The 5 dangerous prostate cancer myths you probably believe – from rectal exams to missed symptoms

IT’S a disease that only affects old men. Wrong. You won’t die of it, you die with it. Wrong again!

Prostate cancer is the most common cancer in England, overtaking breast cancer for the first time since 2019.

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New NHS figures show 55,033 men were diagnosed in 2023, compared to 47,526 cases of breast cancer.

A catch-up campaign to detect cases missed during Covid lockdowns, and awareness fuelled by cycling legend Sir Chris Hoy revealing his terminal diagnosis, have increased patient numbers.

Yet, while awareness is rising, many dangerous myths persist about a disease that kills more than 12,000 men every year, according to - the equivalent of 33 lives lost each day.

“The biggest myth of all when it comes to prostate cancer is you won’t die of it, you die with it,” leading expert, Professor Nick James of the and tells Sun Health.

“The other common myth is the idea that if you don’t have symptoms, you don’t have prostate cancer.

“In the early stages of disease, there are rarely symptoms. 

“It’s only when it’s spread, like in the case of Sir Chris Hoy, that you might get symptoms like he did, in his shoulder, or changes to toilet habits.”

Here, with the help of Prof James we get to the bottom of five common myths…

MYTH #1: Prostate cancer only affects old men, you won’t die of it - you die with it

LIKE all cancers, you can be diagnosed with a prostate tumour at any age.

It’s true that the disease is more common in older men, with around a third (34 per cent) of cases each year diagnosed in men aged 75 and over, according to CRUK.

But flip that and two-thirds of cases are in the under-75 age group.

Sir Chris Hoy was just 47 years old when he was diagnosed with the disease in September, 2023. He revealed late last year that he has two to four years to live.

So where does this idea that ‘you won’t die of prostate cancer, but with it’ come from?

Prof James says: “When you perform post mortems on men who have died of any cause - even men in their 30s and 40s - you will often find they have traces of prostate cancer.

“Of men in their 80s, 80 to 90 per cent will die with some evidence of prostate cancer, while around 1 to 2 per cent will die of it.

“So, it is true that most men will die with it, usually without ever knowing they had it.”

But, he’s quick to point out that of the roughly 50,000 men diagnosed each year, one in five - including young men - will die of their disease.

“Sadly it’s probably the case that Sir Chris will die of prostate cancer,” says Prof James, who was named by the cycling legend in his book, All That Matters, as one of the team caring for him.

“He may live for many years, but the likelihood is that he will die prematurely and lose significant life years.”

MYTH #2: If I don’t have symptoms, I don’t have prostate cancer

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WHEN it comes to cancer, there’s no doubt that knowledge is power.

So recognising the signs and symptoms is vital - and can be the difference between an early diagnosis when the disease is treatable, and late diagnosis, which invariably leads to premature death.

But, some cancers are altogether more sneaky, hiding deep inside the body and giving very little clue as to their existence or whereabouts.

Prostate cancer is a prime example, Prof James explains.

“Tumours tend to arise on the outer surface of the prostate,” he says.

“The middle of the prostate, which sits around the urethra (the tube you pee through), is not commonly affected in the earliest stages of disease.

“So, for a man’s urine flow to be affected by prostate cancer, it has to be quite a large tumour.

“As a result, the earliest prostate cancers don’t tend to show any noticeable symptoms.”

As the disease progresses and a tumour does begin to encroach on the urethra, symptoms can begin to rear their ugly heads.

You might notice:

• Difficulty starting to pee or emptying your bladder
• A weak flow when peeing
• A feeling that your bladder hasn’t emptied properly
• Dribbling urine after you finish peeing
• Needing to pee more than usual, especially at night
• A sudden need to urinate, sometimes leaking before reaching the loo.
• Blood in the urine or semen (not so common with prostate cancer but always important to investigate)

And if the cancer breaks out of the prostate, spreading to other parts of the body, it can cause:

• Back, hip or pelvic pain
• Problems getting or keeping an erection
• Leg or scrotal swelling
• Unexplained weight loss.

Sir Chris’s case once again serves to offer a stark warning to others.

Thinking he had tendonitis in his shoulder, the Olympian was sent for a scan. It revealed a tumour, and further tests traced his disease back to its primary source, his prostate.

By the time it was detected in September 2023, his disease had metastasised - spreading to his bones, hip, spine and rib.

Prof James, says: “If you are diagnosed with metastatic prostate cancer, we can help but invariably it is too late to cure it.”

MYTH #3: Screening doesn’t work

TO screen or not to screen for prostate cancer - that <is> the question. 

The NHS screens for breast and bowel cancer (over the age of 50) and cervical cancer from the age of 25 to 64.

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But currently there is no national screening programme to detect prostate cancer.

A test does exist, but debate has raged for years over whether or not the PSA blood test is reliable enough to be rolled out as a mass screening tool.

It looks for high levels of a protein that can indicate prostate cancer.

The problem? A raised PSA level can also be caused by other things, non-cancerous or benign enlargement of the prostate, which is common as men get older, for example.

Prof James explains: “The debate around screening often throws up two fears, over-diagnosis and over-treatment.

“It’s true that if you just use PSA testing, there is a risk that you will diagnose men who never go on to develop significant disease, and in those with this so-called low-grade disease you then run the risk of over treating them.

“That is certainly what screening trials conducted 20 years ago showed - but a lot has changed since then.”

Once upon a time the route to diagnosis went: PSA test to biopsy via the rectum, which comes with a risk of sepsis, and lethal sepsis in rare cases.

But in recent years, a major development has made all the difference, Prof James says.

“Significantly we can now use MRI scans before a biopsy, which will show up if there is a lesion or not.

“It means many men won’t go on to have unnecessary biopsies.

“Of the men referred to our clinic, only half go on to need a biopsy.”

It’s true that if you just use PSA testing, there is a risk that you will diagnose men who never go on to develop significant disease

Prof James

And the beauty of the MRI at this stage is that it arms urologists with vital information.

“The scans ensure that we can biopsy the right bits of the prostate, instead of going in blind,” Prof James says.

So what’s the reality on the ground in the NHS right now, with regards to PSA testing?

Simply put, Prof James says we’re missing many men who are at greatest risk of prostate cancer.

“The guidelines lean towards using PSA testing in men concerned about symptoms, and only if they request it,” he explains.

“But symptoms are very poor identifiers of disease, and crucially many men don’t get symptoms until it’s too late.
“The result is we test a lot of older men who get symptoms from benign enlargement of the prostate, and we don’t test men in their 50s at high risk.”

In the aftermath of Sir Chris’s emotive interview in The Sunday Times, where he revealed his terminal diagnosis and called for prostate screening for men in their 50s, Health Secretary Wes Streeting has instructed the National Screening Committee to re-review the data.

Prof James is clear, we should be screening for prostate cancer on the NHS.

“There are easy things we could do now,” he says.

“If you are black or African heritage, it is worth doing a PSA test from the age of 45 onwards.

“Similarly, if you have a strong family history of prostate cancer - that is one or more male relatives who needed treatment for the disease under the age of 60 to 65, or a first degree relative who had breast or ovarian cancer young, it is worth having a PSA from 45.

“I would also put in place screening for all men from the age of 50 but stop it at 65.”

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It feels like a no-brainer, but barriers to introducing a national programme exist.

Cost is a factor, but logistics also have to be taken into account.

You can’t just introduce PSA tests for all men over 50 without considering the need for further diagnostic tests in the form of MRI scans and biopsies.

You need to ensure you have the workforce to perform these tests, and it is also vital to increase treatment capacity, to ensure that all those diagnosed can receive the care they need.

While we await a final decision on screening, it is vital all men educate themselves on the main risk factors, Prof James says.

Men with a family history of prostate cancer - Sir Chris’s father and grandfather had the disease - and black men should certainly consider being tested.

And healthy men aged 50 to 65 can, and should, request a PSA.

If you have any of these risk factors, or symptoms speak to your GP.

MYTH #4: Testing requires a rectal exam

UTTER the word prostate cancer around most men, and they’ll likely wince.

Back in the day, it’s true… doctors testing for the disease were likely to pop on a bright blue surgical glove and perform a rectal exam, to check for any enlargement up there.

But those days are long gone, Prof James reassures.

“I have had several PSA tests and I have never had a rectal exam,” he says.

“The only time it might be necessary to have a rectal exam these days is if there is a very good reason to believe someone has cancer.

“If you have a raised PSA test, you still have to go through an MRI scan to determine if you need a biopsy.

“MRI scans pick up lesions and in many cases, men with raised PSA tests won’t go on to need a biopsy or any further tests.

“For those that do need a biopsy, a trans-rectal probe is part of the procedure but biopsies are now via the perineum under local anaesthetic as it is safer. These are only carried out if there is a strong suspicion of cancer that requires treatment.

“Whatever happens, there is certainly no need for a doctor to manually perform rectal exams anymore. It’s a completely useless test that should no longer be done.”

Cue a collective sigh of relief!

MYTH #5: Treatment will destroy your sex life and leads to incontinence

THE prostate is a walnut-sized gland that forms part of the male reproductive system.

It adds fluid to semen and helps with ejaculation.

As a result, treatment can affect a patient’s sex life and continence.

But, Prof James points out, it is not a foregone conclusion.

“If you have cancer that is significant enough to treat, and you have surgery, there are risks of incontinence,” he says.

“Roughly speaking, after surgery around one in five men are not quite water tight and need a pad to soak up leaks when they cough, for example.

“Only a very small number of men are left properly incontinent, it is really rare.

“And flip that figure, and four in five men will recover and be completely dry.”

So what’s the verdict on your sex life?

“The nerves that control a man’s erection are situated on the back of the prostate,” Prof James explains.

“So there is a chance that during surgery to remove a cancer you may have to sacrifice or compromise those nerves.

“It depends on the severity of the cancer, its size and location.

“Most men will experience some erectile dysfunction after surgery, and post-surgery and without a prostate orgasm will feel different.

“So it may alter a man’s sex life but it won’t completely destroy it.”

One in eight men will get prostate cancer

The risk of developing prostate cancer depends on many factors, here are some of the facts about the disease and how many men it affects.

• One in eight men will get prostate cancer in their lifetime
• It is the fourth most common cancer worldwide, and the most common in men
• There are 55,000 new cases every year in the UK, and 1.4million globally
• Around 12,000 people lose their lives to prostate cancer annually in the UK and almost 400,000 around the world
• Prostate cancer accounts for 28 per cent of all new cancer cases in men in the UK, and 14 per cent of all new cancer cases in men and women combined
• Prostate cancer survival has tripled in the last 50 years in the UK
• More than three-quarters (78 per cent) of patients survive for 10 or more years
• About 490,000 men are living with and after prostate cancer in the UK
• It is most common in men aged 75 to 79
• Since the early 1990s, cases have increased by 53 per cent in the UK
• Mortality rates are up 16 per cent since the early 1970s in the UK
• Incidence rates are projected to rise by 15 per cent in the UK between 2023 to 2025 and 2038 to 2040
• Mortality rates are expected to fall five per cent in the UK over the same years

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What’s important to note, is that surgery is not the only option.

Other treatments include radiotherapy and hormone treatment - where testosterone levels are suppressed for a period of time.

While hormone treatment will affect a man’s libido, treatment for low-grade early cancers that involve just radiotherapy don’t come with the same risks of surgery.

“In those cases a man’s sex life is better preserved than after surgery,” Prof James adds.

“But for many men, surgery is a more attractive option because they want the cancer gone.”

The debate over treatment side effects serves to reinforce one of the most pertinent messages in all cancer care: that early diagnosis is vital.

Not only does it save lives, but the earlier a cancer is caught the more likely it is a patient will avoid prolonged treatment.

In the case of prostate cancer, once the disease has spread a patient will need to be on hormone therapy, plus other treatments like chemotherapy for years - usually the rest of their lives. 

“While it’s possible for these patients to live for years, their lives will never be the same,” Prof James says.

“That’s why we want to diagnose men before their cancer has had a chance to spread.”