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Prostate Cancer Symptoms and Screening: What You Need to Know

Medically authored by Dr Aqua Asif and clinically reviewed by Mr Alan Doherty

Early-stage prostate cancer is usually silent — most men have no symptoms at all and feel perfectly healthy. That is why screening matters more than symptoms. A PSA blood test or digital rectal examination (DRE) can detect prostate cancer before it causes any noticeable changes, giving you the widest range of treatment options including focal therapy

“Recognising potential signs of prostate cancer, and more importantly, understanding the role of screening even without symptoms, can lead to timely intervention and better outcomes.”
Mr Alan Doherty, Consultant Urological Surgeon.
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Mr. Marc Laniado from The Focal Therapy Clinic explains how a PSA blood test and MRI scan can detect cancer before it spreads, making targeted, less invasive options like focal therapy possible for suitable patients.

Does Prostate Cancer Have Symptoms in Its Early Stages?

Most urinary symptoms appear in both cancer and benign conditions — and early prostate cancer is often entirely asymptomatic (NICE NG131, 2021). Symptoms alone cannot distinguish cancer from benign disease; PSA testing and (where indicated) MRI followed by targeted biopsy are needed for diagnosis (Kasivisvanathan/Asif et al., VISION, European Urology 2024).

Symptom Prostate Cancer BPH / Prostatitis (benign)
Urinary frequency Common Common
Weak / slow stream Common Common
Blood in urine Possible Possible
Pelvic / perineal pain Rare / late stage Common in Prostatitis
Bone pain / back pain Possible — advanced Not Typical
Feeling unwell / fatigue Possible — advanced Possible in Prostatitis

*Symptom overlap data derived from NICE NG131 (2021), EAU Prostate Cancer Guidelines 2024, and the VISION meta-analysis (Kasivisvanathan/Asif et al., European Urology 2024). Dr Aqua Asif of The Focal Therapy Clinic is a co-author of VISION.

What Are the Symptoms of Prostate Cancer?

Urinary changes

Urinary symptoms are among the most common reasons men visit their GP about prostate health, but they are far more frequently caused by benign prostatic hyperplasia (BPH) than by prostate cancer.

Don't Ignore: Sudden changes in urinary habits that develop over weeks or waking more than twice a night to urinate when this wasn't previously normal for you.

Blood in urine or semen

While blood in urine or semen may be linked to infections or other benign causes, it always merits further assessment by a medical professional.

Don't Ignore: Even a single episode of pink, red, or brown urine should be investigated – even if it clears up on its own.

Pelvic or lower back pain

Although this can be explained by muscle strain or other benign conditions, it may in rare cases suggest prostate cancer that is affecting nearby areas.

Don't Ignore: Unexplained pain lasting more than a few weeks that doesn’t improve with rest or standard pain relief, particularly if it worsens at night.

Erectile difficulties

Early-stage prostate cancer does not typically cause erectile dysfunction; however, any new or persistent erection problem should prompt a consultation with your GP or urologist.

Don't Ignore: Sudden onset of erectile difficulties, particularly in men over 50, especially when combined with urinary symptoms or unexplained pain.

Diagram summarising prostate cancer symptoms, high-risk groups for PSA testing, PSA testing guidelines, and importance of early detection. Common symptoms: urinary difficulties, erectile dysfunction, pelvic discomfort. High-risk groups: men over 50, family history, African or Caribbean descent. PSA testing guidelines: PSA levels in blood, further tests required. Importance of early detection: asymptomatic early stages, regular screening recommended.

When Should You See a Doctor About Prostate Cancer Symptoms?

Being proactive about your health isn't overreacting — it's sensible. If you are concerned about a symptom, it is worth having it checked — your GP can arrange tests quickly.

Your GP can arrange a PSA blood test and, if appropriate, a digital rectal examination. These are quick, straightforward tests that can provide important information about your prostate health


Blood in urine or semen (always get checked within a few days)

Multiple urinary symptoms appearing together

Persistent bone pain in the back, hips or thighs

Unexplained weight loss combined with fatigue

Any symptom that is getting progressively worse

Prostate Cancer Screening — Why It Matters More Than Symptoms

Because early-stage prostate cancer is usually asymptomatic, screening is the most reliable way to detect it early. NICE NG131 (2021) recommends that men concerned about prostate cancer discuss the benefits and limitations of screening with their GP, particularly those over 50 or with risk factors. Prostate Cancer UK recommends Black men start the screening conversation from age 45 (PSA Consensus, 2024).
Step 1:

Speak to your GP

Early prostate cancer causes no symptoms; NICE NG131 recommends informed discussion about PSA testing for men at risk before symptoms arise.

Step 2:

PSA blood test ± DRE

A PSA test measures prostate-specific antigen in the blood, though levels can be raised by BPH, infection, recent ejaculation or vigorous exercise (NICE NG131, 2021).

Digital rectal examination (DRE) allows a clinician to feel for irregularities in the prostate’s shape or texture.

Step 3:

If raised: mpMRI followed by targeted biopsy

If screening raises concern, NICE-recommended multiparametric MRI (mpMRI) followed by targeted biopsy confirms diagnosis. MRI-targeted biopsy detects clinically significant cancers more accurately than standard biopsy while reducing overdiagnosis of clinically insignificant disease(¹). FTC provides both mpMRI and targeted biopsy at our seven UK locations.

(¹) Kasivisvanathan/Asif et al., VISION meta-analysis, European Urology 2024 — Dr Aqua Asif of The Focal Therapy Clinic is a co-author

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Risk Factors for Prostate Cancer

Prostate cancer risk depends on several factors, some of which cannot be changed. Understanding your risk profile helps you and your GP decide whether prostate cancer screening is appropriate for you.


Age: over 50 — risk increases significantly with each decade (NICE NG131, 2021)

Family history: Father or brother with prostate cancer approximately doubles your risk (NICE NG131, 2021). BRCA2 mutation carriers face approximately 7-8 times higher lifetime risk and are more likely to be diagnosed with aggressive disease (Castro et al., J Clin Oncol 2013).

Ethnicity: Black men in the UK have approximately twice the lifetime risk — one in four Black men will be diagnosed with prostate cancer, compared with one in eight white men (Lloyd et al., BMC Medicine 2015). Black men also tend to be diagnosed at a younger age.

Genetics: Specific genetic mutations increase prostate cancer risk: BRCA1 and BRCA2 (Castro et al., J Clin Oncol 2013), and the HOXB13 G84E variant which is associated with approximately twenty times higher risk in carriers (Ewing et al., NEJM 2012). Consider asking your GP about genetic testing referral if you have multiple first-degree relatives affected or relatives diagnosed under age 65.

At The Focal Therapy Clinic, our consultants assess every referral with multiparametric MRI (mpMRI) and targeted biopsy to determine the most appropriate management, whether that is active surveillance, focal therapy, or another approach.


Which Conditions Cause Similar Symptoms to Prostate Cancer?

Benign Prostatic Hyperplasia (BPH)

A very common, non-cancerous enlargement of the prostate.
The most common cause of urinary symptoms in men over 50. Histological BPH is present in approximately 50% of men by age 60 and 90% by age 85 (Berry et al., J Urol 1984), although not all men experience symptoms.

Prostatitis

Inflammation or infection of the prostate gland.
Can cause pain, urinary symptoms, and sometimes fever — usually treated with antibiotics.

Urinary Tract Infection (UTI)

An infection in the urinary system.
Often causes burning sensation and frequency — more common in women but does occur in men.

Can You Lower Your Risk of Prostate Cancer?

While some risk factors can’t be changed, there’s limited evidence that certain lifestyle choices might help reduce risk or help to catch the disease earlier when more treatment options are available:

Maintain a balanced diet(¹):

A diet rich in fruits, vegetables, and whole grains, and low in red and processed meats, may be beneficial. However, the evidence for specific dietary recommendations is not conclusive.

(¹)World Cancer Research Fund Continuous Update Project

Stay physically active(²):

Moderate exercise helps manage weight and can support overall wellness. This might include brisk walking, swimming, or resistance training.

(²)Friedenreich et al., European Urology 2016, systematic review of physical activity and prostate cancer

Regular check-ups(³):

If you are over 50, Black or have a family history of prostate cancer, discuss screening with your GP. Early detection through a PSA test is the single most effective step that you can take.

(³)NICE NG131 / Prostate Cancer UK PSA Consensus

Treatment Options When Prostate Cancer Is Found Early

Active surveillance

This involves closely monitoring the prostate cancer without taking immediate action, often used when tumours are very small or slow-growing. You will undergo regular PSA tests, DREs, and periodic imaging or biopsies to check for any changes.

Recommended by NICE NG131 (2021) for men with low-risk localised prostate cancer (Gleason 6, PSA below 10, stage T1-T2a).


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Focal therapy

A NICE-approved (IPG756, 2023) minimally invasive approach that treats only the confirmed cancer zone within the prostate. This precision approach is designed to preserve both sexual and urinary function. At The Focal Therapy Clinic, over 90% of men maintained erections following focal therapy(¹). Published focal therapy series report erectile function preservation in 74-95% of men, depending on baseline function and treatment volume(²).

(¹)FTC audit, n=265 — methodology available on request
(²)Hopstaken et al., European Urology 2022


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Prostatectomy

A surgeon removes the entire prostate gland and sometimes surrounding tissues. This is a common choice for men with localised but significant prostate cancer.

NICE-recommended treatment for localised and locally advanced disease (NG131, 2021). Outcomes depend on tumour stage and surgical approach.


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Radiotherapy

This can be given externally (external beam radiotherapy) or internally (brachytherapy). Radiation is aimed at cancer cells to shrink or destroy them, often with success in early-stage disease.

NICE-recommended for localised prostate cancer. Patient-reported outcomes from the UK ProtecT trial show comparable cancer-specific survival across active monitoring, surgery and radiotherapy at 15 years (Hamdy et al., NEJM 2023).


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Questions to ask your doctor or nurse



Based on my age, family history and ethnicity, should I be having PSA testing — and how often?
The symptoms I have noticed — are these more likely BPH, prostatitis, or something I should be more concerned about?
If you arrange a PSA test, what does the result actually tell you — and what range would prompt further investigation?
If my PSA is raised, will I be offered an mpMRI scan before any biopsy, in line with NICE recommendations?
My father / brother / uncle was diagnosed with prostate cancer — does that change the screening recommendation for me, and at what age should I start?
Are there any specific tests I should request to rule out causes other than cancer — for example, a urine culture for infection?
If my GP isn't sure whether to refer me, can I get a second opinion directly from a focal therapy specialist?
If prostate cancer is diagnosed, what are my treatment options — and how does focal therapy compare with surgery or radiotherapy for early-stage disease?

Bring these to your GP appointment, or speak to our team first.

Frequently asked questions

What are the early symptoms of prostate cancer?
Most men with early-stage prostate cancer have no symptoms at all. This is why relying on symptoms to detect prostate cancer is unreliable. Symptoms such as difficulty urinating, frequent urination, or blood in the urine or semen are much more often caused by non-cancerous conditions like benign prostatic hyperplasia (BPH) or infections. The best way to detect prostate cancer early is through a discussion with your doctor about PSA testing and DRE, even if you feel perfectly well (NICE NG131, 2021).
What are the symptoms of stage 1 prostate cancer?
Stage 1 prostate cancer is typically asymptomatic. It is usually detected through screening (PSA test and/or DRE), not because of symptoms. The symptoms often associated with prostate cancer — urinary problems, pelvic pain — are more likely to occur in later stages or, more commonly, are due to non-cancerous conditions like benign prostatic hyperplasia.
What is the number one symptom of prostate cancer?
There is no single "number one" symptom of prostate cancer, especially in its early stages. Many men have no symptoms at all. While urinary problems are often associated with prostate cancer, they are far more commonly caused by benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects around 50% of men by age 60 (Berry et al., J Urol 1984). The best approach is to discuss screening with your doctor, not to wait for symptoms.
Do you feel ill with prostate cancer?
Early-stage prostate cancer usually does not make you feel generally unwell. Men with early prostate cancer typically feel perfectly healthy, which is precisely why screening is so important. Symptoms such as fatigue, unexplained weight loss, or bone pain are more associated with advanced prostate cancer that has spread beyond the prostate gland.
Can prostate cancer be detected without symptoms?
Yes — and this is the most effective approach. A PSA blood test measures prostate-specific antigen levels and can flag concern long before symptoms develop. If the PSA is raised, NICE-recommended multiparametric MRI (mpMRI) followed by targeted biopsy confirms or rules out clinically significant cancer (Kasivisvanathan/Asif et al., VISION meta-analysis, European Urology 2024 — Dr Aqua Asif of The Focal Therapy Clinic is a co-author). At The Focal Therapy Clinic we provide both mpMRI and targeted biopsy at our seven UK locations.
What are the risk factors for prostate cancer?
Four main risk factors increase your chance of developing prostate cancer: age over 50; family history (father or brother with prostate cancer doubles the risk, and BRCA2 mutations particularly elevate risk — Castro et al., J Clin Oncol 2013); Black ethnicity (one in four Black men in the UK will be diagnosed with prostate cancer, compared with one in eight white men — Lloyd et al., BMC Medicine 2015); and specific genetic mutations including BRCA1, BRCA2, and the HOXB13 G84E variant which is associated with approximately twenty times higher prostate cancer risk in carriers (Ewing et al., NEJM 2012). If you have one or more of these risk factors, discuss PSA screening with your GP from age 45 (Prostate Cancer UK PSA Consensus 2024).
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    Reference List

    1. Kasivisvanathan V, Wai-Shun Chan V, Clement KD, Levis B, Ng A, Asif A, Haider MA, Emberton M, Pond GR, Agarwal R, Scandrett K, Takwoingi Y, Klotz L, Moore CM. VISION: An Individual Patient Data Meta-analysis of Randomised Trials Comparing MRI-Targeted Biopsy with Standard TRUS-Guided Biopsy in the Detection of Prostate Cancer. European Urology. 2024;87(5):512-523. DOI: 10.1016/j.eururo.2024.08.022. Dr Aqua Asif of The Focal Therapy Clinic is a named co-author.
    2. Giganti F, Ng A, Asif A et al. Global Variation in Magnetic Resonance Imaging Quality of the Prostate. Radiology. 2023;309(1):e231130. DOI: 10.1148/radiol.231130. Dr Aqua Asif of The Focal Therapy Clinic is a named co-author.
    3. Castro E, Goh C, Olmos D et al. Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer. Journal of Clinical Oncology. 2013;31(14):1748-1757. DOI: 10.1200/JCO.2012.43.1882
    4. Ewing CM, Ray AM, Lange EM et al. Germline mutations in HOXB13 and prostate-cancer risk. New England Journal of Medicine. 2012;366(2):141-149. DOI: 10.1056/NEJMoa1110000
    5. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. The Journal of Urology. 1984;132(3):474-479.
    6. Lloyd T et al. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Medicine. 2015;13:171. DOI: 10.1186/s12916-015-0405-5
    7. Hopstaken JS et al. An Updated Systematic Review on Focal Therapy in Localized Prostate Cancer. European Urology. 2022;81(1):5-33.
    8. Hamdy FC et al. (ProtecT Study Group). Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. NEJM. 2023;388:1547-1558. DOI: 10.1056/NEJMoa2214122
    9. NICE NG131: Prostate cancer — diagnosis and management. NICE, 2019 (updated 2021). nice.org.uk/guidance/ng131
    10. NICE IPG756: Focal therapy using high-intensity focused ultrasound for localised prostate cancer. NICE, 2023. nice.org.uk/guidance/ipg756
    11. EAU Guidelines on Prostate Cancer, 2024. uroweb.org/guidelines/prostate-cancer
    12. Prostate Cancer UK PSA Consensus, 2024. prostatecanceruk.org/for-health-professionals/guidelines/psa-consensus-2024
    13. NHS: Prostate cancer — Symptoms. nhs.uk/conditions/prostate-cancer/symptoms
    14. UK Government: PSA testing — advice for men without symptoms. gov.uk/government/publications/prostate-specific-antigen-testing-description-in-brief
    15. FTC erectile function audit (n=265). Methodology summary available on request from The Focal Therapy Clinic clinical team.

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