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.

Last updated January 2011

The prostate gland tends to enlarge from the age of about 50 years onwards. The enlargement is caused by an overgrowth of non-cancerous cells and is known as BPE (Benign Prostatic Enlargement) or BPH (Benign Prostatic Hyperplasia).

In some cases if your prostate gets bigger it can cause the urethra (water pipe) to narrow and slow down the flow of urine. About four out of every ten men (40 per cent) over the age of 50 and three out of four men (75 per cent) in their 70s have urinary symptoms that may be caused byan enlarged prostate.

If symptoms of an enlarged prostate are mild then treatment may not be necessary. Lifestyle changes, such as drinking fewer drinks containing caffeine, artificial sweeteners or alcohol, may help improve symptoms. Medication is often used to ease symptoms and is very effective for many men. Sometimes symptoms of an enlarged prostate can be quite troublesome and may need treating with surgery.

Having an enlarged prostate does not increase your risk of prostate cancer.

Read more about the symptoms, diagnosis and treatment of an Enlarged prostate (BPH)

Last updated March 2011

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

There is currently no genetic test for prostate cancer available on the NHS

In a few families who have a strong history of breast cancer, a change (mutation) in the breast cancer genes BRCA1, and particularly BRCA2 may be identified. In these families male members may be at an increased risk of developing prostate cancer. So if there is a strong history of breast cancer in your family or if a BRCA gene mutation has been found, you may want to discuss your risk of developing prostate cancer with your doctor. Your GP can refer you to a genetics clinic for further advice if necessary.

Last updated September 2011

Sometimes prostate cancer cells will spread outside of the prostate to other parts of the body.

Prostate cancer can spread to the area just outside the prostate gland. This is known as locally advanced prostate cancer. Cancer may spread to:

• The seminal vesicles (glands near the prostate gland that store and produce some of the fluid in semen)
• The nearby lymph nodes (small bean-shaped structures that are part of the body's lymphatic system, and which help 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. This is known as advanced or metastatic prostate cancer. Cancer may spread to:

• The distant lymph nodes
• The bones
• The lungs and liver (but this is less common)

Looking to see how far the cancer may have spread is known as staging. Tests used to stage the cancer may include a CT or MRI scan and bone scan.

Read more about:

• staging
• treatment options for locally advanced and advanced prostate cancer

Updated June 2011

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 of the same age. Researchers are looking at what may be the cause of this increased risk, but it may be due to genetic changes passed down through generations.

Prostate cancer mainly 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 if they are concerned.

For further information, please read our publication, What do you know about your prostate: Information for African Caribbean Men

Last updated June 2011

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.

Small cell carcinoma is a very rare cancer of the prostate. Most prostate cancers affect the glandular cells of the prostate but small cell carcinomais is different because it is made up of small round cells that typically affect the nerve cells. Less than two per cent of prostate cancers are small cell carcinomas.

Small cell carcinomas behave differently to the more common prostate cancers. They 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.

Last updated December 2008

The UK National Screening Committee has decided that the disadvantages of regularly screening every man over 50 for prostate cancer using the PSA test outweigh the possible advantages. It has been found that screening can reduce the number of deaths from prostate cancer. But screening also leads to the over-diagnosis and possible over treatment of 'harmless' prostate cancers that wouldn't harm a man in his lifetime. At present, the Charity supports this position on screening. But we are keeping a close eye on developing research into screening for prostate cancer.

Although there is no organised screening programme in the UK, there is an informed choice programme called The Prostate Cancer Risk Management Programme (PCRMP).

The aim of the PCRMP is to ensure that men who are concerned about their risk of prostate cancer receive clear and balanced information about the benefits and limitations of the PSA test and treatment for prostate cancer. This will help men to decide whether they want to have the test.

All men are entitled to have the test on the NHS if they want it.

There is more information about the PSA test, the Charity's position on prostate cancer screening and our 'Testing Choices' campaign on the Testing Choices pages of the website.

Last updated November 2011

When prostate cancer is suspected usually a biopsy is required to make a diagnosis. The need for biopsy is generally based on the PSA blood test and digital rectal examination (DRE). However these tests are not always accurate. Researchers are looking to finding better tests to help diagnose prostate cancer.

The PCA3 test is a gene-based urine test that is still being investigated. PCA3 is short for Prostate CAncer gene 3. Prostate cells have PCA3 genes that make the cells produce a small amount of a particular protein. Prostate cancer cells make much more of this protein than normal cells. It is hoped that the PCA3 test could help to improve the diagnosis of prostate cancer. It is not yet known how accurate the PCA3 test is and therefore it is not widely available.

Before the urine specimen is collected for the PCA3 test the prostate gland needs to be massaged to release prostate cells. This is done in a similar way to a digital rectal examination. The man is then asked to pass water and a sample containing the released prostate cells is collected. The sample is send to the laboratory to be tested and a PCA3 score is then given.

Early studies have suggested that the higher the PCA3 score the higher the probability of prostate cancer being found on biopsy. It is not a replacement for the PSA test or biopsy but it may provide further information for men suspected of having prostate cancer. Like the PSA test the PCA3 test cannot diagnose prostate cancer, but it may help to predict how likely it is. This further information may help the specialist decide whether a prostate biopsy is necessary.

Currently the PCA3 test is not available on the NHS. The test is only available privately and costs over £300. It may be available to you as part of a clinical trial.

You may wish to discuss the PCA3 test with your doctor to see if it is an option for you.

Read more about the tests to diagnose prostate cancer in our factsheet How prostate cancer is diagnosed

Last updated November 2010

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

A specialist doctor, called a pathologist, looks at prostate cancer cells under the microscope and grades them according to how 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 patterns 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.

Most men diagnosed with prostate cancer will have a Gleason score between 6 and 10. A Gleason score of 6 is classed as a low-grade cancer and is usually slow-growing and less likely to spread. A score of 7 is a moderate grade. High-grade tumours (8-10) are likely to grow more quickly and more likely to spread.

For further information, please read our page gleason score

Last updated June 2011

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.

Last updated March 2010

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.

Last updated July 2010

Oestrogen is a female hormone. Oestrogens are sometimes used as a treatment that may help to control prostate cancer that is no longer responding well to more common hormone treatments. It is most commonly given as a tablet called Diethylstilbestrol. Diethylstilbestrol may continue to control prostate cancer for a further period of time in some men.

Like all other hormone treatments, oestrogens can cause side effects.

The most worrying side effect associated with oestrogens is the increased tendency of the blood to clot, which can lead to problems such as deep vein thrombosis (clots in the legs), heart attacks or strokes. To minimise the risk of this happening, diethylstilbestrol is usually given with aspirin. However it may not be suitable for all men.

Other side effects may include stomach upset and swelling and tenderness of the breasts. Fluid retention and jaundice can also occur.

You can find out more about prostate cancer that is no longer responding well to hormone therapy in our factsheet Treating prostate cancer after hormone therapy

Last updated November 2010

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.

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.

Last updated March 2010

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

Last updated February 2010

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. You may be offered an open prostatectomy or keyhole prostatectomy (either by hand or robot assisted)

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

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.

You may also wish to discuss the issue of urinary problems with your surgeon. For some men, it can 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 starting with a gentle fitness plan may well help your recovery as well as your mental health. It would be important that you discuss your plans in detail with your surgeon and if appropriate take advice from a physiotherapist.

Last updated November 2010

I have heard about a new treatment for prostate cancer called Abiraterone. Where can I find more information about this drug?

Abiraterone is a new type of hormone therapy for men whose prostate cancer has spread to other parts of the body ( advanced prostate cancer) and has stopped responding to other hormone therapy and chemotherapy treatments. It is used to help control symptoms and not to cure prostate cancer.

More information about Abiraterone is available on the New Medicines pages of out website.

Last updated September 2011

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.

Last updated February 2010

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

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

It is 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 better than another. However each treatment for prostate cancer will have its own advantages and disadvantages or benefits and possible risks. 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 early prostate cancer. It will compare surgery, radiotherapy and active surveillance 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 localised prostate cancer, surgery and radiotherapy.

Last updated June 2011

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.

Last updated February 2010

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.

Last updated February 2010

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.

Last updated March 2010

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.

Last updated July 2009

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.

Last updated July 2009

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.

Last updated July 2009

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.

Last updated June 2011

If you have surgery to remove the prostate (radical prostatectomy) there is a risk that you may have problems getting an erection (erectile dysfunction or ED) after your treatment.

You may be offered something called a nerve-sparing prostatectomy to help avoid this. 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 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 or a vacuum pump 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 or a vacuum pump to help erections.

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

Last updated June 2011

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.

Last updated June 2010

We don't know for sure how to prevent prostate cancer. Prostate cancer is complicated and researchers are still trying to understand its causes as well as looking a ways to prevent it.

There are several factors that may increase your risk 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. However we need very large population studies to confirm this.

Men living in Western countries are more likely to get prostate cancer than men in South and Eastern Asian countries such as China and Japan. Researches think that this may be because the typical western diet is high in dairy, red meat, saturated fat, sugar and processed meat, and contains less fruit and vegetables. Eating a balanced diet with plenty of fruit and vegetables, some meat and dairy and a small amount of food and drinks high in fat or sugar, you may lower your risk of developing prostate cancer.

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

Many studies have looked at individual nutrients that may offer protection from prostate cancer. Unfortunately these trials have either not been large enough, have show no proven benefit or have been conflicting. This can be very confusing.

Some studies have shown that a diet high in antioxidants may protect men against prostate cancer. Antioxidants protect cells from the damage caused by unstable molecules known as free radicals. In particular, lycopene (an antioxidant found in tomatoes) has in some studies been linked to a decreased risk of prostate cancer but in other studies has not. Some studies suggest that cooked and processed tomatoes, such as tomato sauces, soups and pastes may be more helpful than fresh tomatoes.

Some studies have suggested that selenium and vitamin E supplements (both antioxidants) may help to protect against prostate cancer. However, a recent large study looking at selenium and vitamin E showed they did not reduce the risk of prostate cancer.

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

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

Research into diet and prostate cancer continues. But whilst current evidence may be a little unclear remember that a balanced diet, a healthy weight and an active lifestyle will have health benefits. It will reduce your risk of developing heart disease and diabetes and may reduce your risk of developing prostate and other cancers.

Read our pages on diet and your risk of prostate cancer for more information.

Last updated June 2011

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.

Last updated July 2010

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.

Last updated February 2010

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.

Last updated February 2010