Just diagnosed with prostate cancer in Gibraltar: what to expect and how to cope

Being told you have prostate cancer can feel like the ground has shifted beneath your feet, especially when you are trying to understand what it means within Gibraltar’s health system. This guide is designed to walk you calmly through what usually happens next, what the main tests and results mean, and how you and your loved ones can find support and make informed decisions together.

A new diagnosis often brings fear, uncertainty and a flood of practical questions. This page keeps the full depth of the longer guide while presenting it in a clear web format, so you can read it section by section and return to it when needed.

Hearing the words “you have prostate cancer”

First reactions: shock, numbness, disbelief

Many men remember the exact moment a doctor said “you have prostate cancer” and describe feeling stunned, detached or unable to take in what was said. Others feel intense worry, anger or sadness in the days that follow, and partners often experience similar emotions.

There is no “right” or “wrong” reaction. You may feel completely fine one moment and overwhelmed the next, and this can continue for a while. It can help to remind yourself that strong emotions are a normal response to serious news, not a sign that you are failing to cope.

Common worries men in Gibraltar tell us about

Men in Gibraltar often tell charities like Prostate Cancer Gibraltar (PCG) that their first questions are: “Will I die from this?”, “What will treatment do to me?” and “How will my family manage?”. These are understandable concerns, especially in a small community where people often know each other.

In reality, many prostate cancers grow slowly and can be treated or monitored safely for years, and a large proportion of men live full lives with or after prostate cancer. Your outlook depends on several factors, including how far the cancer has spread, how aggressive it is under the microscope, and your overall health.

Giving yourself time to process the news

You do not have to understand everything at once. You can:

• Ask your doctor or specialist nurse to repeat information or explain it in different words.
• Take someone you trust to appointments so they can listen and help you remember later.
• Write down what you have been told, or ask if you may record the conversation on your phone.
• If you feel overwhelmed, you can tell your GP, urologist or specialist nurse, and ask about practical or psychological support available through the Gibraltar Health Authority (GHA) or local services. Patients should confirm available support with their doctor, specialist nurse or the GHA.

Understanding your prostate

Where the prostate sits in the body

The prostate is a small gland, usually about the size of a walnut, that sits just below the bladder and in front of the rectum (back passage). It surrounds the urethra, the tube that carries urine from the bladder out through the penis.

What the prostate does

The prostate’s main job is to help make semen, the fluid that carries sperm during ejaculation. It produces a protein called prostate-specific antigen (PSA), which helps semen stay fluid; this is the same PSA measured in your blood tests.

Who has a prostate

Anyone who is born with male reproductive organs usually has a prostate, including most men, many trans women, some non-binary people assigned male at birth, and some intersex people. If you are trans, non-binary or intersex, your care may follow similar principles but some details can be different, so it is important to discuss your situation with your specialist team.

What prostate cancer is – and what it is not

How cancer cells develop in the prostate

Normally, cells in the prostate grow and die in a controlled, orderly way. Cancer develops when some cells start growing out of control and no longer follow the body’s usual rules. When this happens in the prostate, those abnormal cells can form a tumour.

Most men with prostate cancer have a type called adenocarcinoma, which starts in the gland cells of the prostate. There are rarer types of prostate cancer as well, and if yours is less common, your team will talk through what that means for you.

Localised, locally advanced and advanced disease

Doctors describe prostate cancer based on how far it has spread:

• Localised: contained entirely within the prostate.
• Locally advanced: starting to break through the capsule (outer layer) of the prostate or into nearby tissues such as the seminal vesicles, bladder, back passage or nearby lymph nodes.
• Advanced (metastatic): spread to more distant parts of the body, most commonly bones or lymph nodes away from the prostate.

This “spread pattern” is a major factor in deciding which treatments are likely to be useful for you.

Prostate cancer and your outlook

Many prostate cancers are slow-growing and may never cause serious problems, especially if they are localised and low risk. Others are more aggressive and more likely to grow or spread, and these usually need active treatment.

No test can predict the future with certainty, but your doctors will use a combination of PSA level, biopsy findings, scans and your general health to estimate how likely the cancer is to cause problems and to recommend suitable options.

Why some prostate cancers grow slowly and others are aggressive

Slow-growing cancers

Some prostate cancers grow so slowly that they are unlikely to cause symptoms or shorten life, particularly in older men or those with other health conditions. In these situations, carefully monitoring the cancer rather than treating it straight away can be a safe and sensible approach.

Faster-growing, higher-risk cancers

Other prostate cancers have features that suggest they are more active and more likely to spread beyond the prostate. These features include a higher Gleason score or Grade Group, a higher PSA level, or evidence from scans that the cancer is pushing through the prostate capsule or has reached lymph nodes or distant sites.

In higher-risk cancers, treatment such as surgery, radiotherapy and/or hormone therapy is usually recommended to reduce the chance of the cancer spreading or causing serious problems.

Why doctors talk about “risk groups”

To make sense of all this information, doctors group prostate cancers into categories describing the risk of spread. One system used in the UK is the Cambridge Prognostic Group (CPG) approach, which combines PSA, Gleason score/Grade Group and the T stage of the tumour to place men into five risk categories.

These risk groups help your team discuss which treatment options are likely to be appropriate for you, and whether careful monitoring (such as active surveillance) is a reasonable option. Ask your doctor which risk group you fall into and what that means for your choices.

Symptoms, or lack of symptoms, in early prostate cancer

Why early prostate cancer often causes no symptoms

Many men are surprised to learn that early prostate cancer often causes no obvious symptoms. One reason is that prostate cancer typically begins in the outer part of the gland, away from the urethra, so it may not interfere with urine flow at first.

Because of this, men can have a normal pattern of urination and still have early prostate cancer, which is why tests such as PSA and MRI are so important in diagnosis and monitoring.

Urinary symptoms and other possible causes

Some men have urinary symptoms such as getting up often at night, a weak flow, difficulty starting or stopping, or needing to rush to the toilet. These can be caused by prostate cancer, but they are more commonly due to non-cancerous enlargement of the prostate or other conditions such as infection.

If you have new or changing urinary symptoms, you should speak to your GP or specialist nurse to discuss whether further tests are needed. Patients in Gibraltar should confirm the usual referral process with their doctor or the GHA.

When to report new symptoms urgently

You should seek urgent medical advice if you experience:

• New, unexplained pain in your back, hips or pelvis that does not improve.
• Unexplained weight loss, fatigue or a general feeling of being unwell.
• Difficulty passing urine or not being able to pass urine at all.
• New weakness, numbness or tingling in the legs.

These symptoms do not always mean cancer has spread, but they deserve prompt assessment.

Key tests you may have around diagnosis

Different hospitals and health systems arrange tests in slightly different orders, and pathways in Gibraltar may not be identical to those in the UK. The following tests are commonly used; your own team will explain which are relevant for you. Patients should confirm local arrangements with their doctor, specialist nurse or the GHA.

PSA blood test

The PSA blood test measures the level of prostate-specific antigen in your blood. PSA is produced by normal prostate cells and by prostate cancer cells, and levels tend to rise as men get older.

A higher-than-expected PSA can be a sign of prostate cancer, but it can also be raised by benign prostate enlargement, infection, recent ejaculation or even certain medical procedures, so it is not a cancer test by itself. Not all men with prostate cancer have a raised PSA, but it is still a useful guide for diagnosis and monitoring over time.

Digital rectal examination (DRE)

A DRE is when a doctor or nurse gently inserts a gloved, lubricated finger into your back passage to feel the prostate. They are assessing its size, shape and texture, and whether there are any hard or irregular areas.

Some men feel embarrassed or uncomfortable about this test, which is understandable, but it is usually quick and can provide valuable information. If you are worried, you can talk to your doctor or nurse about what to expect.

MRI or mpMRI scan

An MRI uses strong magnets and radio waves to create detailed images of your prostate and the surrounding area. Many hospitals use a multi-parametric MRI (mpMRI), which combines different types of images to give more detail about possible cancer areas.

MRI may be done before a biopsy to help decide whether a biopsy is needed and, if so, where to take samples from. It may also be done after a biopsy to assess whether the cancer is confined to the prostate or has started to grow through the capsule or into nearby tissues.

Prostate biopsy

A biopsy involves taking small samples of tissue from the prostate using a needle, often guided by ultrasound or MRI images. These samples are then examined under the microscope by a pathologist to see if cancer cells are present.

Your biopsy report describes whether cancer was found, how many samples contained cancer, and how aggressive those cells appear. This information is crucial in determining your Gleason score, Grade Group and risk category.

CT scan

A CT (computerised tomography) scan uses X-rays to build cross-sectional images of your body. In prostate cancer, CT can help show whether the cancer has spread to nearby lymph nodes or other areas.

You may be given a contrast dye to improve the pictures; the team will explain any preparation needed.

Bone scan

A bone scan looks for signs that prostate cancer may have spread to the bones. A small amount of radioactive tracer is injected into a vein, and a special camera then detects areas where the tracer has collected, which may indicate areas of bone damage or cancer.

Bone scans can show cancer spread, but also changes due to arthritis or old injuries, so results are interpreted alongside other tests and your clinical picture.

PET scan and when it may be used

PET (positron emission tomography) scans use a slightly different type of radioactive tracer to highlight active cells in the body. Some centres use PET scans to look for spread to lymph nodes, bones or other organs, especially if there is concern that the cancer has returned after previous treatment.

PET scans are not always used at the time of first diagnosis and availability can vary by country and region. If your team feels a PET scan would add useful information, they will discuss this with you; in Gibraltar, patients should confirm availability and referral arrangements with their doctor or the GHA.

Making sense of your results: stage, grade and risk

PSA level and what it tells your team

After diagnosis, PSA becomes a marker that helps your team monitor how your cancer behaves over time and how well treatment is working. A rising PSA may suggest that the cancer is active or growing; a stable or falling PSA can indicate control.

However, PSA is only one part of the picture. Changes in PSA are always interpreted alongside your symptoms, exam findings and scan results.

Biopsy report, Gleason score and Grade Group

When your prostate tissue is examined under a microscope, the pathologist looks at how abnormal the cells appear and how they are arranged. This pattern is given a Gleason grade from 3 to 5 (grades 1 and 2 are no longer used), with higher numbers indicating more aggressive-looking cells.

Two Gleason grades are added together to form a Gleason score, such as 3+3=6, 3+4=7 or 4+3=7. The first number is the most common pattern seen, and the second number is the highest-grade pattern present. A 4+3=7 is considered more aggressive than a 3+4=7 because more of the cancer shows the higher-grade pattern.

To simplify this, doctors now often use a Grade Group from 1 to 5, with Grade Group 1 being the least aggressive and Grade Group 5 the most aggressive. Ask your team for your Gleason score and Grade Group, and ask them to explain what that means in terms of risk.

TNM staging: T, N and M explained

Another way of describing your cancer is the TNM system:

• T (tumour): how far the cancer has grown in and around the prostate.
• T1: cannot be felt on DRE or seen on scans, only under the microscope.
• T2: can be felt or seen but still appears confined within the prostate.
• T3: breaking through the outer capsule or into the seminal vesicles.
• T4: growing into nearby organs such as the bladder, back passage or pelvic wall.
• N (nodes): whether nearby lymph nodes contain cancer.
• N0: no cancer seen in nearby lymph nodes.
• N1: nearby lymph nodes contain cancer.
• NX: lymph nodes not assessed or unclear.
• M (metastasis): whether the cancer has spread to distant parts of the body, such as bones.
• M0: no distant spread seen.
• M1: cancer has spread to distant sites (with subcategories such as M1a, M1b, M1c depending on where it has spread).

Localised, locally advanced and advanced prostate cancer

Your TNM stage helps determine whether your cancer is considered:

• Localised: cancer contained inside the prostate (e.g. T1–T2, N0 or NX, M0 or MX).
• Locally advanced: cancer breaking out of the prostate or just beyond (e.g. T3–T4, and/or N1, but M0).
• Advanced: cancer that has spread to other parts of the body (any T, any N, M1).

Your doctor or specialist nurse can tell you which category you are in and how that influences your treatment choices.

Risk groups in simple language

Combining PSA, Gleason/Grade Group and T stage, doctors place men into risk groups that range from very low risk of spread to high risk.

Lower-risk cancers are usually confined to the prostate, have lower PSA levels and lower Gleason scores/Grade Groups. Active surveillance or treatments such as surgery or radiotherapy may all be options.

Intermediate-risk cancers carry a moderate chance of spread. Active treatment such as surgery or radiotherapy, often combined with hormone therapy, is more likely to be recommended, although selected men may still be offered active surveillance.

Higher-risk cancers are more likely to grow and spread quickly, and treatments usually involve combinations of surgery, radiotherapy and hormone therapy, sometimes alongside chemotherapy.

Ask your team to explain your risk group in straightforward language and how it shapes your monitoring or treatment plan.

Main treatment pathways your team may discuss

Treatment in Gibraltar should follow evidence-based principles, but individual recommendations depend on your specific situation, available local services and your preferences. Always confirm details with your doctor, specialist nurse or the GHA.

Active surveillance and watchful waiting (careful monitoring)

Active surveillance is a structured programme of regular PSA tests, scans (such as MRI) and sometimes repeat biopsies to keep a close eye on localised, lower-risk prostate cancer. The aim is to avoid or delay active treatment, and therefore possible side effects, unless tests suggest the cancer is changing.

Watchful waiting usually involves less intensive monitoring and is often recommended when a man’s overall health or age means that active treatment may not be necessary or appropriate. If symptoms develop, treatments such as hormone therapy can be used to control the cancer and ease symptoms.

Surgery (radical prostatectomy)

Radical prostatectomy is an operation to remove the whole prostate and usually the seminal vesicles, and sometimes nearby lymph nodes. This can be done through open surgery or minimally invasive approaches such as keyhole or robot-assisted surgery, depending on local availability and expertise.

Surgery is commonly offered to men with localised cancer who are fit for an operation, and sometimes to carefully selected men with locally advanced disease. Possible side effects include urinary leakage and difficulty with erections; some men also notice changes in orgasm and fertility. There are treatments and supports that can help manage these effects.

Radiotherapy (external beam and brachytherapy)

External beam radiotherapy uses high-energy X-rays from outside the body to target the prostate and sometimes nearby areas. For localised and locally advanced cancers, it is often combined with hormone therapy, which may be given before, during and after the radiotherapy course.

Brachytherapy is a form of internal radiotherapy, either by placing tiny radioactive seeds into the prostate (permanent seed brachytherapy) or by using temporary high-dose-rate sources delivered through needles into the prostate. Brachytherapy may be used alone in selected localised cancers or in combination with external beam radiotherapy as a “boost” to the prostate.

Side effects of radiotherapy can include urinary and bowel problems, fatigue and erectile difficulties. Some effects improve over time, but others can be long-lasting, so it is important to discuss these with your team.

Hormone therapy and newer hormone treatments

Prostate cancer cells usually depend on testosterone to grow. Hormone therapy works by reducing the amount of testosterone in the body or blocking its effect on cancer cells. It can be given as injections or implants, tablets or occasionally surgery to remove the parts of the testicles that produce testosterone.

Hormone therapy is often combined with radiotherapy for localised and locally advanced disease and is a mainstay of treatment for advanced cancer. Side effects can include hot flushes, loss of sex drive, erection problems, tiredness, weight gain and breast swelling or tenderness, but there are ways to manage many of these.

Newer “second-generation” hormone treatments such as abiraterone, enzalutamide, apalutamide and darolutamide can be used in some situations, particularly if cancer is high risk, advanced or no longer responding well to standard hormone therapy. Availability and funding may vary and should be discussed with your specialist.

Chemotherapy and newer combinations

Chemotherapy, such as docetaxel, uses anti-cancer drugs to slow or shrink prostate cancer throughout the body. It is most commonly used in advanced prostate cancer, often alongside hormone therapy, and sometimes earlier in high-risk cases.

Side effects can include fatigue, nausea, hair loss, increased risk of infection and other symptoms, but these are usually temporary and there are medicines and strategies to help. A newer approach called “triplet therapy” combines standard hormone therapy, chemotherapy and a newer hormone drug like darolutamide, and has been shown to help some men with newly diagnosed advanced disease live longer.

Treatments to control advanced cancer and manage symptoms

If prostate cancer has spread, treatment focuses on controlling the disease and managing symptoms for as long as possible. In addition to hormone therapy and chemotherapy, options can include newer hormone drugs, targeted radiotherapy to painful bone areas, drugs like radium-223 for bone metastases, bone-strengthening medicines (bisphosphonates), steroids, and newer targeted therapies such as olaparib in specific genetic situations.

Your team will adjust treatment over time depending on how your cancer responds and how you feel.

Why treatment decisions are individual

Which treatments are suitable for you depends on:

• Whether your cancer is localised, locally advanced or advanced.
• Your PSA, Gleason score, Grade Group and risk category.
• Your general health and other medical conditions.
• Your personal preferences about potential side effects and lifestyle impact.

There is rarely only one “right” answer. It is appropriate to ask questions, request time to think, and involve your partner or family in discussions if you wish.

Coping emotionally after diagnosis

Common emotional responses for men and partners

Beyond the initial shock, many men experience ongoing worries about recurrence, treatment side effects, masculinity, sexuality and work or finances. Partners and family members may feel frightened, helpless or unsure how best to support you.

These feelings can fluctuate. Some people find the waiting for test results harder than treatment itself, while others struggle with long-term uncertainty. Talking openly about emotions can be difficult, especially in close-knit communities, but it often reduces distress.

When to seek extra emotional or psychological support

You may benefit from professional support if you:

• Feel persistently low, anxious or unable to enjoy things you used to enjoy.
• Struggle to sleep or concentrate because of worry about cancer.
• Feel you are withdrawing from your usual relationships or activities.
• Have thoughts of harming yourself or feel that life is not worth living.

If this sounds familiar, talk to your GP, specialist nurse or another member of your team about psychological or counselling support available locally or online. Patients in Gibraltar should confirm referral options with their doctor or the GHA.

Talking to your partner, children, family and friends

Preparing for difficult conversations

Deciding who to tell and when is a personal choice, and it may take time to find the words. It can help to:

• Choose a quiet, private moment without interruptions.
• Use simple, clear language such as “I’ve been told I have prostate cancer” rather than medical jargon.
• Share as much or as little detail as you feel comfortable with, and be honest about what you do and do not yet know.

You can offer relatives the opportunity to ask questions and, if you are unsure of an answer, write their questions down to discuss at your next appointment.

Talking to children and teenagers

Children can often sense that something is wrong, even if they do not know the details. Using age-appropriate language, explain that you are unwell, name the illness (“cancer” or “prostate cancer”), and outline what the doctors are doing to help.

Teenagers may want more detailed information and a chance to be involved in practical support. It can be helpful to reassure them that they are not to blame for your illness and that there will be people to support all of you.

When you do not feel ready to talk

If you do not feel able to tell certain people yet, you might ask a trusted friend, partner or family member to share the news on your behalf. You can also let your team know if you would like written information to pass on to others.

Remember that it is acceptable to protect your own emotional energy while you adjust.

Thinking about family risk and talking to male relatives

How family history can influence risk

Men are at higher risk of prostate cancer if a close male relative, such as a father or brother, has had the disease. Research suggests this increases risk roughly two-and-a-half-fold compared to men without such a family history.

If you have brothers, sons or other close male relatives, it can be helpful to tell them about your diagnosis, as they may wish to discuss their own risk with a doctor when they reach middle age (often from around 45 onwards).

Encouraging male relatives to speak to their GP or the GHA

You could suggest that male relatives talk to their GP about their risk and whether tests such as PSA are appropriate for them. In Gibraltar, relatives should confirm the recommended approach with their GP or the GHA, as pathways and screening policies may differ from those in the UK.

Practical ways to help yourself after diagnosis

Learning about your options

Reliable information can reduce fear and help you feel more in control. Consider:

• Asking your team which written materials or websites they recommend.
• Bringing a list of questions to each appointment.
• Asking for clarification if you are unsure about anything.

At the same time, try to avoid overwhelming yourself with online searches from unverified sources.

Looking after your body: diet and physical activity

We do not yet know for certain whether specific foods directly influence prostate cancer growth, but eating a balanced, varied diet and maintaining a healthy weight is good for general health and may help with recovery and side effects.

Regular physical activity at a level that is safe for you can help improve mood, energy levels and physical strength, and may reduce some treatment-related side effects. Even gentle activities such as walking can make a difference. Discuss any new exercise plan with your doctor if you have other medical conditions.

Work, finances and everyday life

Cancer can affect your work, income, family roles and day-to-day routines. It may be helpful to:

• Talk to your employer about your diagnosis and any adjustments you may need.
• Ask your team about sources of financial or practical advice suitable for Gibraltar residents.
• Accept offers of practical help from friends or family with tasks such as shopping, transport to appointments or childcare.

Making the most of your appointments

Questions you may want to ask

You might find it helpful to bring a written list of questions such as:

• What stage is my cancer and has it spread?
• What is my PSA level, Gleason score and Grade Group, and what do these mean?
• Which treatment options are appropriate for me, and what are the pros and cons of each?
• What side effects are most likely with these treatments?
• What happens if we delay treatment or choose monitoring?
• How often will I need check-ups and tests?
• Who should I contact if I have a problem between appointments?

Having your questions written down can help you stay focused and ensure you leave the appointment with the information you need.

Keeping a record of your results and plans

Many men find it useful to keep a notebook, folder or digital file with:

• Appointment dates and times.
• PSA test results and scan reports (if available).
• A summary of the treatment plan agreed with their team.

This record can help you track how things are going and make it easier to share information if you see different health professionals.

Working with your multi-disciplinary team

Prostate cancer care usually involves a team of professionals, such as urologists, oncologists, specialist nurses and others. This group is often called a multi-disciplinary team (MDT).

They discuss your case and recommend treatment options based on guidelines and your individual situation. It is appropriate to ask who your key contact is (often a specialist nurse) and how best to reach them between appointments.

How Prostate Cancer Gibraltar can support you

Information and awareness in Gibraltar

Prostate Cancer Gibraltar (PCG) is a local charity dedicated to raising awareness of prostate cancer, promoting early detection and providing trustworthy information for men and families living in Gibraltar. PCG works alongside, but independently from, the Gibraltar Health Authority.

We aim to present clear, balanced information tailored to the needs of our community, including cultural and practical realities of living in a small territory.

Peer and family support

Hearing from someone who has been through diagnosis and treatment can be reassuring. PCG may facilitate or signpost to support opportunities where men and partners can share experiences, ask questions and feel less isolated.

Family members and carers are welcome to seek information and support too, as we recognise that prostate cancer affects the whole family, not just the man with the diagnosis.

Working alongside the Gibraltar Health Authority (GHA)

PCG does not provide medical treatment or replace your clinical team, but we aim to complement the GHA by:

• Encouraging men at risk to speak to their GP or specialist about testing.
• Helping newly diagnosed men and their families understand what the medical information means.
• Supporting informed decision-making and communication with healthcare teams.

Patients should always confirm specific medical pathways, referral routes and treatment availability directly with their doctor, specialist nurse or the GHA.

Frequently asked questions