctor or nurse. If you need to speak to someone immediately, you could ring the Samaritans on 08457 90 90 90.

You may find it helps to talk to your family or friends. Or you could speak to one of our Specialist Nurses, or your GP, doctor or nurse.

Or you could try talking to someone who’s been there. We have volunteers who have had hormone therapy and can understand what you’re going through. There are also support groups across the country, where you and your family can meet others affected by prostate cancer. Or you could join our online community where you can talk to men with prostate cancer and their families.

Read more about the side effects of hormone therapy and how it affects your mood.

Last updated November 2013

To be reviewed May 2015

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How can I manage hot flushes?

Hot flushes are a common side effect of hormone therapy.1 They can vary from a few seconds of feeling overheated to several hours of sweating. Hot flushes can be similar to those women get when they’re going through the menopause.

If hot flushes disrupt your everyday life, there are a number of things you can do to help manage them. These include lifestyle changes, medicines and complementary therapies. Find out more about managing hot flushes in our booklet, Living with hormone therapy: a guide for men with prostate cancer.

Last updated October 2013

To be reviewed May 2015

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What causes lymphoedema and how can I stop the swelling?

Lymphoedema is caused by a blockage in part of the body's immune system called the lymphatic system. This causes fluid to build up in the body's tissues, causing swelling. This is lymphoedema. 

Some of the lymph nodes are in the groin and pelvic area - near the prostate. The cancer might spread to the lymph nodes or to surrounding tissues and press on the lymph vessels. Treatments for prostate cancer can also affect the lymphatic system. You may be at greater risk of lymphoedema if you have had surgery or radiotherapy to the lymph nodes. 

What can help?

Speak to your nurse or GP if you have any of the symptoms. Treatments can manage it, although they cannot cure it. They are most effective if started early. You may be referred to a specialist lymphoedema nurse.  Click here to read about treatments which might help.

Last updated January 2013

To be reviewed January 2015

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I am 40 years old and recently noticed blood in my sperm. Could this be a sign of prostate cancer?

Blood in the semen (Haematospermia) is not uncommon and may affect men of any age after puberty.

It may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive system. Sometimes this happens only once and a cause is never determined. As a symptom on its own, it is rarely associated with cancer. We do however suggest you make an appointment to see your GP so he or she can physically examine you and carry out some simple tests.

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I was diagnosed with chronic prostatitis three months ago. My doctor gave me tablets but I still have pain. What can I do?

Prostatitis can be caused by an infection or inflammation of the prostate gland. It can cause pain in the lower back, penis and the area between the anus and testicles (the perineum). In severe cases it may cause fever and burning when you pass urine. If your symptoms last for longer than a few weeks you may have chronic prostatitis. Chronic prostatitis may be due to infection that has not responded to treatment (bacterial). However, in about 95% of cases, there will be no infection present. This is called nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS).

Nobody knows what causes CPPS but both physical and psychological factors seem to cause the symptoms. There appears to be a connection between raised levels of stress and anxiety and CPPS but this does not mean that CPPS is "all in the head". If you are feeling stressed and depressed, you may get physical symptoms that trigger CPPS.

The symptoms of CPPS vary from man to man but may include pain between the scrotum and anus (perineum), pain in the stomach, pain in the penis, especially the tip, pain in the testicles, pain in the back passage (rectum) and lower back and pain when you ejaculate.

There is no single recommended treatment for CPPS. There is some evidence that drug treatments may be useful. These include antibiotics, alpha-blockers, finasteride and anti-depressants such as fluoxetine.

The following suggestions are not proven as effective treatments but some men may find them helpful:

  • Regular ejaculation
  • Exercises designed to relax the muscles of your pelvic floor and abdomen
  • A treatment called the Stanford Protocol which combines medication, psychological and physical therapies to break a cycle of pain, anxiety and tension that appears to cause CPPS in some men.
  • Prostate massage
  • Warm baths
  • Exercise
  • Cognitive behavioural therapy
  • Avoiding activities which may provoke attacks such as cycling.

You may be offered a single treatment or several treatments at once. CPPS is not the same for everyone so your treatment will be tailored to you.

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I have been told that I have benign enlargement of my prostate – what does this mean?

The prostate gland tends to enlarge in men from about 50 years onwards. This enlargement is known as BPH (Benign Prostatic Hyperplasia). Nearly half (around 43%) of men over the age of 65 have either urinary symptoms or a reduced urinary flow due to BPH. BPH is the benign (non-cancerous) overgrowth of prostate cells. The overgrowth and enlargement of the gland can cause a narrowing or constriction of the urinary pipe (urethra) which passes through the middle of the prostate. This narrowing can reduce the urinary flow and the stream of urine can become weaker. Some men find that it is more difficult to empty their bladder.

If symptoms of BPH are mild then treatment may not be necessary. Medication is often used to ease symptoms and prove very effective for many men. Sometimes symptoms of BPH can be quite troublesome and need treating with laser or surgery.

Having benign enlargement of the prostate does not increase your risk of prostate cancer.

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My Father has been diagnosed with prostate cancer at the age of 58, does this increase my chance of developing prostate cancer?

Having a close family member diagnosed with prostate cancer does increase your chance of developing the disease.

You are two and a half times more likely to get prostate cancer if your father or brother has been diagnosed. The risk increases to about four times the average if your relative was under the age of 65 when they were diagnosed.

The younger a man is when diagnosed or if several members from the same side of the family have been affected, then it could be a sign that there is a faulty gene running in the family. However, only a small number of prostate cancers (5-10%) are thought to be due to an inherited gene. Researchers continue to work trying to identify faulty genes that could cause an increased risk of developing prostate cancer. So far research has not identified a specific 'prostate cancer gene' that could be the cause in most cases.

Men with a family history of prostate cancer may want to discuss their risk of developing prostate cancer with their GP.

Please visit our page on how prostate cancer is diagnosed for further information on tests and investigations.

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Where does prostate cancer spread to?

The most common place for prostate cancer to spread to is the bones rather than other organs.

Prostate cancer can spread to the area just outside the prostate gland (locally) or to other parts of the body.

Local spread, often called locally advanced prostate cancer, can affect;

  • The seminal vesicles (glands near the prostate gland that store and produce some of the fluid in semen).
  • Nearby lymph nodes (small bean-shaped structures that are part of the body's lymphatic system , which helps the body to fight disease and infection).
  • The bladder or rectum (back passage) but this is less common.

Prostate cancer can also spread to other parts of the body, also known as advanced or metastatic prostate cancer. This can affect;

  • Distant lymph nodes.
  • The bones.
  • Less commonly the lungs and liver.
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Is it true that African-Caribbean men are more likely to get prostate cancer?

Yes, prostate cancer is more common in Black African and African Caribbean men. In the UK African Caribbean men are almost three times as likely to develop prostate cancer as white men. Researchers are looking at what may be the cause of this increased risk, but diet and genes are thought to play an important role.

Prostate cancer generally affects men over the age of 50 and is rarely found in younger men. With this in mind, it is important that African-Caribbean men are aware of their increased risk and seek the advice of their GP should they be concerned.

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Can you tell me more about the treatment for small cell carcinoma of the prostate?

Yes, treatment for small cell carcinoma is often different to the treatment for more common prostate cancers. This is because of the way small cell tumours behave.

The vast majority of prostate cancers are adenocarcinomas which affect the glandular cells of the prostate. Small cell carcinoma is a very rare cancer of the prostate. This kind of cancer is made up of small round cells that typically form at nerve cells. Less than two per cent of prostate cancers are small cell carcinomas.

Small cell carcinomas behave differently and are more likely to spread than the more common adenocarcinoma of the prostate.The most common part of the body for adenocarcinoma of the prostate to spread to is the bone. Small cell cancers are more likely to spread to other organs in the body, such as the lungs or liver.

Men with small cell carcinoma often have a normal PSA level even if the cancer is at an advanced stage.

Treatment for small cell carcinoma of the prostate will depend on the stage of your cancer. In other words, how far the cancer has spread.If the cancer has not spread beyond the prostate gland, surgery is a treatment option. Chemotherapy is usually given before or after surgery to reduce the risk of the cancer coming back.

Small cell cancers have often spread beyond the prostate gland when they are diagnosed because the PSA level is often normal. If the cancer has spread outside the prostate gland the main treatment would be chemotherapy. Unlike adenocarcinoma of the prostate, small cell carcinoma is more likely to respond to chemotherapy than to hormone therapy.

If the cancer has spread beyond the prostate, the aim of the treatment is to control the cancer and any symptoms you may have. Radiotherapy may also be used to shrink the prostate and help to control the cancer and to help with symptoms.

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Why is there no screening programme for prostate cancer?

Screening men for prostate cancer would involve measuring the PSA level of all men in the 'at risk' age group (over 50 years) without any symptoms of prostate cancer.

The most important part of a screening programme is a simple and reliable test. Unfortunately there is not a single reliable test for diagnosing prostate cancer. There remains is a great deal of medical debate over the value of the PSA test as a screening test.

All men have some PSA in their blood and the level can be affected by several factors including the size of the prostate, age, infection and inflammation. The PSA test alone can not diagnose prostate cancer but it can indicate a problem with the prostate. A normal result does not rule out prostate cancer and similarly a high result does not always mean you have prostate cancer.

Unlike most cancers, prostate cancer can be present for years. Most prostate cancers are slow growing and a large number of men who have prostate cancer will go through life without any symptoms or shortening of their life span. On the other hand some prostate cancers are more aggressive and may spread. Currently there is no reliable way of knowing which prostate cancers will cause symptoms or be life threatening.

Treatment for prostate cancer may cause unpleasant side effects such as erectile dysfunction and incontinence. Most specialists feel screening could lead to a large number of men having worse effects from their treatment than they would have had from their disease. However for some, with more aggressive prostate cancer, early diagnosis may be essential.

Although there is no screening programme for prostate cancer in the UK any man over the age of 50 is entitled to ask his GP for a PSA test. The doctor should give information on the advantages and disadvantages of the test to help a man decide if he wants to go ahead with the test.

Men over the age of 50 who have symptoms of prostate cancer will be offered the PSA test as a routine part of their investigations.

For further information, please read our page on the PSA test.

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What is the PCA3 test and where can I find out how to get it?

PCA3 is short for Prostate CAncer gene 3. PCA3 genes in the prostate cells make the cells produce a protein. When prostate cancer cells are present more of this particular protein is produced.

The PCA3 test is a urine test which measures the PCA3 protein commonly expressed in prostate cancer. The prostate gland is massaged to release prostate cells into the urine. This is done in a similar way to a digital rectal examination. A urine sample is then taken to be tested.

Further research is being done to look at how accurate the PCA3 test is and when it is most appropriate to use.

The test appears to be most suitable for men with raised PSA levels following a negative prostate biopsy. It is carried out to provide additional information as to whether a repeat biopsy is needed and does not in itself diagnose cancer. If a man has a positive PCA3 test result, he will still need to undergo a prostate biopsy.

Currently the PCA3 test is not available on the NHS and costs over £300. The following laboratories offer this test privately. You can contact them directly for further information including how to obtain the test. You may also wish to discuss the PCA3 test with your doctor.

For more information on the PCA3 test, read our position statement.

Bostwick Laboratories
Fitzroy Square
London, W1T 5HE
Telephone: 020 7255 9700

The Doctors Laboratory
60 Whitfield Street
London, W1T 4EU
Telephone 020 7307 7373

Medi-Lab
Michigan Avenue
Salford Quays
Manchester M50 2GY
Telephone 0161 877 6336

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What does ‘Gleason score’ mean?

Gleason score is based on how prostate cancer cells look under the microscope and is a way of predicting how prostate cancer may behave.

A specialist doctor, called a Pathologist, looks at prostate cancer cells under the microscope and grades them according to how abnormal the cells appear. The cells may be at different stages of development, with some behaving more aggressively than others. The Pathologist will look for the most common types of cancer cell patterns. These are given a Gleason grade between 1 to 5, with 5 being the most aggressive.

The grades of the two most common types of cell are then added together to give the total Gleason Score.

For further information, please read our page Gleason grading scores.

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I have been told the stage of my cancer is T2 M0 N0. What does this mean?

Staging is a way of recording how far the cancer may have spread. The most common method is the TNM (Tumour-Nodes-Metastases) system. This will allow your doctor to describe how far the cancer may have spread and will help your specialist team decide what the best treatment options are. This system separately assesses the tumour (T), lymph nodes (N) and secondary cancer or metastases (M).

  • T = Tumour - How far the cancer has spread in the prostate gland and nearby tissues. This is measured by a Digital Rectal Examination (DRE).
  • N = Nodes - Whether the cancer has spread to the lymph nodes. This is measured using an MRI or CT scan. This stage may not be measured if it does not affect your treatment options.
  • M = Metastases - Whether the cancer has spread to other parts of the body, such as the bone. This is measured using a bone scan. This stage may not be measured if it does not affect your treatment options.

Numbers are used together with each of the letters to describe where the cancer is in the body.

T stage

  • T1 The tumour cannot be felt
  • T2 The tumour can be felt but it is contained within the prostate
  • T3 The tumour can be felt breaking through the capsule of the prostate gland
  • T4 The tumour has spread to nearby organs, such as the bladder neck, back passage or pelvic wall

N stage

  • NX The lymph nodes were not measured
  • N0 The lymph nodes do not contain cancer cells
  • N1 The lymph nodes contain cancer cells

M stage

  • MX The spread of the cancer was not measured
  • M0 The cancer has not spread to other parts of the body
  • M1 The cancer has spread to other parts of the body

Therefore a cancer described as T2 N0 M0 would be a cancer that can be felt but is contained within the prostate gland. It has not spread to the lymph nodes and it has not spread to other parts of the body.

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What is a multi-disciplinary team (MDT)?

The diagnosis and treatment of cancer requires a team of experts with different skills and training. This team is called a multi-disciplinary team (or MDT for short) and includes health professionals who specialise in diagnosing and treating cancer. You may not meet all the members of the team, but they will be involved in planning your care.

Each MDT works by following national guidelines or rules on how they should work with each other, with your GP and with the other specialist services. The teams are there to make sure that each patient is given the same high standard of care and has the most appropriate tests and treatment, no matter who their GP is or which hospital they attend.

It may include the following people:

Consultant urologist

This type of doctor is a surgeon who specialises in the urinary system and male reproductive system.

Consultant oncologist

This type of doctor specialises in treating cancer. Clinical oncologists specialise in radiotherapy but may also have expertise in chemotherapy (drug treatment). Medical oncologists specialise in chemotherapy. The oncologist advises the team about the non-surgical treatments you could have.

Consultant radiologist

This is a doctor who is an expert in carrying out and interpreting x-rays and special scans, for example, Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) scans. The Consultant Radiologist can also advise the team about which tests you should have.

Consultant histopathologist or pathologist

This is a doctor who is an expert in looking at tissue samples under a microscope to see if cancer cells are present, and if so the type of cancer. This helps to work out how the cancer cells might behave, which is very important in deciding on the best treatment.

A cancer nurse specialist

This is a nurse who is an expert in the care and support of people with cancer. The nurse specialist can provide support, information and help you to manage difficult symptoms. He/She can also liaise between all the members of the team, you, your family, your GP and community staff.

Macmillan palliative care specialist nurse

A nurse who is specially trained to help you and your family achieve the best quality of life. This is called palliative care and includes managing your symptoms and giving emotional support.

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Can you tell me more about the side effects of oestrogen as a treatment for prostate cancer?

After a period of hormone treatment prostate cancer cells can become used to the hormones and so begin to grow again. Your doctor will be able to tell this by a rise in your PSA level. The amount of time it takes for cancer to become resistant to hormones varies from person to person. It can be quite a short time in some men - only a few months - and in others it can take several years. On average this may happen after around two years.

When your cancer becomes hormone resistant it can be a worrying time, but there are other treatments available which can help to control the progression of the disease. One of these treatments is oestrogen.

Oestrogen is a female hormone which is used in some contraceptive pills and hormone replacement therapy (HRT) in women. In prostate cancer it has been shown to be effective at controlling the disease in some men. However like all treatments it does have side effects. The oestrogen drug often used to treat prostate cancer is called Stilboestrol and is usually prescribed in doses of between 1 - 3mg daily.

The side effects of this treatment include:

  • Erectile dysfunction (impotence)
  • Enlargement of the breast tissue (gynaecomastia)
  • Swelling in the limbs due to fluid retention (oedema)
  • Blood clots
  • Yellowing of the skin (jaundice)

If you have a problem with blood clotting (including stroke or heart disease) or liver disease your doctor may decide not to prescribe this treatment for you or you may be able to take Stilboestrol with aspirin to lower the risk. If you have any worries about starting this treatment and/or the side effects it may cause, it is important to discuss them with your doctor.

Read more about oestrogen and other hormone treatments.

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I have been offered active surveillance to monitor my cancer. How will I know if the cancer is spreading?

Many prostate cancers are not life threatening because they are small and slow-growing. Active surveillance is a relatively new way of monitoring prostate cancer, which aims to avoid unnecessary treatment in men with low-risk cancer.

It is thought a large proportion of men with early prostate cancer do not need to be treated, however at present doctors have no good way of telling which need treatment and which do not. Active surveillance aims to detect changes in the prostate cancer that may be starting to become more active and need treatment.

If you choose this option you will have regular PSA tests, usually every 3 months for 2 years, then every 6 months. You may be offered repeat biopsies every 2-3 years and regular digital rectal examinations (DRE). If there is any sign that the cancer is growing more quickly you will be offered active treatment still aimed to cure you of prostate cancer.

The choice between curative treatment and continued observation is based on evidence of the cancer changing or progressing.

Early results from clinical trials suggest that, in carefully selected cases, as many as 60-80% of men on active surveillance may never need treatment for their prostate cancer.

For further information, please read our page on Active Surveillance.

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I have not been able to get an erection since my treatment for prostate cancer. Can anything be done to help me?

Treatments for prostate cancer often affect a man's ability to have an erection. This may be because of damage to the nerves or blood vessels, which control erections. This may be the case after surgery, radiotherapy, brachytherapy or HIFU. Alternatively, hormone treatments for prostate cancer may result in a low sex drive and a lack of interest in sex, which may mean that it becomes difficult to achieve an erection.

There are a variety of available treatments for erection problems. These are discussed in our sexuality fact sheet.

If you are feel that you are having problems with erections and this bothers you, it is important that you let your consultant or specialist nurse know. They will be able to advise you on suitable treatments.

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I had a radical prostatectomy two months ago and I still need to wear a pad. When can I expect to stop leaking urine?

The time it takes to regain urinary control (continence) following surgery (radical prostatectomy) can vary from person to person.

You may experience urinary problems ranging from occasional drops of urine escaping when exercising, coughing or sneezing (stress incontinence) through to not being able to control your flow of urine at all. These side effects tend to improve over time and many men will notice a big improvement in the first few months following surgery. Within a year of surgery most men will have stopped leaking urine but a small number of men continue to have problems.

There are a number of things which may help you to regain your continence. This is discussed in detail in our Tool Kit fact sheet Urinary problems and prostate cancer.

If you are experiencing continence problems after your surgery, it is important that you let your consultant or specialist nurse know. They will be able to refer you to a specialist continence advisor if necessary.

Things to remember:

  • For most men urinary incontinence is a short term problem
  • How quickly urinary control returns varies from person to person
  • Most men will recover urinary control within three to six months
  • Although improvement can be ongoing for up to a year, most men are stop having problems well before that time
  • Pelvic floor exercises may improve your chances of regaining control of your bladder more quickly
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How soon will my husband be able to start playing sport again after a radical prostatectomy? He is very fit and runs, cycles and lifts weights.

Radical prostatectomy is major surgery, although the length of stay in hospital and the number and size of incisions will vary depending on the technique used. Your husband may be offered open prostatectomy or keyhole (or laparoscopic) prostatectomy. For further information, please read our page on surgery.

Typically men can expect to return to normal activity around a month after keyhole surgery, or around two months after open surgery. However, very strenuous activity such as weight-lifting or mountain biking may well take longer.

In addition, many men report tiredness for many months after major surgery. In some cases it may take between six months and a year to feel fully back to normal.

Your husband may also wish to discuss the issue of continence with his surgeon. For some men, it can again take many months to see an improvement in continence. Exercises that put stress on the abdominal muscles and pelvic floor such as weight lifting may make continence problems worse in the short term.

However, fitness is important and a modified fitness regime may well aid your husband's recovery as well as his mental health. It would be important that he discussed his plans in detail with his surgeon and if appropriate took advice from a physiotherapist also.

Our website has a forum where you can talk to men who have had experience of all kinds of prostate cancer treatments. You and your husband may find it useful to visit this.

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What is Abiraterone and how does it work?

Abiraterone is a new hormone therapy drug that is being tested in clinical trials for advanced prostate cancer. It is given as a tablet taken daily.

Existing hormone treatments treat prostate cancer by blocking or stopping production of the male hormone testosterone.

In a man most testosterone is made by the testicles, however a small amount is produced in other tissue and possibly by the cancer itself. In order to produce testosterone the body needs a special enzyme called cytochrome P17 (CYP17). Abiraterone blocks this enzyme so that testosterone cannot be produced.

At the present time Abiraterone is still undergoing clinical trials. To find out more about the different types and phases of clinical trials read our clinical trials fact sheet.

Researchers are looking at using Abiraterone to treat men with advanced prostate cancer that is no longer responding to hormone therapy (hormone resistant).

Both Phase 1 and 2 clinical trials have shown very promising results. The Phase 2 trial showed that in most men taking abiraterone alone their PSA level went down. It decreased by at least a half in about two thirds of men (67%) taking part in the trial. In just over a third of the men (37%) whose tumours could be measured on a scan, the cancer got smaller. After some time though the men's PSA level started to rise again.

Larger studies are now taking place.

A large phase 3 clinical trial has recruited over 1000 patients worldwide between may 2008 and April 2009 to examine the safety and effectiveness of abiraterone on men with hormone resistant prostate cancer. This trial was for men who have received chemotherapy. The trial was randomised to compare abiraterone with standard treatments. The trial is due to end in 2011.

A new trial has recently started recruiting men to study the use of abiraterone in men who are no longer responding to hormone therapy but who are in an earlier stage of the disease and who haven't had chemotherapy. The trial is for men with no symptoms or mild symptoms of prostate cancer and will compare the benefits of abiraterone plus a steroid with a placebo plus a steroid.

To find out more about these and whether or not you may be eligible for the trial you may wish to discuss abiraterone with your specialist. You can also call our free and confidential Helpline to speak to a specialist nurse. Call 0800 074 8383begin_of_the_skype_highlighting0800 074 8383end_of_the_skype_highlighting (Mon to Fri, 10am to 4pm, and Wed evenings from 7 to 9pm).

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Why is chemotherapy not used to treat early prostate cancer?

Prostate cancer is generally a slow growing cancer with cells dividing at a similar rate to healthy prostate cells. Chemotherapy works by killing rapidly dividing cells and is therefore not effective at treating early prostate cancer.

Treatment options for localised prostate cancer include active surveillance, surgery and radiotherapy (external beam or brachytherapy).

Chemotherapy may be an option for men with advanced prostate cancer when hormone therapy is no longer effective.

For further information, please read our treatments for prostate cancer page.

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I have been diagnosed with prostate cancer. I have been given the choice of surgery or radiotherapy. Which should I choose? My consultant says it is my choice, but which is best?

Treatment options for early prostate cancer are based on a number of factors including:

  • the stage of the prostate cancer
  • the grade of the cancer
  • the amount of cancer found in the biopsy sample
  • your PSA level
  • your age and overall health

It is very common to be offered a choice of treatments when diagnosed with early prostate cancer.

At present there is no convincing evidence to suggest that one treatment for early prostate cancer is superior to another. However each treatment for prostate cancer will have its own advantages and disadvantages or benefits and possible harms. Therefore your decision should be based on what is important to you.

To help you make your decision it is important to find out as much as possible about each treatment option and the impact it may have on you. Only you will know which treatment you will feel best able to cope with. There is no right or wrong decision and it is important to bear in mind you do not need to rush the decision.

Some men find it helpful to have another medical opinion to help them make their decision. Your consultant will be happy to refer you for a second opinion. It may be helpful to have the opinion of both a urologist (to discuss surgery) and an oncologist (to discuss radiotherapy).

A large study called the ProtecT study is currently underway to evaluate treatments for localised prostate cancer. It will compare surgery, radiotherapy and active monitoring and will follow men up for 10-15 years. It is hoped that this trial will give better evidence about the best way of treating localised prostate cancer.

For further information please read our pages on surgery and radiotherapy.

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I am experiencing terrible hot flushes from my hormone treatment. Is there anything I can do to reduce them?

Between five and eight out of every ten men (50-80 per cent) taking hormone therapy will get hot flushes. These give a sudden feeling of warmth in the upper body. Hot flushes can vary from a few seconds of feeling overheated to an hour of sweating that can stop you from sleeping or cause discomfort. They may happen suddenly without warning or they may be triggered by stress, a hot drink or a change in the air temperature. Some men find their hot flushes get better over time.

You can help to prevent or reduce hot flushes by cutting back on smoking, alcohol and drinks that contain caffeine, such as tea and coffee. Using light bed sheets and wearing cotton clothes, especially at night, can also make you feel more comfortable.

Recent reports have suggested that eating soy may help to reduce hot flushes. If you would like to include soy in your diet, try natural forms such as soy beans, miso, tempeh, tofu and soy milk.

Oestrogen patches have been found to help in some cases. Tablets such as megestrol acetate and cyproterone acetate also help but they can affect your liver function so this will need to be monitored. A small number of studies have found that acupuncture reduces hot flushes in some men.

Although there is no scientific evidence, some men have found that sage tea helps them to cope with hot flushes. Always tell your specialist team if you are thinking of taking herbal or complementary medicines because some of them cannot be taken alongside other medicines. Your pharmacist can also give you advice on this.

For further information please read our hormone therapy pages.

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I've heard that I can stop my hormone therapy from time to time to help reduce the side effects. Could you tell me more about this please?

Prostate cancer cells depend on testosterone to grow. Injections of a drug, called an LHRH agonist, work by stopping the brain from telling the testicles to produce testosterone. By reducing the amount of testosterone it is possible to shrink and control the growth of prostate cancer cells.

Some doctors believe that intermittent hormone therapy can be as good as continuous hormone therapy at controlling prostate cancer. Intermittent hormone therapy may involve stopping injections once the blood PSA level drops to a very low level. If the PSA level begins to rise, the drugs are started again. This process is continued as long as it continues to work. Another form of intermittent therapy involves using hormone therapy for fixed periods of time, for example, 6 months on followed by 6 months off. Your doctor will be able to advise you whether either of these approaches is suitable for you.

Clinical trials of intermittent hormonal therapy are still in progress. It is too early to say whether this new approach is better or worse than continuous hormonal therapy. However, one advantage of intermittent treatment is that for a while some men may avoid the side effects of hormonal therapy such as hot flushes and loss of sex drive. However it can take six to nine months for testosterone levels to rise and cause any side effects to wear off.

For more information, please read our page on hormone therapy.

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My husband has been on hormone injections for his prostate cancer for nine months. He has been feeling very ‘low’. Is this a side effect of the treatment?

It is understandable to feel very low at times following a cancer diagnosis and during or after treatment. This may be because of a variety of reasons including the reaction to the diagnosis, the treatment itself or a reaction to the side effects.

Hormone therapy can affect mood. Many men find they are more emotional than usual and a low mood may lead to depression.

Symptoms of depression can include feelings of hopelessness, loss of interest in usually enjoyable activities, inability to concentrate and changes in appetite and sleeping patterns. Anti-depressants are often very successfully used to treat hormone therapy related depression.

Many men find they are able to cope better with the treatment if they get help early on. It may be helpful for him to talk to family and friends about how he is feeling as well as his GP. Talking to men who have had similar experiences of treatment can also be very helpful. Please click on the following links for further information on prostate cancer support groups and our volunteers affected by prostate cancer.

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I have been diagnosed with prostate cancer and am waiting to have a radical prostatectomy. How can I find out if my consultant is a good surgeon?

Studies have shown that patients treated by experienced surgeons in centres with high volumes of patients have fewer complications following radical prostatectomy compared to those with less experience and low volumes of patients.

With this in mind many men want to ask the surgeon about his/her experience with the procedure, its outcome, and the hospital in which the operation will be performed.

Unfortunately, we have not got a reliable source for this kind of information. Ask your surgeon if you are worried. Most surgeons will be happy to share their experience and outcomes with you.

You may find it helpful to ask your surgeon the following questions:

  • How many radical prostatectomies do you do a year? (Each treatment centre should do more than 50 a year but these may be done by more than one surgeon)
  • Do you perform this surgery on a regular basis?
  • Will you try to do nerve-sparing surgery, if possible?
  • Do you keep a record of patient outcomes?
  • In your experience, how successful is surgery on its own at curing prostate cancer?
  • How many of your patients need extra treatment for cancer after surgery?
  • How many of your patients develop incontinence and erectile dysfunction?
  • Are the nursing staff used to caring for men following this surgery?

For more information please read our surgery fact sheet.

The following website has also has questions about surgeons:
Royal College of Surgeons of England.

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My husband has advanced prostate cancer and has lymphoedema in his legs. What causes lymphoedema and can you suggest any treatments that may help to reduce the swelling?

Lymphoedema of the legs is a swelling caused by the build-up of a fluid called lymph. Lymph is carried around the body in a network of vessels called the 'lymphatic system' and helps the body fight infection. Cancer-related lymphoedema may be caused by a blockage of the lymphatic system. This blockage may be caused by either the cancer itself or some treatments for cancer, for example surgery or radiotherapy.

Once lymphoedema has been diagnosed, your specialist team will discuss with you the most appropriate treatment for you.

Here are some helpful tips that may help the swelling:

  • Sit with your legs elevated on the sofa or a footstool. This will help drain fluid from the feet and lower legs.
  • Take regular gentle exercise. Muscle movements can help to move fluids around the body.
  • Keep skin well moisturised to stop it becoming dry, itchy or cracked, which can lead to infection.
  • Don't sit or lie with legs crossed.

If your prostate cancer has spread to the lymph nodes, chemotherapy or radiotherapy may be an appropriate treatment and can help to improve lymphoedema in some men.

In some areas of the country lymphoedema clinics are available to provide specialist treatment and advice. A list of centres is available from the British Lymphology Society.

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I had radiotherapy for prostate cancer 4 years ago. I recently passed blood from my back passage and my doctor says this is likely to be due to the radiotherapy. Can this happen so long after my treatment?

Most of the side effects of radiotherapy for prostate cancer will settle down in the weeks or months after the radiotherapy treatment has finished. Sometimes side effects may occur many months or even years after treatment.

Up to 30% of men have mild episodes of rectal bleeding as a late side effect, requiring no treatment. The bleeding is often due to changes or inflammation of the small blood vessels of the bowel wall. These blood vessels become more fragile and bleed easily, especially if a hard stool is passed.

Bleeding from the bowel should always be investigated to rule out more serious conditions. The bowel can be viewed using a flexible sigmoidoscopy (a thin, flexible tube with a light on the end). If bleeding is as a result of changes to the blood vessels of the bowel wall, it will usually settle down without the need for treatment. You may be advised to avoid constipation.

Heavy or persistent bleeding is rare. Treatments to help stop bleeding may include;

  • Medication given in the form of an enema or suppository to coat the lining of the bowel.
  • Laser treatment to the affected area.
  • Formaline given into the rectum has been helpful to some people.
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I have heard about a new way of removing the prostate using a robot. Is this better than open surgery?

There are a number of ways of removing the prostate gland to treat prostate cancer. This is known as radical prostatectomy.

The most common way to remove the prostate is through an opening in the abdomen, known as an open prostatectomy. Another way is to remove the prostate using keyhole surgery, which can be done by hand (laparoscopic) or with the help of a robot (robot-assisted).

The robot-assisted operation is relatively new and is only available in a small number of centres in the UK.

A recent review (2009) has looked at the available evidence comparing open, laparoscopic and robot-assisted prostatectomy.

Overall the review showed side effects such as incontinence and sexual function were similar regardless of the method of surgery.

Advantages of laparoscopic and robot-assisted prostatectomy compared to open prostatectomy were;

  • Less blood loss during surgery
  • Shorter hospital stay
  • Quicker recovery

A previous review in 2007 found that robot assisted prostatectomy was as good at removing the cancer as laparoscopic and open surgery.

Other studies have shown that patients treated by experienced surgeons in centres with high volumes of patients have fewer complications following radical prostatectomy compared to those with less experience and low volumes of patients.

Recovery of urinary and sexual function seems to be related to the experience of the surgeon rather than whether the procedure was done by an open, laparoscopic or robotic approach.

For further information please read our pages on surgery.

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What can I do to help get my erections back after surgery to remove my prostate?

There are two bundles of nerves running either side of the prostate that control erections. These are called cavernous nerves. Saving these nerves during surgery is known as a nerve-sparing prostatectomy and increases the chances of erections recovering following surgery. It is only suitable if it is unlikely that your cancer has spread outside of the prostate. Sometimes the nerves can only be saved on one side of the prostate.

Many men are not able to get an erection in the early weeks and months following surgery. This may be due to nerve injury or because the nerves have become inflamed after surgery. It can take up to two years after surgery for the nerves to recover and to be able to have spontaneous erections .

Before surgery it is normal for a man to have three to six erections every night. It is believed these nocturnal erections help to keep the erectile tissues healthy. Without blood regularly flowing into the erectile tissues of the penis, over time it may deteriorate. With this in mind some specialists will prescribe tablets called PDE5 inhibitors to treat erectile dysfunction (ED) in the early stage after surgery. This approach is known as penile rehabilitation.

The aim of penile rehabilitation is to encourage regular blood flow into the erectile tissue keeping it healthy and helping the recovery of normal erections.

You may wish to speak to you specialist about penile rehabilitation and at what stage he would suggest prescribing tablets to help erections.

For further information please read our pages on surgery and sexuality.

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Do you have any tips for coping with incontinence when travelling abroad?

Taking a holiday can be more difficult to plan when you have a medical condition to consider, however by planning your holiday carefully in advance you can have a relaxing holiday that will make you feel refreshed.

Incontinence can limit the activities you feel comfortable to undertake so think about how you might feel before you go. Make sure that you pack an adequate supply of pads, catheters, pants, creams, wipes, etc. to cover the length of your holiday. It may also help to pack a few extra in case you experience any unexpected delays. These items can be quite bulky so be aware of any weight limitations on your baggage.

Put some equipment in your hand luggage so that you have a supply which is easily accessible during your journey, and also should your suitcase go missing you still have some with you. It might be possible to find a shop at your destination where you could go to get more equipment if necessary. The manufacturer of the pad you use may be able to advise you about this. They may also be able to help you to obtain information about your needs written in French (or other languages as necessary). This might help you to explain your needs to the local shop staff if you are unable to speak the language.

If you often have urinary tract infections your doctor may want you to take a course of antibiotics with you just in case. Check this with your doctor before your holiday.

It may be helpful to carry a supply of wet and/or dry wipes in your hand luggage to help you to freshen up during your journey. Washing facilities are not always available. Some people also like to carry a deodorant spray. Travel companies are usually helpful if you let them know about your needs before your journey and may be able to arrange seating near a lavatory for you.

It may be useful to buy a portable urinal if you are travelling a long distance by car because it may not be possible to reach a lavatory easily.

Make sure that you are able to keep pads dry and wipes wet by storing them in plastic bags or containers. Some people find a supply of plastic bags is useful to wrap wet clothing, or so that you can store wet pads for disposal.

When going through customs it may be necessary to have information from your doctor explaining why you need the equipment you carry. This may include a prescription form.

If you are worried about bed protection it is a good idea to contact your hotel or accommodation before your holiday so that a protective sheet is on the bed ready for your arrival. Failing this you will have to take a cover with you, but this can add to the weight of your luggage.

Find out what the laundry arrangements are at your destination as there may be an additional cost for this service. Sometimes people are able to do their own small items of laundry so some washing powder, pegs and a piece of line in your bag might help.

Some people like to reduce the amount they drink before making a long journey so that they produce less urine. This is not to be recommended because it can cause infection, however if you do choose to do this it is very important that you drink extra fluids on arrival at your destination. It is also important to drink more if the weather is hot.

Read more about travel and travel insurance.

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Is there anything I can do to help prevent me developing prostate cancer?

There are several factors that may increase your chance of being diagnosed with prostate cancer including age, ethnicity and family history. Although these factors cannot be changed there are changes that can be made in your diet and lifestyle that may be important in protecting you against the disease.

The typical western diet is high in saturated animal fats and red meat. Researchers think this may be responsible for the higher rates of prostate cancer seen in Western countries. By reducing the amount of animal fat in your diet and eating more fruit and vegetables, you may lower your risk of developing prostate cancer.

Research also suggests obese men may have a higher risk of prostate cancer, and that men who exercise have a lower risk.

You may be able to help reduce your risk of prostate cancer by:

  • Reducing the amount of animal fat in your diet.
  • Eating a wide range of fruit and vegetables.
  • Cutting down on dairy products if you eat a very high calcium diet.
  • Maintaining a healthy weight.
  • Exercising regularly.

There are a number of nutrients which may offer protection from developing prostate cancer and continue to be researched. These include lycopene, selenium, soya and vitamin E.

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I have been including vitamin E and selenium in my diet because I heard it protects against prostate cancer. However, I read recently that a trial had proved that it doesn’t help. Do you have any information on this?

Yes. The trial you mention is called the SELECT trial (the Selenium and Vitamin E Cancer Prevention Trial) and is the largest ever prostate cancer prevention trial.

Selenium and vitamin E are both antioxidants, which may help control cell damage that can lead to cancer. Previous smaller studies had suggested that selenium and vitamin E (alone or in combination) might reduce the risk of developing prostate cancer. The SELECT trial is a very large trial of over 35,000 men.

Unfortunately results from this study published in December 2008 have shown that selenium and vitamin E supplements taken alone or together for an average of five years did not prevent prostate cancer. The SELECT data showed two trends: there were slightly more cases of prostate cancer in men taking only vitamin E and slightly more cases of diabetes in men taking only selenium. But this data was not statistically significant and neither trend proves an increased risk from the supplements and may be due to chance.

Participants in the trial have been told to stop taking their supplements but continue to be monitored.

The SELECT trial was studying selenium and vitamin E supplements. There have been no proven harms or benefits of a diet high in these antioxidants.

You should be able to get all the nutrients you need by eating a healthy, balanced and varied diet.

Please visit our pages diet and prostate cancer for further information on improving your diet.

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Does alcohol increase risk of prostate cancer?

Alcohol is known to increase the risk of a range of cancers, including mouth and oesophagus, breast and bowel cancer. Research looking at alcohol consumption and prostate cancer risk has been inconclusive.

Recently a large study in America known as the Prostate Cancer Prevention Trial (PCPT) has shown that heavy, daily drinking increased the risk of high-grade (aggressive) prostate cancer.

In this study, researchers looked at the drinking patterns of 10,920 men who were enrolled in PCPT. The researchers looked at the amount, frequency, and type of alcohol each man drank and his risk of developing prostate cancer. Men who drank over 6 units of alcohol per day were at an increased risk of developing high-grade prostate cancer.

The researchers say more studies are needed to confirm their findings.

Although the relationship with prostate cancer and alcohol is still not proven, alcohol abuse can lead to a wide range of health problems, including some types of cancer, liver damage, and heart disease.

The Department of Health advises that men should not drink more than three to four units of alcohol per day, and women should drink no more than two to three units of alcohol per day.

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I have heard red wine helps to prevent prostate cancer. Is this true?

Red wine contains the antioxidant resveratrol which may have anti-cancer properties. However there is not enough evidence to show red wine will help to prevent prostate cancer.

One small study showed men who drank 4-7 glasses of red wine per week halved their risk of developing prostate cancer. However since then two larger studies have found no relationship between drinking red wine and the risk of prostate cancer.

Antioxidants are thought to play a part in the prevention of cancer. A good way to include antioxidants in your diet is to eat a wide range of fruit and vegetables.

Further information on diet and prostate cancer.