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Urology • Urological Oncology

Prostate Cancer

Medical terms: Prostate Adenocarcinoma • Carcinoma of the Prostate • PCa

Prostate cancer begins when cells in the prostate grow abnormally. Many prostate cancers grow slowly and remain localised; others are biologically aggressive and can spread to lymph nodes, bones or other organs.

PSA is an important starting test, but it cannot diagnose cancer by itself. MRI, biopsy findings, Grade Group, stage, general health and personal priorities together determine whether monitoring or active treatment is appropriate.

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Could This Be Urinary Obstruction or Spinal Cord Compression?

Seek urgent care for:

  • New severe back pain with leg weakness, difficulty walking, numbness around the genitals or buttocks, or new loss of bladder or bowel control.
  • Sudden inability to pass urine, a painfully swollen lower abdomen or very little urine with known prostate disease.
  • New severe bone pain, inability to bear weight or suspected fracture.
  • Visible blood with clots, heavy bleeding, faintness or inability to urinate.
  • Fever, shaking chills, confusion or severe illness after a prostate biopsy, catheter procedure or during cancer treatment.
  • New breathlessness, chest pain, one-sided leg swelling or another possible blood-clot symptom during treatment.

Most prostate-cancer appointments are not emergencies. However, metastatic disease can rarely compress the spinal cord, and prostate disease can obstruct the bladder or kidneys. Prompt treatment can protect nerve, bladder and kidney function.

What is Prostate Cancer?

The prostate is a gland below the bladder that surrounds the first part of the urethra and contributes fluid to semen. Most prostate cancers are adenocarcinomas arising from gland-forming cells, commonly in the outer part of the prostate.

Localised prostate cancer Cancer appears confined to the prostate. Depending on its risk features, active surveillance, surgery or radiotherapy may be considered.
Locally advanced prostate cancer Cancer extends through the prostate capsule, into seminal vesicles or nearby structures, or involves regional lymph nodes. Combined treatment is often needed.
Metastatic prostate cancer Cancer has spread beyond the pelvis, most commonly to bone or distant lymph nodes. Modern systemic treatments can control disease and symptoms for many patients.
Recurrent prostate cancer PSA or imaging shows cancer returning after previous surgery or radiotherapy. Salvage treatment depends on where it has returned and what treatment was given first.

Most people with a prostate are men. Trans women and non-binary people who retain a prostate can also develop prostate cancer and should receive an appropriate risk assessment.

Does Early Prostate Cancer Cause Symptoms?

Often it does not. Many localised cancers are detected through PSA testing before any urinary change occurs. Urinary symptoms are common with benign prostate enlargement and do not by themselves indicate cancer.

Weak or interrupted flow More commonly caused by benign enlargement, but still worth assessing.
Frequency or nocturia Passing urine often or waking repeatedly at night.
Difficulty starting Hesitancy, straining or a feeling that the bladder has not emptied.
Blood in urine or semen Not specific to prostate cancer and requires evaluation for other causes.
Persistent bone pain Back, hip or rib pain can occur when advanced cancer involves bone.
Advanced-disease symptoms Weight loss, fatigue, leg swelling, weakness or reduced kidney function.

Symptoms Cannot Reliably Separate BPH From Cancer

A very large benign prostate can cause major urinary difficulty without cancer, while a clinically important cancer may cause no urinary symptoms at all. PSA, examination, MRI and biopsy are used according to the individual risk—not symptoms alone.

Who Has a Higher Risk?

Increasing age Risk rises substantially with age. A person's general health and life expectancy matter because some slow-growing cancers may never cause harm.
Family history Risk is higher with a father or brother diagnosed with prostate cancer, especially at a younger age, and rises when several close relatives are affected.
Inherited genetic change BRCA2 and selected other DNA-repair or Lynch-syndrome genes can increase risk or be associated with more aggressive disease.
Ancestry Men of African ancestry have a higher risk and may develop disease younger. Risk assessment and the age to begin PSA discussions should reflect ancestry and family history.
Previous findings A persistently raised PSA, abnormal rectal examination, suspicious MRI or selected atypical biopsy findings may require closer review even after a negative biopsy.

Lifestyle affects overall health and treatment fitness, but no food, supplement or sexual habit has been proven to guarantee prevention. A strong inherited risk cannot be “cancelled” by lifestyle alone.

What Does the PSA Blood Test Tell Us?

Prostate-specific antigen (PSA) is made by prostate cells. Cancer can raise the level, but PSA is prostate-specific—not cancer-specific. The result is interpreted with age, prostate volume, previous values, examination, family history, medicines and overall health.

PSA can also rise because of:

  • Benign prostatic hyperplasia (BPH) and a larger prostate volume.
  • Prostatitis, urinary infection or recent urinary retention.
  • Recent catheterisation, cystoscopy, biopsy or another prostate procedure.
  • Ejaculation or vigorous cycling shortly before testing in some individuals.
  • Normal biological and laboratory variation between samples.

Prostate-shrinking medicines can lower PSA and change its interpretation. Tell the clinician about all prostate medicines rather than applying a correction yourself. An unexpectedly raised result is often repeated under standardised conditions before biopsy decisions.

Should Everyone Have PSA Screening?

PSA testing can detect clinically important cancer earlier, but it can also identify slow-growing disease that would never cause harm. This may lead to anxiety, biopsy and treatment side effects. Testing is therefore a shared decision rather than an automatic test for every person at every age.

A useful discussion includes:

  • Age, general health and whether early detection could realistically improve length or quality of life.
  • Family history, ancestry and known inherited mutations such as BRCA2.
  • The person's priorities regarding early diagnosis, uncertainty and possible further tests.
  • Previous PSA values rather than a single isolated number.
  • The possibility of active surveillance if a low-risk cancer is found.

People with a strong family history, African ancestry or an inherited cancer-risk mutation may begin individual PSA discussions earlier. The starting age and interval should be personalised.

Questions Your Doctor May Ask

Has PSA changed over time?

Bring previous reports with dates and laboratories. A repeat result, PSA density and the wider clinical picture are often more informative than treating one threshold as a diagnosis.

Is there a family cancer pattern?

Prostate cancer at a young age, multiple relatives, male or female breast cancer, ovarian, pancreatic or colorectal cancer may suggest inherited risk and the need for genetic counselling.

Are there urinary, sexual or bowel symptoms already?

Baseline flow, continence, erections, ejaculation, fertility priorities and bowel function affect both investigation and how treatment trade-offs should be discussed.

Which health conditions affect treatment?

Heart and lung fitness, diabetes, obesity, bone health, anticoagulants, previous abdominal or pelvic surgery, inflammatory bowel disease and prior radiotherapy can change treatment suitability.

What matters most to you?

Cancer control, avoiding unnecessary treatment, preserving erections or continence, treatment time, recovery, travel, work and caregiving responsibilities may carry different weight for each patient.

How is Suspected Prostate Cancer Assessed?

1 Confirm the reason for concern

Review PSA, urinary symptoms, infection, medicines, previous procedures, family history and general health. Repeat PSA may be appropriate before further testing.

2 Examine the prostate

Digital rectal examination assesses prostate size, firmness, nodules and local fixation. A normal examination does not exclude cancer.

3 Perform prostate MRI

Multiparametric MRI identifies suspicious areas, estimates prostate volume and helps decide whether and where biopsy should be performed.

4 Obtain tissue when indicated

Targeted and selected systematic or perilesional biopsy cores establish whether cancer is present and provide the Grade Group.

5 Stage and risk-stratify

PSA, biopsy, Grade Group, examination, MRI and selected PSMA PET-CT, CT or bone imaging determine the extent and guide the treatment discussion.

What Does a Prostate MRI Show?

Multiparametric MRI combines anatomical and functional sequences. The radiologist reports the likelihood of clinically significant cancer using a structured score such as PI-RADS, along with lesion location, prostate volume and signs of spread beyond the gland.

Low-suspicion MRI May allow biopsy to be deferred when PSA density and clinical risk are also low, with an agreed PSA follow-up plan. MRI cannot exclude every significant cancer.
Equivocal MRI PSA density, family history, examination, age, previous biopsy and patient preference help determine whether biopsy or surveillance is more appropriate.
Suspicious MRI Usually leads to targeted biopsy, often with additional cores to assess cancer that may not be visible or may be present elsewhere in the prostate.

MRI quality and specialist interpretation matter. MRI is a risk-stratification tool, not a pathology result, and a suspicious lesion is not confirmed cancer until tissue is examined.

What Happens During a Prostate Biopsy?

Biopsy obtains small tissue cores for microscopic examination. MRI-targeted cores sample suspicious lesions, while systematic or perilesional cores may assess areas that MRI misses. The route, anaesthesia and number of samples are tailored to the diagnostic question. Our Prostate Biopsy guide explains MRI-led planning, preparation, pathology, risks and follow-up in detail.

Transperineal biopsy Needles pass through cleansed skin between the scrotum and anus. It can be performed under local or general anaesthesia and has a lower infection risk than the transrectal route.
Transrectal biopsy Needles pass through the rectal wall under ultrasound guidance. It remains used in some settings but requires careful infection-risk assessment and antibiotic planning.

Possible after-effects include:

  • Blood in urine, semen or from the rectum for an expected limited period.
  • Perineal discomfort, bruising or temporary urinary burning.
  • Difficulty passing urine or acute urinary retention.
  • Urinary infection and, rarely, severe infection or sepsis.
  • A negative result despite persistent clinical suspicion, requiring structured follow-up.

Anticoagulants and antiplatelet medicines must be managed through the biopsy team. Never stop prescribed blood-thinning treatment independently.

What Do Gleason Score and Grade Group Mean?

The pathologist grades the two most important growth patterns. Their Gleason patterns are added, while the International Society of Urological Pathology (ISUP) Grade Group presents the result on a scale from 1 to 5. A higher group generally indicates more aggressive biology.

Grade Group 1 Gleason 3 + 3 = 6; often suitable for active surveillance when other features are favourable.
Grade Group 2 Gleason 3 + 4 = 7; contains mostly pattern 3 with a smaller pattern 4 component.
Grade Group 3 Gleason 4 + 3 = 7; more pattern 4 and a less favourable outlook than 3 + 4 disease.
Grade Group 4 Gleason score 8; high-grade cancer requiring assessment for definitive or combined treatment.
Grade Group 5 Gleason score 9–10; the highest-grade group, with greater risk of spread and recurrence.

The report may also describe the number and length of positive cores, percentage of pattern 4, cribriform or intraductal features, perineural invasion and other findings. Grade alone never replaces stage and PSA.

How is Prostate Cancer Staged?

TNM staging describes the primary tumour (T), regional lymph nodes (N) and distant metastases (M). Risk groups combine stage with PSA and Grade Group to estimate the chance of progression or recurrence.

T1–T2 Cancer is not palpable or appears confined within the prostate.
T3 Cancer extends through the prostate capsule or involves the seminal vesicles.
T4 Cancer invades nearby structures such as the bladder neck, rectum or pelvic wall.
N1 Regional pelvic lymph nodes contain cancer.
M1 Cancer has spread to distant lymph nodes, bone or another organ.

PSMA PET-CT can detect prostate-cancer deposits at lower disease volumes than conventional imaging and is increasingly used for selected higher-risk staging and biochemical recurrence. It is not automatically required for every low-risk localised cancer.

How is Treatment Chosen?

There is no single operation or medicine that is right for every prostate cancer. A multidisciplinary discussion combines cancer control with the patient's health, life expectancy, existing urinary and sexual function, treatment side effects, recovery priorities and personal tolerance of uncertainty.

  • PSA level and change over time.
  • Grade Group, biopsy volume and adverse pathological features.
  • Clinical stage, MRI findings and staging scans where indicated.
  • Age, frailty, heart and lung fitness and other major conditions.
  • Baseline erections, urinary control, bladder emptying and bowel health.
  • Previous prostate surgery, abdominal surgery, radiotherapy or inflammatory bowel disease.
  • Patient priorities after balanced surgical and oncology consultations.

Low-risk disease may be monitored safely. Intermediate- and high-risk localised disease may be treated with surgery or radiotherapy, sometimes combined with hormone therapy. Advanced disease usually requires systemic treatment, with radiotherapy or procedures added for selected sites and symptoms.

What is Active Surveillance?

Active surveillance is a structured curative-intent strategy for selected localised cancers that are unlikely to cause harm in the near future. It avoids or delays treatment side effects while preserving the option of surgery or radiotherapy if the cancer shows meaningful progression.

Monitoring may include:

  • Regular PSA testing and review of PSA density or trend.
  • Clinical assessment and digital rectal examination at selected visits.
  • Repeat MRI to look for radiological change.
  • Confirmatory or repeat biopsy when required by the surveillance protocol.
  • Movement to treatment for grade, volume, stage or MRI progression—or patient preference.

Active Surveillance is Not “Doing Nothing”

It is an organised monitoring programme with predefined triggers for reassessment and treatment. Missing PSA, MRI or biopsy follow-up can turn a safe strategy into unsafe neglect.

Is Watchful Waiting the Same as Active Surveillance?

No. Watchful waiting is usually chosen when age, frailty or serious health conditions make curative treatment unlikely to improve overall survival or quality of life. Monitoring is less intensive, and treatment is introduced primarily to control symptoms rather than to cure the cancer.

Active surveillance keeps a patient within a window for curative treatment; watchful waiting accepts that treatment will be symptom-directed if the disease becomes troublesome. The distinction should be documented clearly so the patient and family understand the aim.

What Does Radical Prostatectomy Involve?

Radical prostatectomy removes the prostate and seminal vesicles and reconnects the bladder to the urethra. Selected patients also undergo pelvic lymph-node dissection. Surgery may be open, laparoscopic or robot-assisted.

Cancer-control aim Remove localised cancer with a clear margin and provide the most complete pathological stage. Further radiotherapy or hormone treatment may still be needed for adverse findings or PSA recurrence.
Urinary recovery A catheter remains temporarily while the join heals. Leakage is common early and usually improves; pelvic-floor rehabilitation is important, but persistent stress incontinence can require further treatment.
Sexual and fertility effects Semen and natural ejaculation are permanently lost. Erectile recovery depends on baseline function, age, nerve-sparing feasibility and cancer location and may take many months.
Other risks Bleeding, infection, blood clots, rectal injury, urine leak, bladder-neck narrowing, lymphocele and anaesthetic complications are discussed according to the planned operation.

A robotic platform is a surgical approach, not a guarantee of better cancer or functional outcomes. Surgeon and centre experience, case selection, cancer anatomy and honest outcome reporting remain important.

How Does Radiotherapy Treat Localised Prostate Cancer?

Radiotherapy damages cancer-cell DNA while limiting dose to surrounding organs. Planning uses imaging, immobilisation and carefully shaped treatment fields. Hormone therapy may be added according to risk group.

External-beam radiotherapy (EBRT) Radiation is delivered from outside the body. Conventional, moderately hypofractionated and selected stereotactic schedules divide the total dose differently; suitability depends on disease and anatomy.
Brachytherapy Radioactive sources are placed temporarily or permanently within the prostate. It may be used alone for selected localised cancers or combined with EBRT for higher-risk disease.
Short-term effects Urinary frequency, urgency, burning, weaker flow, fatigue, loose stools, rectal discomfort and skin irritation vary with the technique and usually improve after treatment.
Long-term effects Erectile dysfunction, rectal bleeding, bowel change, urethral narrowing, persistent urinary symptoms, haematuria and rarely severe bladder or bowel injury can occur months or years later.

Significant pre-existing urinary obstruction should be assessed before radiotherapy or brachytherapy. Previous TURP, prostate size, inflammatory bowel disease, anticoagulation and hip implants may affect planning.

What is Androgen Deprivation Therapy?

Most prostate cancers use androgen signalling to grow. Androgen deprivation therapy (ADT) lowers testosterone production or blocks its action. It may accompany curative radiotherapy, treat metastatic disease or control selected recurrences; it is not automatically needed for every localised cancer.

Possible effects include:

  • Hot flushes, loss of libido, erectile dysfunction and reduced testicular volume.
  • Fatigue, reduced muscle mass, increased body fat and lower physical capacity.
  • Bone-density loss and increased fracture risk.
  • Changes in glucose, cholesterol, weight and cardiovascular risk.
  • Mood, concentration or sleep disturbance in some patients.
  • Breast tenderness or enlargement with selected hormonal agents.

Baseline cardiovascular and metabolic risk, bone health, exercise and nutrition should be addressed. Resistance and aerobic exercise can help preserve strength, function, bone and emotional wellbeing.

How is Metastatic Prostate Cancer Treated?

Treatment usually begins with ADT and, for fit patients, is intensified with another life-prolonging therapy rather than relying on testosterone suppression alone. The combination is selected through disease volume, symptoms, fitness, prior treatment, genetics, access and patient preference.

Androgen-receptor pathway treatment Medicines in this pathway suppress androgen production or signalling in different ways and require treatment-specific monitoring.
Chemotherapy Systemic chemotherapy can control cancer and prolong life in suitable patients. Blood counts, infection risk, neuropathy, fatigue and general fitness are monitored.
Targeted and precision therapy PARP inhibitors may benefit selected cancers with homologous-recombination DNA-repair alterations. Tumour and inherited genetic testing can therefore change treatment and inform family counselling.
Radiopharmaceutical treatment Selected advanced cancers may be treated with agents directed towards PSMA or bone metastases after appropriate imaging, blood, kidney and marrow assessment.
Local symptom treatment Radiotherapy can relieve painful bone disease or protect threatened structures. Surgery, stents, nephrostomy or catheter treatment may relieve obstruction or stabilise selected bones.

Palliative care can be integrated at any stage to control pain, fatigue, urinary symptoms and emotional burden. It is compatible with active cancer treatment and is not limited to end-of-life care.

What About Focal Therapy?

Focal high-intensity focused ultrasound, cryoablation and other techniques treat a selected prostate region rather than the whole gland. They aim to reduce urinary and sexual side effects, but prostate cancer is often multifocal and long-term comparative evidence is less mature than for surgery or radiotherapy.

Focal treatment is not a routine replacement for established therapy. Carefully selected patients require specialist review, high-quality MRI and targeted biopsy, a clear explanation of uncertainty, and lifelong PSA, imaging and repeat-biopsy surveillance because untreated prostate tissue remains.

How Can Treatment Affect Continence, Erections and Fertility?

Urinary continence Surgery can cause early stress leakage; radiotherapy can cause urgency, frequency and later scarring. Baseline assessment, pelvic-floor training and specialist continence care support recovery.
Erectile function Surgery, radiotherapy and hormone treatment can impair erections through different mechanisms and timelines. Tablets, vacuum devices, injections and implants provide stepped rehabilitation options.
Ejaculation and orgasm Radical prostatectomy permanently removes semen production and ejaculation, although orgasmic sensation may remain. Radiotherapy can reduce or eliminate semen and alter orgasm.
Fertility Radical treatments can cause infertility. Patients who may want biological children should discuss sperm storage before surgery, radiotherapy or systemic treatment.

These are core treatment outcomes, not minor side notes. Patients and, if desired, their partners should have enough time to discuss realistic recovery, rehabilitation and the possibility of persistent change.

Who Should Consider Genetic Testing?

Genetic counselling and germline testing may be appropriate with metastatic or high-risk disease, young age at diagnosis, a strong family cancer history, known familial mutation or ancestry associated with a founder mutation. Tumour genomic testing may be performed separately to identify treatment targets.

A germline result can affect the patient's treatment and indicate risk for relatives, including risks of prostate, breast, ovarian, pancreatic or colorectal cancer depending on the gene. Testing should include consent, privacy, interpretation and a plan for communicating relevant results to family members.

What Follow-up is Needed After Treatment?

Follow-up monitors cancer control, treatment toxicity and quality of life. PSA is central, but its expected pattern differs after prostatectomy and radiotherapy.

After prostatectomy PSA should fall to an undetectable or very low level because the prostate has been removed. A confirmed rise may indicate biochemical recurrence and prompt early salvage-treatment discussion.
After radiotherapy PSA falls more gradually because benign prostate tissue remains. Temporary fluctuation or “bounce” can occur, so recurrence is defined differently from recurrence after surgery.
During systemic treatment PSA, testosterone where appropriate, symptoms, examination, blood counts, kidney and liver tests, metabolic health and imaging are selected according to the medicines and disease state.

Routine scans are generally unnecessary after local treatment while PSA is stable and the patient is asymptomatic. Imaging is used when symptoms or PSA change and when the result would alter treatment planning.

How Can Health and Recovery Be Supported?

  • Remain physically active with aerobic, resistance and balance exercise adapted to fitness and bone risk.
  • Maintain adequate protein, calcium and vitamin D through a clinician-guided diet when bone health is a concern.
  • Stop smoking and moderate alcohol to improve surgical, cardiovascular and overall health.
  • Manage diabetes, blood pressure, cholesterol, weight and sleep during hormone treatment.
  • Use pelvic-floor physiotherapy, continence support and erectile rehabilitation when indicated.
  • Discuss anxiety, depression, relationship strain, body-image change and fear of recurrence openly.
  • Avoid unproven supplements that may interact with cancer medicines or provide false reassurance.

A healthy lifestyle supports treatment tolerance and long-term wellbeing, but it does not replace evidence-based cancer monitoring or treatment when these are indicated.

Myth vs Fact

Myth A raised PSA means prostate cancer.
Fact BPH, inflammation, infection, retention and recent procedures can raise PSA. Cancer risk is assessed with repeat testing, examination, MRI and biopsy where appropriate.
Myth Every prostate cancer must be treated immediately.
Fact Selected low-risk cancers can be monitored safely with active surveillance, avoiding or delaying treatment side effects while preserving a curative option if risk changes.
Myth Robotic surgery guarantees cure and preserved erections.
Fact The robot is a surgical platform. Cancer stage, anatomy, surgeon experience, margin status, baseline function and nerve-sparing safety influence cancer and functional outcomes.

Frequently Asked Questions

What PSA level means I have cancer?

No single PSA value proves cancer. Risk rises across a continuum and depends on age, prostate size, examination, trend, infection, medicines, family history and MRI. An unexpectedly raised result is often repeated before deciding whether biopsy is needed.

Can prostate cancer be cured?

Many localised prostate cancers are curable with surgery or radiotherapy, while selected low-risk cancers may never require treatment. Metastatic disease is usually managed as a long-term condition rather than considered curable, but modern combined treatment can provide meaningful control and prolong life.

Can MRI replace a prostate biopsy?

MRI can identify suspicious areas and help some low-risk patients avoid immediate biopsy, but it cannot detect every clinically significant cancer or provide a Grade Group. Tissue remains necessary when the combined clinical risk justifies biopsy.

Is prostate biopsy likely to spread cancer?

Routine prostate needle biopsy has not been shown to cause clinically meaningful cancer spread. Its genuine risks include bleeding, infection, discomfort and urinary retention, which should be discussed and reduced through careful technique and preparation.

Which is better—surgery or radiotherapy?

Neither is universally better. For many localised cancers both provide strong cancer control, but they differ in urinary, sexual and bowel effects, treatment experience, recovery and possible salvage options. A balanced surgical and radiation-oncology discussion should reflect the patient's cancer and priorities.

Will treatment always cause impotence or incontinence?

Risk varies. Age, baseline function, cancer location, nerve-sparing feasibility, treatment type, radiation dose, hormone therapy and recovery time all matter. Early leakage after surgery is common but often improves; erectile changes may be gradual after radiotherapy and more immediate after surgery.

Why can PSA rise after treatment if I feel well?

Biochemical recurrence is often detected before symptoms. A confirmed PSA pattern is interpreted according to whether the first treatment was surgery or radiotherapy, the interval since treatment and the cancer's original risk. Early review may allow targeted salvage treatment.

Related Patient Guides

Benign enlargement, urinary obstruction, bleeding and post-treatment leakage can overlap with the prostate-cancer pathway but require their own assessment and management.

Condition Enlarged Prostate Benign Prostatic Hyperplasia (BPH) Read guide → Procedure Prostate Biopsy Transperineal / Transrectal / MRI-Targeted Read guide → Symptom Blood in Urine Haematuria Read guide → Radiology Transrectal Prostate Ultrasound TRUS / Prostate-Volume Scan / Biopsy Guidance Read scan guide →

A Note From Our Doctors

The information on this page is intended to help you understand your condition. It should not be considered a diagnosis or a substitute for a consultation with a qualified medical professional.

Every patient is unique. The same symptom can have different causes in different individuals, and the most appropriate investigations and treatment depend on your medical history, examination findings, age, existing medical conditions and test results.

At SR Speciality Hospital, we believe in treating the whole patient—not just a symptom, scan or laboratory report. Every treatment plan is individualised after careful medical evaluation.

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