Time for treatment: Surgery, radiotherapy plus ADT, or wait and see?

Time for treatment: Surgery, radiotherapy plus ADT, or wait and see?

  November 10, 2026    Stephen Cobb

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This article, the seventh in my 30-article series to raise money for prostate cancer research during November, 2026, discusses some of the things you need to think about if doctors recommend "radical treatment" for your prostate cancer.

(Note: I pledged to produce these articles, even though I am currently undergoing prostate cancer treatment, for a fundraising pledge which you can donate to here. Please consider doing so and sharing a link to this blog (CobbsBlog.com) on social media.)

How do you arrive at radical treatment?

First of all radical treatment is, in my opinion a poor choice of words when talking to patients about life-altering conditions. When they say "radical treatment" doctors are not considering doing anything out of the ordinary to you or your prostate. 

I feel the same way about deranged results from blood tests. These are results outside the "normal" or "preferred" range. In fact, your prostate cancer may have come to light due to one or more deranged PSA test results. Those can lead to an MRI, the results of which can lead to a biopsy. 

I discuss PSA number in this section an section of a post I wrote after my first biopsy. In my case, that first biopsy did find cancer cells, but only a tiny amount of them (tiny is the word urologist used and he recorded it on a CD for posterity, as described in this post). 

From then on my PSA was checked several times over the years until the point at which it had doubled. This was five years and that triggered a fresh MRI, of which my urologist said the following:

Thank you for attending for multi parametric surveillance MRI of your prostate. This shows changes, which suggest a more significant cancer than your known grade group 1 (Gleason 3+3) cancer. In light of this I recommend transperineal biopsy.

Some weeks later, after the biopsy, my urologist wrote to say that the MRI indicated: "grade progression of your cancer from Gleason 6 to Gleason 4+3 (grade group 3) cancer." And as a result of this:

...the specialist MDT now recommends radical treatment. We can offer either robot-assisted radical prostatectomy or hormone-ablation and radical radiotherapy...

There's that word radical again, and this time it is feeling very real. Either option is going to make a big difference to my life. If you are reaching this point, I think the first advice I would give is: don't panic. The general medical consensus is that most cases of prostate cancer don't get worse overnight, they develop over time, so you have time to weigh the options. 

I'm going to call these options Surgery, and RT+ADT for Radiotherapy and Androgen Deprivation Therapy (ADT) because the latter is the most common form of Hormone-Ablation therapy, the testosterone-crushing chemicals I have described elsewhere.

Speaking of terminology, note that the recommendation for radical treatment did not come from my urologist, it came from. the "specialist MDT" where MDT stands for Multidisciplinary Team. This typically consists of:

• Urology Consultants: Surgeons who specialize in urological conditions. They perform diagnostic procedures (like transperineal prostate biopsies) and surgical treatments, such as robot-assisted radical prostatectomy (RARP).
• Oncologists: Cancer specialists who plan and oversee non-surgical treatments like hormone therapy or advanced radiotherapy techniques (such as stereotactic ablative radiotherapy / SABR).
• Radiologists: Specialized doctors who interpret your prostate MRI, CT, or bone scans.
• Histopathologists: Experts who examine the tissue samples from your biopsy under a microscope to determine the exact stage and grade (Gleason score) of the cancer.

I mention this because for a long time it bothered me to think that I had cancer but had not been seen by a cancer specialist. Turns out the MDT is where oncologists get involved, and that involvement precedes any treatment suggestions.

That same letter from my urologist included one more crucial piece of information: "we need a bone scan to complete your cancer staging". This is a type of scan that can look at your entire body for signs of cancer spreading, technically known as metastasizing. What you hope for is what my bone scan found: no sign of spread. This means it's likely that your cancer in limited to, or contained by, your prostate. Encapsulated is another term for this. 

In practical terms, encapsulated means that removing your prostate, or zapping it with radio waves stands while taking hormone pills, stands a good chance of preventing the cancer from spreading. If that is the case, you then need to choose between Surgery or RT+ADT

Weighing the options

I will go into more detail on what Surgery or RT+ADT involves in another post. I will also cover side effects. These can be very serious for both options. Hopefully, if you are at the decision stage you will have be told about the side effects. You will definitely have to sign a piece of paper stating you understand them before you can receive your chosen treatment. (There is one notable exception to this informed consent — the ADT, which is a prescription for tablets, the implications of which I will discuss in another post). 

Based on the research I did, it seems the outcomes for both surgery and radiotherapy combined with hormone therapy (RT+ADT) have excellent records of success when prostate cancer is detected before it has spread. One of the most important studies, the British ProtecT trial, followed more than 1,600 men with localised prostate cancer for an average of 15 years. Among those assigned to surgery, just 2.2% died from prostate cancer, compared with 2.9% of those assigned to radiotherapy. The difference was not statistically significant. 

The likelihood of the cancer spreading to other parts of the body was also remarkably similar: 4.7% for surgery and 5.0% for radiotherapy. In other words, both treatments offered a roughly 97% probability of surviving prostate cancer for 15 years. Those are encouraging numbers, however there are caveats on both sides: the study included many men with less aggressive cancers, but the stats were for treatments that have since been improved.

Of course, these figures are averages, not guarantees. The probability of successful treatment depends on several factors, including how aggressive your cancer is (its Gleason score or Grade Group), how far it has developed, your PSA level and general health. Nor does successful treatment necessarily mean that every cancer cell has been permanently eliminated. Some men experience a recurrence years later and require additional treatment.

With all that said, current evidence does not establish surgery as universally more effective than RT+ADT, or vice versa. Both are established treatments intended to cure cancer that remains confined to the prostate or its immediate surroundings. For many patients, therefore, the decision comes down not simply to which treatment offers the best chance of staying alive, but which offers the best chance of staying alive with an acceptable quality of life.

The treatment decision

The factors involved in choosing a prostate cancer treatment option are many and varied. I chose RT+ADT partly because of age but there were other factors that I might blog about when I get a chance. Both choices put your sexual functionality a risk. Neither is conclusive. The cancer could come back in either scenario. You could have surgery then later need RT+ADT. I have a friend who has not had any recurrence after surgery, but another who had a prostatectomy and later needed RT+ADT.

Something you can't expect to do is have RT+ADT then later opt for surgery. The radiotherapy damages the prostate to a point where surgeon's are loathe to operate. It is possible, but more risky than removal before RT.

There is one other treatment option that needs to mentioned: no treatment at all. Some men may prefer to take their chances without surgery or radiotherapy and hormone tablets. This could be due to specific circumstances or beliefs and I am not qualified to say whether this is a good idea. However, I'm pretty sure your urologist will be honest about the implications. From what I have read, if your prostate cancer is not very aggressive and you are over 80 for example, they might be okay with "wait and see." 

In my next post, I will describe Surgery and RT+ADT in more detail. In a further post I will compare the side effects of each. Please bear in mind that every case of prostate cancer is different. In these articles I am drawing on my own experience combined with many hours of research. I am not a doctor and nothing on this website is to be taken as advice from a medical professional.

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Refining existing prostate cancer treatments: radiotherapy timing

Refining existing prostate cancer treatments: radiotherapy timing

  November 08, 2026    Stephen Cobb

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One of the main treatment options for prostate cancer is radiotherapy. This article, the sixth in my 30-article series to raise money for prostate cancer research during November, 2026, describes a fascinating example of the potential for progress in reducing the adverse effects of radiotherapy treatment.

(Note: I pledged to produce these articles, even though I am currently undergoing prostate cancer treatment, for a fundraising pledge which you can donate to here. Please consider doing so and sharing a link to this blog (CobbsBlog.com) on social media.)

Prostate cancer radiotherapy 101

The impressive collection of high tech equipment you see in the photo at the top of this article is a state-of-the-art radio therapy system configured for a prostate cancer patient. The horizontal unit is the 'bed' where the patient lies down, feet on the right, head on the left. This bed then slides to the left while the four large modules on the left rotate around the body to deliver the radio waves to the target, i.e. the prostate.

The idea is that accurately focused radio waves damage and kill cancer cells. That accuracy depends in part on the patient. I will go into more detail about all of this a future post, and I provide tips on meeting the rather exacting biological requirements for the patient. In crude terms: fill bladder, empty bowel, clear gas, lie very still. 

Fortunately, each treatment session takes only a few minutes and they do not hurt. A typical course of treatment is 20 sessions performed on consecutive weekdays (mine went: Wed/Thu/Fri; Mon thru Fri; Mon thru Fri;  Mon thru Fri; Mon/Tue).

Is there a "right time of day" for safer prostate cancer radiotherapy?

When I was going through my radiotherapy, in July of 2026, I found that meeting the biological requirements for morning appointments was easier than for those later in the day. I spoke to several fellow patients that felt the same way. 

In fact most of my appointments were for 9:30 in the morning, but not all. The same equipment is used to treat a range of cancers in patients of all ages and genders and levels of health. Not everyone can walk in and hop up on the treatment bed. Also, the equipment is on strict maintenance schedules that take it offline.

Basically, prostate cancer radiotherapy is scheduled around practical questions: when is the machine available, when can the patient get to hospital, and how can the staff fit everyone in? But intriguing new research suggests another question may need to be added: what does the patient's body clock think is a good time?

Researchers at the University of Leicester, working with European colleagues, have found evidence that the time of day at which prostate cancer patients receive radiotherapy may influence their chances of developing long-term side effects. (I will be talking about what those side effects are in a separate article.) 

Crucially, the answer appears to depend on their genes. (As reported here.) The researchers used data from the international REQUITE study, which followed 1,760 men undergoing external-beam radiotherapy, the kind described above. For 877 of these men, researchers had sufficiently detailed information about treatment times, genetic variations and side effects over the following two years.

Researchers focused on variations in PER3, a gene involved in regulating circadian rhythms, that internal 24-hour clock which influences our sleep, hormone activity, and our body's ability to repair damaged cells. The findings were striking:

• For men carrying one particular PER3 variant, the researchers' model predicted that avoiding radiotherapy around midday could reduce the risk of subsequent urinary incontinence from 15% to 5%.
• For another genetic group, receiving treatment at 5pm rather than 9am was associated with a predicted reduction in rectal bleeding risk from 11% to 5%.

But apparently this is not a case of simply declaring afternoon appointments safer. Some genetic groups appeared to benefit from midday treatment, while others showed little effect from timing at all. There are also important caveats. 

This was an observational study, not a clinical trial in which men were deliberately assigned different treatment times. The percentages are model-based predictions, not demonstrated improvements. Further research is required to establish whether adjusting appointment times actually reduces harm without affecting cancer control. (Full study published in Clinical Cancer Research.)

Despite tohse caveats, I find the implications fascinating. If the results hold up, a relatively simple genetic test could help hospitals allocate radiotherapy appointments according to patients' biological clocks. No new radiation machine, miracle drug or expensive treatment would be required, just a more "intelligent" timetable.

As someone who recently completed prostate radiotherapy, I find this a particularly appealing idea. The goal should not simply be to eradicate the cancer, but to minimise the price patients pay for surviving it. Kudos to all involved in this research!

P.S. My enthusiasm for this research has nothing to do with the fact that the University of Leicester is only 25 miles from where I live and also my alma mater (MSc in Security and Risk Management, School of Criminology, 2016).

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Good news about prostate cancer: three pieces of progress

Good news about prostate cancer: three pieces of progress

  November 07, 2026    Stephen Cobb

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Not all the news about prostate cancer is bad. For the fifth article in my 30-article series for Movember, 2026, I present the first of three examples of progress in treatment and diagnosis.

 

(I pledged to produce these articles, even though I am currently undergoing prostate cancer treatment, as part of a fundraising pledge to which you can donate here. Please consider doing so and sharing a link to this blog (CobbsBlog.com) on social media.)

Prostate cancer drugs

Prostate cancer is a large and growing challenge to men's health, as documented in this article, and that means there's plenty of financial incentive, as well as compassionate incentive, to find drugs that can help treat prostate cancer.

I am on a prostate cancer drug right now, Relugolix, which belongs to a class of drugs called GnRH antagonists, which are used in androgen deprivation therapy (ADT). The goal of this therapy is to suppress the body's production of testosterone, a hormone that fuels the growth of most prostate cancers. 

To get technical, GnRH stands for gonadotropin-releasing hormone receptor antagonists. Relugolix does not block testosterone itself. It blocks hormonal signals from the pituitary gland that tell the testicles to produce testosterone. Unfortunately, while it makes sense to starve prostate cancer cells of the testosterone they need to grow, testosterone is also essential to a healthy male body; that means the implications of going without testosterone for months at a time are quite serious, something I will get into in a separate post.

A promising new PCa drug

But I digress, the new drug I wanted to highlight comes from pharmaceutical giant Johnson & Johnson. Last month the company announced promising results from an early clinical trial of an experimental drug with the snappy name of JNJ-6143. Like Relugolix, this drug is taken as a daily pill. But unlike conventional hormone treatments, which attempt to control prostate cancer by depriving it of testosterone, this drug is designed to interfere directly with proteins that cancer cells need to survive, triggering their destruction. 

The results are striking: among patients receiving the selected dose, 77% experienced a reduction in PSA levels of at least 50%, and nearly half saw their PSA fall by 90% or more. Even more encouraging, among patients with tumours that could be measured on scans, 75% experienced significant tumour shrinkage or complete disappearance of the measurable tumours. These were men with advanced prostate cancer who had already undergone several other treatments, making the results particularly encouraging. 

This trial was small and much larger studies are needed to establish whether the benefits last and whether patients actually live longer. Nevertheless, this is an exciting development, suggesting that researchers may be able to find new ways to attack prostate cancer beyond the familiar strategy of suppressing testosterone. 

If, like me, you are familiar with having your testosterone suppressed, you know that avoiding this would be a big help. Unfortunately, JNJ-6143 is not yet an alternative to testosterone suppression. In fact, the Phase 2 trial requires patients to continue ADT. Right now the focus of the drug's developers is fighting metastatic castration-resistant prostate cancer—cancer that continues growing despite very low testosterone levels. 

Nevertheless, what I take from learning about this new drug is that, in the future, it is may be possible to defeat prostate cancer without chronic testosterone suppression.

Next up: an exciting development in "Refining existing treatments." That will be followed by progress in the genetics of prostate cancer which could help find men at risk earlier than current technology allows.

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About this Movember thing: from pub dare to global prostate cancer support movement

About this Movember thing: from pub dare to global prostate cancer support movement

  November 04, 2026    Stephen Cobb

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My pledge to write 30 blog posts about prostate cancer in November, while undergoing prostate cancer treatment, came about because there is a charity called Movember that started raising money for The Prostate Cancer Foundation of Australia in November, 2004. Several hundred men took part and raised tens of thousands of dollars, then the largest single donation that foundation had received.

In proper Aussie fashion Movember began as a dare in a pub. This one involved growing a moustache during the month of November, hence the name — Movember — and of course the logo, seen here:

Since its inception the Movember Foundation has raised more than A$1.8 billion and funded over 1,600 projects. Basically, a moustache-growing dare has become one of the largest sources of men’s health funding in the world. 

Stephen Cobb
Growing facial hair
for charity,
November, 2012

I first became aware of Movember when a colleague at ESET in San Diego, California, led a fundraising drive in November of 2012. Because I already had a moustache and beard, I agreed to shave them off and regrow them, as seen in this photo taken on  the 22nd of November (Thanksgiving). I think I raised $100.

The Movember Foundation was officially recognised as a charity by the Australian government in 2006. In 2007 the foundation launched campaigns in Canada, Spain, the United Kingdom and the United States, with Prostate Cancer UK as the British beneficiary. 

Of course, moustache growing is not the point. Its role was to start conversations  about prostate cancer that many men avoid. The foundation’s remit has since widened to include testicular cancer, mental health and suicide prevention. Amazingly, a moustache-growing dare has become one of the largest sources of men’s health funding in the world.

Along the way, other challenges and dares have been employed to the same end. This year I decided to participate but without removing my facial hair. Instead, I pledged to publish 30 blog posts about prostate cancer that could be helpful to men like me who are living with it, or worried about it.

I'm going to try to achieve this goal while undergoing one form of prostate cancer treatment, specifically the testosterone-crushing tablets known as Relugolix, a form of ADT or Androgen Deprivation Therapy. The idea is to stop the body's production of testosterone which is what those evil little cancers cells feed on. Two of the effects of this are serious fatigue and brain fog, both of which make writing more of a challenge than it normally is.

Movember is a reputable global charity. The donation process is simple and safe, so please consider clicking the banner below and chipping in, wherever you are. I'm trying to make the blog posts useful to both US and UK readers. So donating £5 would cost you about $7 if you pay by American credit card. If we can get to £300 before Thanksgiving (the 26th) I will kick in £50 myself.

Notes

Sources: Movember history, Wikipedia · A Hairy Tale, Movember · Movember’s ‘hairy’ history · Movember, Wikipedia mirror)

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Diagnosing prostate cancer: the PSA testing debate

Diagnosing prostate cancer: the PSA testing debate

  November 03, 2026    Stephen Cobb

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PSA testing, a major factor in prostate cancer diagnosis, is my chosen topic for this, the third blog of the 30 that I have pledged to publish this November, a.k.a. Movember, the prostate cancer charity for which I am trying to raise money.

PSA testing is a major factor in prostate cancer diagnosis, but it is also hotly debated when governments look at how they should respond to the rising tide of prostate cancer cases (a trend discussed and documented in yesterday's Movember post: Prostate cancer by the numbers). 

After explaining what PSA testing is and how it is used, I will explain why some people believe PSA testing can be harmful. Not long ago, one of those people complained when I recommended PSA testing on social media. I took that seriously, investigated the claim, and decided it was groundless. To be clear, this is my position:

I think PSA testing is very useful, particularly over time,

and it's not harmful when understood and handled properly.

I have paid for PSA tests myself when doctors would not. 

What is PSA?

So let's take a look at the role of PSA — Prostate Specific Antigen — and the tests that measure it. Those tests are performed by taking a sample of your blood. This is done with a needle and vial like other blood tests such as a Full Blood Count, or tests for cholesterol levels and liver function. 

PSA is a protein manufactured almost exclusively by the prostate gland. The role of PSA is to produce enzymes that keep semen fluid. Under healthy conditions, the cellular barriers of your prostate keep most of this protein locked inside the gland, allowing only a tiny, baseline amount to drift into the bloodstream. 

This is why everyone who has a prostate, even one like mine that has been repeatedly blasted by a photon beam, will have some amount of PSA in their blood. I currently have 0.5 ng/mL (half a nanogram of PSA per milliliter of blood). However, I am on medication that reduces PSA, something I will get into in a future post.

For a healthy young man a PSA score of 1.0 ng/mL or less is likely. As men age, more PSA tends to leak, so that PSA number may get up to 2.0 by the time you are in your 40s, without any cause for concern. The "nothing to worry about number" continues to rise over time, but a PSA of 4.0 in anyone under 60 will typically lead to further investigation. (See the disclaimer regarding "typical" at the end of this post: every person is different and there are multiple factors involved in prostate cancer diagnosis other than PSA test results.)

Because the prostate constantly releases small amounts of PSA into the bloodstream, a low level is normal. However, when your prostate is disrupted those cellular barriers become leaky. Those leaks allow PSA to spill directly into the blood and raise your PSA score. 

There are numerous things that can cause this leak-inducing disruption of your prostate: inflammation: natural aging and enlargement, or the structural disorganization caused by cancer cells. In other words, the level of PSA in your blood is not a direct indicator of cancer, and it can rise with age without implying you have cancer.

(I talk about "safe" age ranges for PSA scores in this blog post.) 

To reiterate, a high PSA score is not a definitive diagnosis for cancer. Non-cancerous conditions—such as benign prostatic hyperplasia (BPH) or a urinary tract infection—frequently cause elevated PSA levels. Basically, doctors use the PSA result as an initial screening tool to determine if further evaluation is necessary.

Back in 2020, I told my GP I was getting up several times a night to pee. I was 68 at the time. He sent me to a urologist who used his finger to check the size of my prostate. It was fairly normal for my age. Because an enlarged prostate can cause PSA to leak, but mine was not enlarged, the urologist ordered a PSA test to see if cancer was involved. 

The result was 5.0. That was cause for concern, so a second test was ordered. That was lower, 4.2, but it was still cause for concern because, by then, the urologist was aware that my brother had a serious case of prostate cancer. Apparently, prostate cancer in your blood relatives increases the probability that you might have it too. (There will be a post about the genetics of prostate cancer later in this series.)

PSA misconceptions

When I recommended PSA testing in a recent social media post I got this pushback: "PSA is not a reliable cancer indicator." The commenter also implied that PSA testing could be harmful. These responses embody the two main "beliefs" I see in public discourse about PSA tests:

A: PSA tests are no good.
B: PSA tests can lead to harm.

So let me address these, briefly and then in more detail. 

Belief A is technically correct. As you now know from this article: a single PSA result is not a reliable diagnostic test for prostate cancer; however, multiple PSA tests over time are a very valuable indicator of prostate health relative to cancer. A man who gets a PSA test when he turns 40, then annually after that, is much better placed to notice changes that might be an early indicator of prostate cancer, worthy of further investigation. 

The source of belief A is the fact that the PSA test is prostate-specific, not cancer-specific. That means levels can rise because of benign enlargement, infection, inflammation, recent ejaculation, and normal biological variation (I scored a 5 and then had several lower scores).

However, the value of PSA becomes substantially greater when it is measured repeatedly over time. A persistent elevation or an upward trend—considered alongside age, prostate volume, family history and other risk factors—can provide a strong signal that further investigation is warranted. The UK guidelines specifically recognise PSA velocity and PSA density as factors that can justify further investigation, while European guidelines recommend repeating a moderately elevated PSA before proceeding further.

Belief B, that PSA tests can lead to harm, is bogus because there is no harm in a PSA test at all, unless there are serious deficiencies in the medical system where the man is tested. Decades ago an abnormal PSA score could lead to a biopsy, which carries risks of harm (which I talk about here). These days, a high PSA score rarely leads straight to biopsy. 

A scan of some form is done before biopsy and only if that indicates cancer might be present does a biopsy get scheduled. As in my case, an initial score of 5 only led to a repeated test. Only after a second test and family history did biopsy enter the picture, but that was preceded by scanning. 

In modern UK practice, a multiparametric MRI is normally the first line of investigation for suspected localised prostate cancer. The national guidelines explicitly advise against offering biopsy on PSA alone, and men with a low-risk MRI may avoid biopsy altogether. When biopsy is indicated, MRI can identify suspicious areas and permit more targeted sampling.

Consequently, properly conducted PSA testing—with informed counselling and an MRI-led diagnostic pathway—carries little direct physical risk. Psychological harms such as anxiety and overdiagnosis remain possible, but these can be substantially reduced by appropriate explanation, repeat testing, and selective use of imaging and biopsy.

I hope this information has been helpful. I will be looking at PSA testing in a future post when I address the arguments about prostate cancer screening.

Disclaimer: This article was not written by a medical professional and should not be used as the basis for any medical decisions. Please consult a medical professional before taking any medical action as a result of reading this article. Every person's biological characteristics are unique, as are their genes and their personal circumstances. Similarly, every case of prostate cancer is different. While talking about "typical" cases and scenarios can be useful for presenting information, it does not establish any facts or diagnosis or prognosis specific to you or anyone else.

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Prostate cancer by the numbers

Prostate cancer by the numbers

  November 02, 2026    Stephen Cobb

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To raise funds for prostate cancer research and patient support through the Movember charity, I pledged to publish 30 blog posts in November of 2026, while undergoing prostate cancer treatment. This is the second of those 30 posts. (To be completely transparent, it is an expanded version of a shorter piece I originally put together in August, but I think it still counts as one of the 30.) 

While yesterday's post was a brief and rather blunt introduction to the prostate itself and the prostate cancer experience, today I have focused on the scale of the prostate cancer problem, and by implication, the number of people experiencing prostate cancer. 

So, yes, there will be a bunch of statistics. However, I don't want to lose sight of the fact that, behind all these numbers are people coping with cancers that are life limiting and life ending. Although cancer survival rates today are far higher than they used to be, fear of cancer is still strong and widespread. If you need support, I have listed resources on my Prostate Cancer page.

Headline Prostate Cancer Numbers

Prevalence: Roughly 600,000 men are currently living with or after a prostate cancer diagnosis in the UK. 
Mortality: Over 12,000 men die from the disease each year in the UK.
Lifetime Risk: About 1 in 8 men will be diagnosed with prostate cancer in their lifetime (rising to about 1 in 6 depending on specific definitions). 
Age Factor: Most cases are diagnosed in men aged 50 and older, with incidence rates peaking in the 75–79 age group. 
Ethnicity Risk: Black men face a significantly higher risk, with approximately 1 in 4 developing prostate cancer in their lifetime—roughly double the general population risk. 

These are UK numbers but America's data is comparable. These stats come from Prostate Cancer UK, Cancer Research UK,  World Cancer Research Fund, ITV News, Focal Therapy Clinic. For more sources see final section of this post: Prostate Cancer Data Sources.

The growth of prostate cancer

The rise of prostate cancer (Urological) in the UK from April 2020 to October 2024 

As a public health issue, prostate cancer (PCa), has growing rapidly this century; it is now comparable in scale to breast cancer (BCa). By some key numerical measures PCa has now overtaken BCa, for example in terms of UK deaths, recent UK diagnoses, and projected US new cases.

I'm not pointing this out to diminish breast cancer, but to put prostate cancer in perspective. In most countries, PCa has become a major national cancer problem warranting a focus on screening, detection, treatment, patient and partner support, and research into cure and prvention.

You can see the dramatic rise in the number of prostate cancer patients being treated in the UK since 2000 in chart at the top of this post. This is from the UK publication Urology News. (Sources for the statistics in this article are listed in the final section: Prostate Cancer Data Sources).

Prostate Cancer (PCa) in the US

The American Cancer Society has projected 333,830 new prostate cancer cases in 2026, making it the single largest named cancer category in its table of estimated new cancers. That is slightly higher than 324,580 breast cancer cases when female and male breast cancer are counted together. 

It's important to note that in terms of projected deaths, breast cancer (BCa), remains higher in the US: (42,670 versus 36,320 deaths in 2026). An accurate statement of the situation would be: prostate cancer is now numerically bigger in the US than breast cancer in terms of projected new diagnoses, but not deaths.

To put the scale of PCa in context we can look at population rates. The US National Cancer Institute’s SEER data put prostate cancer at 123.2 new cases per 100,000 men per year, with a death rate of 18.9 per 100,000 men, based on recent incidence and mortality periods. Female breast cancer is still slightly higher at 132.5 new cases per 100,000 women, with the same reported death rate of 18.9 per 100,000 women. 

The UK PCa picture

In the UK, the organization Cancer Research UK projects 57,900 new prostate cancer cases per year, or roughly 160 diagnoses a day, using 2019 and 2021–2022 data. Prostate cancer accounts for 14% of all new UK cancer cases and is the most common cancer in men, representing 28% of new male cancer cases. 

The UK incidence of PCa has risen sharply over the longer term: CRUK reports that incidence rates in males have increased by 54% since the early 1990s, and are projected to rise a further 14% between 2024–2026 and 2038–2040, reaching about 85,100 new cases a year by 2038–2040.

The UK breast cancer comparison is striking but slightly time-sensitive. CRUK’s consolidated figures still list breast cancer at about 59,400 new cases per year, just above the prostate figure in that dataset. But Prostate Cancer UK, citing the latest NHS figures, reported in January 2026 that UK prostate cancer diagnoses rose from just under 52,000 in 2021 to more than 64,000 in 2022, a 24% increase, making prostate cancer more commonly diagnosed than breast cancer.

On mortality, the UK comparison is already clearer. CRUK reports around 12,300 prostate cancer deaths per year, compared with around 11,200 breast cancer deaths. Prostate cancer is the third most common cause of cancer death in the UK overall and the second most common cause of cancer death in men. Breast cancer remains the second most common cause of cancer death in women, but numerically, prostate cancer now causes slightly more UK deaths each year.

Beyond the numbers

I was completely ignorant of prostate cancer numbers before March of 2018; that's when my brother told me he had been diagnosed with it. At that time he was 60. In hindsight, back then I did not do enough to educate myself about prostate cancer, or support what he was going through. 

That changed three years later when a series of PSA tests led to a urologist writing this statement in a letter to my doctor:

I have contacted Mr Cobb to discuss his persistently mildly raised PSA. This has remained constant around the value of 4.4 mcg/L and it would be recommended for us to further investigate the matter. Have informed him that the routine investigation pathway includes an MRI scan of the prostate and a prostate biopsy. The MRI scan will show any suspicious areas that might need a targeted biopsy. The LAD prostate biopsy is a local anaesthetic transperineal approach to biopsying the prostate and it carries the risk of bleeding, bruising, temporary erectile dysfunction or numbness, discomfort on urination or urinary retention. This gentleman has agreed to have both procedures and I have added his name to the waiting list.

Basically, this was the consultant saying there was chance I had prostate cancer. At this point my brother had been living with prostate cancer for three years, three very active and productive years. Ironically, that had a positive effect on how I coped with the news I too might have to live with prostate cancer. I did not feel a sense of dread.

Yes, I was deeply concerned, but I threw myself into research mode. At this point I was 69 and it became clear that, with all the treatment options available, having prostate cancer was probably not going to shorten my life.

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Movember is here! Please donate to my effort to raise money for prostate cancer research and patient support

Movember is here! Please donate to my effort to raise money for prostate cancer research and patient support

  November 01, 2026    Stephen Cobb

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This November, a.k.a. Movember, I have dared myself to raise funds to
fight prostate cancer. HOW? By trying to write and post 30 articles
about prostate cancer on this blog, while coping
with my ongoing cancer treatment.
Wish me luck, and please share this post.
And if you to donate: THANK YOU!

For this, the first of my 30 prostate cancer awareness raising blog posts, I'm going to start with the basics, like what is the prostate and what does it do? Hopefully, you won't be insulted by this, but in my five years of living with prostate cancer I have encountered a surprising number of people who didn't understand what this crucial male gland does, or even where it is. So let's get started with a helpful diagram:

Diagram showing the location of the prostate (adapted from public domain image)

The prostate is a small gland that resides between the bladder and the rectum. Present in most people who are assigned male at birth, the prostate is about the size or a walnut or ping-pong ball. The main function of the prostate is to produce seminal fluid, the liquid that mixes with sperm to form semen. That puts the prostate at the heart of multiple critical bodily functions. And that makes treating cancer in the prostate very tricky, not to mention scary.

Basically, and I feel this is not acknowledged enough in conversations about prostate cancer, this cancer puts at risk the patient's ability to have sex, specifically erection and ejaculation. Why? During ejaculation, the prostate contracts to help propel semen through the urethra and out of the penis. Furthermore, the prostate is closely surrounded by nerves and blood vessels that control erections, and these can be damaged by prostate cancer treatment, potentially causing erectile dysfunction.

Because the penis also handles output from the bladder, the urethra passes through the prostate, as you can see from the diagram above. That's why an enlarged prostate impacts urination, and why one of the other risks associated with prostate cancer and its treatment is damage to "water management," meaning the ability to start peeing, stop peeing, and fully empty the bladder.

To be clear, it's not the presence of cancer in the prostate that affects sexual function so much as the treatment to remove the cancer. This is true of both surgery to remove the prostate and the use of radiotherapy and hormone therapy to kill off the cancer cells. I will be talking about this in more detail in future articles.

Given all this, you might be wondering: if the treatment comes with risks like that, why not just leave the cancer alone? A closely related question, one that my mum asked me, is: does prostate cancer hurt? In my case, the answer is "not so far," and that is the same for most men whose cancer, like mine, is confined to the prostate. However, some men do experience pain with "confined" or "contained" prostate cancer, and not all men experience pain when the cancer spreads — metastasises — to other parts of the body.

All of which makes things complicated to say the least. Having prostate cancer is not a death sentence, although it can be fatal, and in some cases extremely painful, but treatment can be painful too. This complex reality helps to explain why some men chose not to get tested for prostate cancer, and some who have it decline to get it treated. I hope to explore these aspects of prostate cancer in future articles.

Hopefully, this article has been helpful. If there is one important takeaway it's this: bear in mind that every case of prostate cancer is different, unique to each patient. This means that making assumptions about people based solely on "he's got prostate cancer" is a fool's errand. The effect of the cancer and the treatment of it varies from man to man. What is common to all cases of prostate cases is their capacity to induce fear, anxiety, and a sense of mortality that can sometimes be hard to handle.

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