Prostate cancer doesn’t cause ANY symptoms IN its early stages – but most cases are caught early through testing. That’s why if you are a man over 50 you should talk to your doctor about having a PSA test. If you are in a higher risk group – for example, if you are of African or Caribbean ancestry – then ask for one after the age of 40.

Prostate cancer starts to cause symptoms until it starts to grow and push on the tube that carries urine out of the body. At this stage it may cause poor flow, difficulty starting to pee, a feeling of urgency when you get the urge to pee, a need to pee more often than normal or a sensation that the bladder isn’t empty, despite having just peed.

However, remember that, while these symptoms can be a sign of cancer, they are also a sign of an enlarged prostate, a natural part of the ageing process.

Once the cancer starts to become more advanced, it may lead to other symptoms such as bone pain – often in the hips, back or chest – or unexplained weight loss.

This is a blood test that checks your levels of a protein called prostate-specific antigen (PSA). This protein is made by the prostate and the amount that is shed into the blood can give doctors an idea of the general health of the gland.

What is defined as a normal PSA level varies according to age and ethnicity, but generally anything below 3 ng/ml of blood is normal for men aged 50-70 and a level below 5 ng/ml is normal for men aged 70-80. However, a higher reading doesn’t mean you have cancer. Levels can rise due to, for example, an infection, enlargement of the prostate, vigorous exercise, or even as a result of having had sex.

Normally, your doctor will look at your individual circumstances to decide if further tests are necessary. They make this decision taking into account, for example, your age, symptoms and whether there is a family history of prostate cancer. They may decide that the best course of action is to have your doctor recheck your PSA again in six months or a year – only a small proportion of those men who have a raised PSA will have prostate cancer. Or they may decide to send you for an MRI or a biopsy.

The time it takes for PSA levels to double. The quicker the PSA doubles, the higher the chance that this is due to the presence of cancer. This might be mentioned if you have a higher-than-normal PSA or if you have had treatment and are having regular check-ups.

In the UK, as yet, there is no alternative blood test that is widely available – although a new test that looks for differences in immune cells called white blood cells is showing promise in trials.

In the US there are other options. PSA comes in two forms – one is attached to proteins in the blood and the other circulates freely in the blood. The 4k test looks at other specific PSA-like proteins also known to be prostate biomarkers and combines it with a clinical examination. There is also the Stockholm 3 test (STHLM3) that looks at five different prostate blood biomarkers.

The terms may sound complex, but what they represent is straightforward. If you have a large prostate gland – simply through age or swelling, for example – you will most probably have higher levels of PSA anyway. The PSA density calculation accounts for that by measuring the volume of the prostate with ultrasound and dividing that by the PSA level. A high PSA in a small prostate suggests a higher chance of finding cancer at prostate biopsy.

PSA velocity is the rate at which the PSA level climbs. This is similar to PSA doubling time – except it measures the rate of the rise, not the time that it takes to double. The higher the rate, the higher the chance of finding cancer during a biopsy, or the higher the likelihood the cancer has returned after treatment.

This is offered if your PSA and other previous assessments suggest that it warrants it. It helps give your doctor a better idea of what is going on in the prostate and helps them decide if you need a biopsy of the prostate.

Unlike a biopsy an MRI is noninvasive, although the machine can be noisy and some men may find lying in the scanner uncomfortable if they don’t like being in confined spaces. However, it should take no more than 30-40 minutes.

If you have been diagnosed with low-risk cancer that is confined to the prostate, it is likely that your urologist will recommend you just stay under surveillance, with regular PSA checks and MRIs.

For those with the next level, intermediate or high-risk localized prostate cancer, you aim to make your decision about starting treatment within three or six months.

Finally, for patients with advanced disease the situation is a bit different. The recommendation is to start treatment, which is likely to be hormone therapy to begin with, as soon as possible.

You are usually offered this option if the tests conducted suggest that you have low-risk, slow-growing cancer that is confined to the prostate.

It means that rather than having any active treatment, such as radiotherapy or surgery, your cancer will be monitored to see if it progresses.

You will typically have a PSA blood test every three months, an annual MRI and a repeat biopsy about 2 years after your initial biopsy. The MRI may be repeated more frequently if your PSA climbs quickly.

This varies from centre to centre, but you will normally have a repeat biopsy one or two years after your first. Further biopsies after this may be required if there are any changes in your physical examination, PSA, or MRI results.

Radiotherapy may be suggested if and when your PSA starts to rise after surgery. If your PSA reaches 0.2 mg/ml, this is then termed a biochemical recurrence and may mean your cancer has come back.

Radiotherapy may also be suggested if the surgeon thinks that not all of the cancer cells were removed during surgery. This may be suspected if, for example, your pathology report suggests that there were some cancer cells at the edge of the tissue removed during surgery.

Secondary radiotherapy like this may be targeted both at your prostate bed (i.e. where the prostate gland was) and the surrounding lymph nodes, as this gives a better chance of cure than targeting the prostate bed alone.

Evidence from recent studies suggests that there is no real benefit to having secondary radiotherapy unless your PSA level climbs above 0.2. Starting the radiotherapy before this happens may also bring a higher risk of long-term side effects.

The side effects will last as long as you’re taking the hormone therapy (although they can take some months to clear fully).

The exception to this is if you have had surgery to remove your testicles, as the effects of this will be permanent.

If you find the side effects hard to cope with, it may be possible in some circumstances (if your PSA levels are low) to take the hormone therapy intermittently, but this is something to discuss with your medical team.

A follow-up appointment is a chance for the doctor (or nurse) to see how you are and to check on any side effects, and for you to raise any concerns you may have.

Normally, prior to the appointment you will be asked to have a PSA test, and this meeting is a chance to review the results. If there is a rise compared to a previous result, further tests, such as an MRI or a physical examination of the prostate (if you still have one), may be suggested.

Don’t be embarrassed to raise any concerns you have, as these appointments are intended to provide you assurance and to help you access any further help you may need.

This is a type of PSA test that measures PSA in the blood at very low levels – much lower than the normal PSA test.

The theory behind ultrasensitive PSA tests is that they can give a better idea if the cancer is starting to return. However, their use is controversial – they can give fluctuating results – and some hospitals in the UK and the US have stopped offering them.

Not necessarily. While the ability of the ultrasensitive test to detect tiny levels of PSA is why it is sometimes used after surgery, as levels of PSA are so low once the prostate gland is removed (because this is where PSA is made) as to be barely detectable (usually 0.1 mg/ml or less), this sensitivity also means it can detect tiny changes in PSA levels, which may not in fact be significant. This is why the use of ultrasensitive PSA tests remains controversial.

If your PSA level does start to climb, your urologist will usually review your original reports and take a view based on these as well – not just the ultrasensitive PSA results – as to whether there is any need for further (adjuvant) treatment.

PSA is created in the prostate, so if you have that gland removed, your PSA level should be barely noticeable – by which we mean, typically, 0.1mg/ml or less. If your levels rise above 0.2mg/ml, this can be a sign the cancer has returned. Your doctor may refer to this as biochemical recurrence.

Some variation in PSA levels up to three years after radiotherapy is normal – in fact, this actually has a name: PSA bounce. Typically, levels rise by between 0.1 and 0.5 mg/ml and then go down again.

Quite why this happens is not fully understood. One theory is that cancer cells destroyed by radiotherapy release PSA; another is that it is a late reaction to the radiotherapy, causing some inflammation in the prostate.

One study found that 12 per cent of men who had external beam radiotherapy had PSA bounce nine months after their treatment ended – but this can occur for up to three years. Studies suggest that it can be even more common after brachytherapy.

A study published in 2017 even suggested that those who have a PSA bounce are at reduced risk of their cancer returning.

However, your doctor may propose further tests if your PSA level changes by more than 2 mg/ml above its lowest level, as this may suggest some cancer is present.

Possibly, as your doctor will need to weigh up whether more treatment is necessary.

You may be offered a PET scan which checks the whole body for the presence of cancer – dyes or reactive agents help show up areas of high cell turnover or activity which could indicate cancer. You may also be offered a CT scan (a series of X rays), or a bone scan.

The most sensitive is the PSMA PET scan which can detect cancer even when your PSA is below a relatively low 0.5. It works by detecting PSMA, a protein that is found on prostate cancer cells. A radioactive dye is injected, which is then attracted to the PSMA and shows up on the scan. However, it is only recommended for those who satisfy certain criteria – for example, those at high risk of recurrence – so check if this is an option for you.

If your PSA is rising after surgery, you will normally be advised to have radiotherapy, which will be targeted at the prostate bed (in other words, where your prostate gland was) and lymph nodes in the pelvis. You will also usually be given a six-month course of hormone therapy – the two together appear to be more effective.

If  your PSA is rising and scans show there is cancer in one or more lymph nodes in the pelvis, some surgeons will consider removing the lymph nodes alone at a second operation. For some patients, this can result in a long-term drop in PSA. However, it may not be suitable for all – your medical team can advise you.

If your PSA is rising after radiotherapy, the most common next treatment is hormone therapy.

However, other options may be suitable, such as surgery, cryotherapy, or HIFU.

Some groups of cells may have migrated beyond the prostate (for example into the pelvic lymph nodes) before your treatment, but your pre-operative tests were not sensitive enough to pick them up. These would then grow sometime after treatment and subsequently show up on your PSA test.

Recurrence is more likely if, after surgery, there was a positive margin on the tissue removed – in other words, if cancer cells were found right up to the edge of the tissue removed. However, even where this is the case, it doesn’t always mean that the cancer will recur.

Having your prostate gland removed will not interfere with your life expectancy. Indeed, if you’ve had it removed as a result of prostate cancer it will, potentially, improve it.

However, the removal of the gland, which is made up of a mixture of muscle and glandular tissue, will have a knock-on effect on some of your normal bodily functions.

One of those effects is on the way you orgasm.

That is partly because the prostate produces PSA, the protein that helps make semen more fluid, so allowing sperm to swim freely.

It’s also because during surgery the seminal vesicles, which are attached to the prostate and which produce around 70 per cent of the volume of semen, are also removed.  This means that although you will continue to produce sperm cells (in the testicles) you will no longer produce semen or be able to father children.

The muscle of the prostate normally forcibly pushes out semen into the urethra (the tube that carries it out of the body), so you will have largely dry orgasms – in other words there is no ejaculate (although some men may produce a small amount of fluid before or after an orgasm, which is fluid made by glands in the urethra). The intensity of your orgasms, however, should not be affected.

The removal of the prostate gland can also lead to incontinence issues. The surgeon will usually have to remove one of the two valves that controls the flow of urine through the urethra (the tube which also carries urine out of the body). These issues normally resolve over time.