If you have spotted signs linked to prostate cancer, start by booking an appointment with your GP. If you have already done so, naturally you will have questions about what happens next.
The prostate cancer diagnosis process in the UK usually begins with a PSA blood test and sometimes a physical examination. You may then be referred for a scan and, if needed, a biopsy. A biopsy is the only test that can confirm prostate cancer.
Having prostate cancer tests does not necessarily mean you have cancer. And for many men diagnosed with prostate cancer, they don’t need treatment right away. At each stage, your doctors use the results to decide what tests, if any, are needed next, and keep you informed.
We have put together this helpful guide to explain what conditions cause similar symptoms to prostate cancer, the tests carried out at each stage of prostate cancer diagnosis, and what happens next.
At Proton International London, we treat many prostate cancer patients with proton beam therapy at our private clinic. If you would like to understand whether this advanced form of radiotherapy could be suitable for you, please speak to our team.
How prostate cancer is diagnosed in the UK
There is currently no national prostate cancer screening programme in the UK. If you are aged 50 or over, have symptoms associated with prostate cancer, or have risk factors that increase your chances of developing prostate cancer, you can speak to your GP.
Click here to understand more about prostate cancer risk and learn about the signs of prostate cancer. Early detection is important as it can give you more treatment options and improve your chances of successful treatment.
Investigations usually begin at your GP surgery, with follow-up hospital tests if necessary.
Initial tests for prostate cancer carried out by a GP
Your GP will ask about your symptoms (if any), your general health, and any family history of prostate cancer. If necessary, they may offer two initial checks: a PSA test and a digital rectal exam.
If the findings from these two tests suggest further investigation is needed, your GP can refer you to a hospital specialist.
Prostate-specific antigen (PSA) test
The PSA test is a simple blood test that measures prostate-specific antigen, a protein made by the prostate gland. It is normal to have some PSA in your blood, and levels naturally rise with age.
A raised PSA level can be a sign of prostate cancer, but it can also be caused by more common, non-cancerous conditions such as an enlarged prostate or an infection.
Some men with prostate cancer also have a normal PSA level. For this reason, your GP will look at your PSA result alongside your age, symptoms and other findings rather than on its own.
Some things can temporarily raise your PSA level. You may be asked to avoid ejaculation and vigorous exercise, including cycling, for 48 hours before your test.
Let your doctor know if you have recently had a urinary infection or a procedure involving your prostate or bladder.
Digital Rectal Exam (DRE)
A digital rectal examination allows your doctor to feel the prostate, which sits just in front of the rectum (back passage). Your doctor will put on a glove, apply some lubricating gel and gently insert a finger into your rectum. They will check the size of your prostate and feel for any lumps, hard areas or an irregular shape.
Many men feel anxious about this examination, which is understandable. But it’s usually over within a minute or two, and while it may feel uncomfortable, it shouldn’t be painful. You can ask for a chaperone to be present if you wish.
You will not necessarily have a DRE at your first appointment. Your GP may offer one depending on your symptoms and medical history, but should explain why they recommend it and ask for your consent.
Recently diagnosed with prostate cancer? Speak to a specialist prostate cancer consultant about your treatment options, including whether proton beam therapy may be suitable for you. Get in touch with our team.
What else can cause symptoms similar to prostate cancer?
Several common, non-cancerous conditions can cause symptoms similar to prostate cancer, or raise your PSA level. These include:
- Benign prostatic hyperplasia (BPH): A non-cancerous enlargement of the prostate, which is very common as men get older.
- Prostatitis: Inflammation of the prostate, sometimes caused by infection.
- Urinary tract infections (UTIs): Bacterial infections that can cause a burning sensation when urinating, cloudy urine and needing to go more often. They can also raise PSA levels temporarily.
- Bladder or kidney stones: Hard deposits that can cause pain when urinating, pain in the lower back or side, and blood in the urine.
This is one reason why a raised PSA result or urinary symptoms do not necessarily mean cancer. If you notice any changes, it is always best to seek medical advice.
Further tests used to diagnose prostate cancer
If your PSA level is raised or your prostate feels abnormal, you are likely to be referred for further tests. These help your specialist decide whether cancer is likely, and whether a biopsy is needed.
Urine Tests
A urine sample may be requested to check for signs of infection, which can cause symptoms similar to prostate problems and raise your PSA level. If you have an infection, your doctor may treat it first and repeat your PSA test several weeks later.
Some private clinics also offer specialist urine or blood tests that look for particular markers linked to prostate cancer. These are not part of routine NHS testing. Your specialist can advise whether they would add anything useful in your case.
Blood tests
During the diagnosis process, regular PSA tests may be carried out to identify increases from normal levels. If you are later diagnosed, they will also be used to monitor your cancer.
You may also have other blood tests to check your general health and kidney function. Kidney function is often checked before an MRI scan that uses contrast dye.
Multiparametric MRI Scan
Multiparametric MRI is often recommended before performing a biopsy. MRI stands for magnetic resonance imaging. It uses magnets and radio waves (not radiation) to produce detailed images of the prostate. A multiparametric MRI scan combines several types of images, giving a much clearer picture than a standard MRI.
You will lie on your back inside the scanner, which is open at both ends. The scan is painless but noisy, and you will usually be given headphones or earplugs. You may have an injection of contrast dye to make the images clearer. If you feel uneasy in enclosed spaces, let the team know beforehand.
A specialist radiologist reviews the images and applies scores to any areas of concern. This helps your doctors decide whether you need a biopsy and, if so, exactly which areas to sample.
Prostate Biopsy
A biopsy is the only test that can confirm whether prostate cancer is present. A specialist urologist uses a thin needle to take small tissue samples from the prostate that are sent to a laboratory to be examined.
There are two main ways of carrying out a biopsy:
Transperineal biopsy: The needle passes through the skin between the scrotum and the back passage. This is now the most common approach in the UK and is often carried out under local anaesthetic.
Transrectal biopsy: The needle passes through the wall of the back passage, guided by an ultrasound probe. It is typically carried out under a local anaesthetic, and you will usually be prescribed antibiotics to reduce the risk of infection.
Afterwards, you may notice some bruising or soreness. You may also see blood in your urine, stools or semen. This is common and usually settles, although blood in the semen can last for a few weeks. There is a small risk of infection, so contact your doctor straight away if you develop a high temperature or feel unwell.
What happens next
After your tests, you will want to know when to expect answers and what they mean for you. Here’s how your results are explained and used to guide the next steps.
How long does it take to diagnose prostate cancer?
The time it takes to diagnose prostate cancer varies from person to person. In England, the NHS aims to confirm or rule out cancer within 28 days of an urgent suspected cancer referral. This is known as the Faster Diagnosis Standard and applies to urgent referrals; non-urgent investigations may take longer. The tests needed and appointment availability also affect how long the process takes.
As a general guide:
- PSA test and rectal examination: These take a few minutes and are carried out at your GP surgery. PSA results are usually available within a few days.
- MRI scan: Usually arranged within a few weeks of your referral and carried out in a hospital.
- Biopsy: The procedure itself is fairly short. Results usually take one to two weeks, as the samples need careful analysis in a laboratory.
Waiting for results is naturally a worrying time. If you have questions, you do not need a confirmed diagnosis to ask for support. You can contact your GP or your hospital team for advice, or Prostate Cancer UK’s specialist nurses offer free, confidential information and support.
Recently diagnosed with prostate cancer? Speak to a specialist prostate cancer consultant about your treatment options, including whether proton beam therapy may be suitable for you. Get in touch with our team.
Discussing your results
You will be invited to an appointment with your specialist to discuss your results. You are welcome to bring a partner, family member or friend with you. It can help to write down any questions you have beforehand.
If prostate cancer is confirmed, your results will be reviewed by a multidisciplinary team (MDT). This is a group of specialists that usually includes urologists, clinical oncologists, radiologists and pathologists.
Together, they consider:
- The grade of the cancer: How abnormal the cancer cells look, which indicates how quickly the cancer may grow.
- The stage of the cancer: How large the cancer is and whether it has spread beyond the prostate
- Your PSA level: This is considered alongside the grade and stage to help assess risk.
- Your general health and priorities: Including your age, other medical conditions and how different treatments may affect your daily life.
If anything in your results is unclear, ask your consultant or specialist nurse to explain it. It is always fine to ask them to go through it again to ensure you fully understand.
How to understand prostate cancer grading
Prostate tissue samples help specialists understand how the cancer is likely to behave. A pathologist compares the cancer cells from your biopsy samples with healthy prostate cells to determine how likely it is to grow and spread. It is then assigned a grade.
Prostate cancer is graded on a scale from 1 to 5, known as the Grade Group:
| Grade Group | What it generally means |
| 1 | The cancer is likely to grow very slowly, and may never cause problems. |
| 2 | The cancer is likely to grow slowly. |
| 3 | The cancer may grow at a moderate pace. |
| 4 | The cancer is more likely to grow quickly. |
| 5 | The cancer is the most likely to grow quickly. |
Your grade is considered alongside the stage of the cancer, your PSA level and your general health. Together, these help your specialist team recommend the options that are right for you.
Many men with a lower Grade Group are offered active surveillance, which means monitoring the cancer closely rather than treating it straight away. For men with a higher Grade Group, treatment is more likely to be recommended.
What about the Gleason score?
Your results letter may also mention a Gleason score, such as “3 + 4 = 7”. This is an older way of describing the same information, and each Gleason score matches a grade group. For example, a Gleason score of 3 + 4 = 7 is Grade Group 2. You do not need to work this out yourself. Your specialist will explain what your score means.
What if the cancer has spread?
Cancer contained within the prostate is called localised prostate cancer. If your results suggest the cancer has spread beyond the prostate, your specialist may arrange further imaging tests to find out where it has spread. These could include a CT scan, bone scan or PSMA PET-CT scan.
Cancer that has grown into nearby tissues is described as locally advanced. If it has spread to distant parts of the body, such as the bones, it is called metastatic prostate cancer.
This can be difficult news to hear. Your specialist will explain what the findings mean for you and discuss appropriate treatment options to control the cancer and manage any symptoms. If you need further support, consider reaching out to Prostate Cancer UK’s specialist nurses.
Prostate cancer treatment options
Treating prostate cancer depends on the cancer’s size, grade and location, whether it has spread, and your PSA level. Your specialist will also consider your age, general health, risk factors, existing symptoms and any previous treatment, alongside your preferences and the possible effects on your quality of life.
Your consultant will talk you through the options and the possible side effects of each. You can take time to consider your choices, ask questions and, if you wish, seek a second opinion.
Not all prostate cancer cases need treatment straight away. For men with lower-risk cancer contained within the prostate, Active Surveillance can avoid or delay treatment and its side effects. This involves regular checks, with treatment offered if the cancer shows signs of progressing. Many men on active surveillance never need treatment.
If the cancer has a higher risk of growing or spreading, or has already spread locally, your specialist may recommend the following as part of your treatment plan:
- Radiotherapy. Options include external beam radiotherapy and, for suitable patients, brachytherapy. Proton beam therapy for prostate cancer is another form of external beam radiotherapy that may be considered, and is available on a private basis.
- Hormone therapy may be given alongside radiotherapy, particularly for higher-risk cancers. This treatment lowers or blocks testosterone, which prostate cancer cells use to grow.
- Surgery may be offered for localised prostate cancer, to remove the prostate gland, known as a radical prostatectomy. If it is locally advanced, surgery may be considered in selected cases.
For more advanced prostate cancer, where it has spread to more distant parts of the body, the following treatments may be used to help control it.
- Hormone therapy, often combined with additional hormone medicines
- Chemotherapy. Medicines that travel through the bloodstream to kill cancer cells.
- Other treatments: Other options, including targeted or radioactive medicines, may be suitable depending on the cancer’s characteristics and previous treatments.
Your care team will talk you through the options and support you with treatment and any symptoms, with your comfort and quality of life a priority.
Private proton beam therapy treatment for prostate cancer
If you have been diagnosed with prostate cancer and are exploring treatment options, you may have come across proton beam therapy, a precise form of external beam radiotherapy. It uses protons rather than X-rays to target the prostate accurately, limiting radiation exposure to nearby healthy tissue.
For some men, this may help reduce the risk of certain side effects affecting bladder, bowel and sexual function. In some cases, treatment can be completed in five sessions.
Proton beam therapy is not suitable for everyone and is only available on a private basis in the UK. Whether it is right for you depends on your diagnosis, your overall health and the recommendation of your specialist team.
Proton International London is the UK’s only private proton beam therapy centre, located within University College Hospital London. We are part of Proton International, which has more than 30 years’ experience of treating patients with proton beam therapy in the United States.
If you would like to find out more, you can read about proton beam therapy for prostate cancer or make an enquiry to speak with our team.
