The prostate is a small gland, about the size of a walnut, that sits just below the bladder and wraps around the tube you pass urine through. It helps make semen, and it’s normal for it to grow larger with age.

Prostate cancer develops when cells in the gland start growing in an uncontrolled way. It behaves very differently from one man to the next: some prostate cancers grow so slowly they may never cause any problems, while others grow more quickly and need treating. Your PSA level, the grade of the cells on biopsy and whether the cancer is contained within the prostate all help us work out which situation you’re in, and whether it needs treating now, or monitoring closely with treatment held in reserve.

Early prostate cancer often causes no symptoms at all, because it usually starts in the outer part of the gland. Many prostate cancers are found through a PSA blood test rather than because someone felt unwell.

Urinary symptoms, such as needing to go for a wee more often at night, difficulty getting started, a weaker flow than you’re used to, are far more commonly caused by benign enlargement of the prostate than by cancer. Less commonly, men notice blood in the urine or semen. None of these mean you have cancer, but they are worth getting checked.

Diagnosis usually involves a PSA blood test, an examination, an MRI scan of the prostate, and a biopsy if the MRI shows an area of concern. Further scans are sometimes needed to check whether the cancer has spread. If some of this has already been done by the time you see me, we’ll go through what it actually shows.

There is rarely one ‘right way’ to treat prostate cancer. What I recommend depends on the stage and grade of the cancer, whether it’s confined to the prostate, your general health, any treatment you’ve already had, and what matters to you.

Not everyone needs treating straight away. For lower-risk cancers, active surveillance, (close monitoring, with treatment started if things change) spares you side effects from treatment you may not need to go through yet.

Where treatment is needed, the options I offer are external beam radiotherapy using IMRT/VMAT, hormone therapy, chemotherapy, radioligand therapy for selected men, or a combination of these. Surgery to remove the prostate is also well established; that’s carried out by a urological surgeon rather than by me, but I can work with your surgeon and other members of a multidisciplinary team on your treatment.

My job is to set out the reasonable options and explain the benefits and potential side effects of each, so you understand not just what I’d suggest, but why.

The bladder is a hollow, muscular organ that stores urine. Its inner lining stretches as the bladder fills, and it’s in the cells of this lining that most bladder cancers begin.

The key question is how deep the cancer has gone. Non-muscle-invasive bladder cancer is confined to the lining, or the thin layer of tissue just beneath it. Muscle-invasive bladder cancer has grown into the muscle wall and carries a greater risk of spreading. The distinction matters because the two are treated quite differently: non-muscle-invasive disease is usually managed by removing the growth and treating the bladder lining directly, with regular checks afterwards, while muscle-invasive disease needs more intensive treatment.

The most common symptom is blood in the urine. It’s usually painless, it can come and go, and sometimes it’s only picked up on a urine test. Other possible signs include needing to pass urine more often or more urgently, discomfort when doing so, or infections that keep returning.

Most people with blood in their urine don’t have cancer. Infections, stones and an enlarged prostate are all far more common. But it should always be checked, even once, and even if it settles on its own.

Investigation usually involves urine tests, a cystoscopy to look inside the bladder with a thin camera, and a TURBT under anaesthetic to remove and analyse any growth. Scans of the urinary tract complete the picture.

Treatment depends on whether the cancer is non-muscle-invasive or muscle-invasive, how the cells look under the microscope, whether it has spread, and your general health.

Non-muscle-invasive bladder cancer is usually led by the urology team. The growth is removed, and depending on the risk of it coming back this may be followed by chemotherapy or BCG given directly into the bladder, with regular cystoscopy checks afterwards.

For muscle-invasive bladder cancer there are two main approaches: surgery to remove the bladder, carried out by a urological surgeon, or radiotherapy given alongside a drug that makes it work more effectively, which allows the bladder to be kept. Both are well established, and for many people it’s a genuine choice rather than a fallback. Chemotherapy is sometimes given first to shrink the cancer.

If the cancer has spread beyond the bladder, treatment focuses on controlling it and keeping you as well as possible. Usually chemotherapy, immunotherapy, or both, with radiotherapy also very effective at relieving specific symptoms.

The radiotherapy and drug treatment is my part of your care. If surgery is the better option for you, I’ll say so, explain why, and work with the surgeon on providing pre- or post-treatment.