Prostatic carcinoma

Prostate carcinoma is considered to be a spectrum of diseases which may vary from slow growing tumours (which are often asymptomatic) to very aggressive tumours (1).

• it is the most common cancer in men in the UK
• is largely a disease of older men and is rare before 50 years (1)
• prostate cancer is the most common cancer in men and makes up 26% of all male cancer diagnoses in the UK (2,3)
  • prostate cancer is the most common cancer in men, and the second most common cancer in the UK
    • in the UK, prostate cancer is the most common cancer, with around 55,300 new cases every year - 28% of all new male cancer cases in the UK (2017-2019). About 1 in 8 men will get prostate cancer at some point in their life
    • prostate cancer can also affect transgender women, as the prostate is usually conserved after gender-confirming surgery, but it is not clear how common it is in this population
    • more than 50% of prostate cancer diagnoses in the UK each year are in men aged 70 years and over (2012), and the incidence rate is highest in men aged 90 years and over (2012 to 2014)
    • out of every 10 prostate cancer cases, 4 are only diagnosed at a late stage in England (2014) and Northern Ireland (2010 to 2014)
  • in the UK, a man's lifetime risk of being diagnosed with prostate cancer is 1 in 8 (4)
    • study evidence revealed that:
      • lifetime risk of being diagnosed with prostate cancer is approximately 1 in 8 for White men, 1 in 4 for Black men, and 1 in 13 for Asian men, whereas that of dying from prostate cancer is approximately 1 in 24 for White men, 1 in 12 for Black men, and 1 in 44 for Asian men

Prostate tumours can be divided into:

• localised prostate cancer
  • the tumour is confined to the capsule of the gland
  • grows slowly and usually remains asymptomatic (1)
• locally advanced prostate cancer
  • cancers have extended outside the prostatic capsule
  • frequently asymptomatic
• metastatic prostate cancer
  • may be the first sign of prostate cancer
  • frequently spreads to the bone and causes pain
  • majority die due to the metastatic disease
  • 5-year survival rate is approximately 30% (1)

UK stage at diagnosis (3):

• prostate cancer patients diagnosed with a known stage are most commonly diagnosed at stage I in England (35%), stage II in Northern Ireland (39%) and stage IV in Scotland (34%)
• more prostate cancer patients with a known stage are diagnosed at an early stage (57-63% diagnosed at stage I or II) than a late stage (37-43% diagnosed at stage III or IV) in England and Northern Ireland
• however, in Scotland more prostate cancer patients with a known stage are diagnosed at a late stage (44% diagnosed at stage III or IV) than an early stage (57% diagnosed at stage I or II)
• between 17% and 34% of prostate cancer patients have metastases at diagnosis (stage IV)

Open Image in Modal

Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer (5)

• UK RCT (n=1643) found similar prostate cancer mortality regardless of treatment (3.1% in active-monitoring group; 2.2% in prostatectomy group; 2.9% in radiotherapy group)
  • for men on androgen deprivation therapy, clinical progression occurred in 25.9%, 10.5% & 11.0%, respectively
  • authors concluded that the choice of therapy for men with localized prostate cancer involves weighing trade-offs between benefits and harms of treatment

A review states (6):

• approximately 1.5 million new cases of prostate cancer are diagnosed annually worldwide.
  • approximately 75% of patients present with cancer localized to the prostate, which is associated with a 5-year survival rate of nearly 100%.
  • approximately 10% of patients present with metastatic prostate cancer, which has a 5-year survival rate of 37%
    • first-line therapies for metastatic prostate cancer include androgen deprivation and novel androgen receptor pathway inhibitors, and chemotherapy for appropriate patients

Patients with localized disease are often asymptomatic (7).

The UK National Screening Committee state (8):

“..Based on the 2025 to 2026 review of evidence into prostate cancer screening, the modelling study and consultation with stakeholders, the UK NSC:

• does not recommend population screening for this condition
• recommends a targeted screening programme, involving PSA testing every 2 years, for men aged 45 to 61 who have a pathogenic (able to cause disease) BRCA2 variant with a family history of breast, ovarian, pancreatic, or prostate cancer
• recommends that the best method of identifying and inviting the above high-risk group should be evaluated over time
• does not recommend targeted screening for any other risk groups
• will continue to work closely with UK researchers, including the TRANSFORM trial, to address uncertainties in the evidence regarding targeted screening of black men and other risk groups

The committee concluded that screening is more likely to cause more harm than good in the whole population and in men with a family member who has had breast, ovarian or prostate cancer but who do not have a BRCA2 variant. For black men, there is ongoing uncertainty as to whether screening would cause more good than harm. The main harms of prostate cancer screening include incontinence and erectile dysfunction in men who do not need treatment…”

Reference:

1. Prostate Cancer Risk Management Programme Information for primary care; PSA testing in asymptomatic men. Evidence document. NHS Cancer Screening Programmes, 2010
2. NICE. Prostate cancer: diagnosis and management. NICE guideline NG131. Published May 2019, last updated December 2021
3. CRUK. Prostate cancer statistics
4. Lloyd, T., Hounsome, L., Mehay, A. et al. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Med 13, 171 (2015). https://doi.org/10.1186/s12916-015-0405-5
5. Hamdy FC et al.Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer NEJM March 11th 2023.
6. Raychaudhuri R, Lin DW, Montgomery RB. Prostate Cancer: A Review. JAMA. Published online March 10, 2025.
7. Voelker R. What Is Prostate Cancer? JAMA. Published online July 24, 2025.
8. "Prostate Cancer Screening Recommendation." GOV.UK, UK National Screening Committee, Accessed 3 June 2026