Prostate Cancer

What prostate cancer is — in plain words

The prostate is a walnut-sized gland that sits below the bladder in men and produces some of the fluid in semen. Prostate cancer begins in the gland's cells, most often in the outer (peripheral) zone. It is overwhelmingly a disease of men over 50; risk rises with age and is higher in men with a family history.

Unlike many cancers, prostate cancer often grows slowly. The same word — "cancer" — covers everything from a tiny, indolent finding that may never cause trouble to an aggressive disease that demands urgent treatment. Telling them apart is the first job.

Signs and symptoms to take seriously

Early prostate cancer rarely causes symptoms. When symptoms do appear, they are often the same as benign prostate enlargement:

"Prostate cancer is the one cancer where I most often tell patients, 'You don't need treatment today. You need careful follow-up.' That conversation is just as important as starting therapy."

How prostate cancer is diagnosed

• PSA blood test — prostate-specific antigen. Not a perfect test (it rises with benign enlargement and infection too), but a rising or markedly elevated PSA triggers further work-up.
• Digital rectal examination — a brief physical exam to feel for nodules.
• Multi-parametric MRI of the prostate — the modern standard. Identifies suspicious areas and reduces unnecessary biopsies.
• Targeted prostate biopsy — needle samples guided by the MRI findings. The pathologist assigns a Gleason score (or Grade Group 1–5) based on how aggressive the cells look.
• Staging scans — for higher-risk disease, a bone scan and a PSMA-PET scan look for spread.
• Genetic testing — BRCA2 and other DNA-repair gene mutations affect both treatment choices and family screening.

Risk groups — the framework that drives decisions

How we treat prostate cancer

Active surveillance

For low-risk disease, the safest path is often no immediate treatment. Instead, regular PSA tests, repeat MRI and biopsies on a planned schedule, and treatment only if the cancer shows signs of progressing. Many men stay on surveillance for years and never need surgery or radiation.

Surgery (radical prostatectomy)

Removing the entire prostate, usually with robotic or laparoscopic technique. Suitable for fit men with localised disease and an expected life span of at least 10 more years. Recovery of urinary control and sexual function takes months and varies between men — an honest conversation about these effects belongs at the start.

Radiation therapy

External-beam radiation (often combined with hormone therapy) or brachytherapy (seeds implanted in the prostate). Outcomes for localised disease are comparable to surgery, with a different side-effect profile.

Hormone therapy (androgen deprivation)

Prostate cancer is fuelled by testosterone. Drugs that switch off testosterone production (LHRH agonists like leuprolide and goserelin, or LHRH antagonists like degarelix) are the cornerstone of treatment for advanced disease and for higher-risk localised disease combined with radiation. Side effects include hot flushes, fatigue, weight gain and bone thinning — most are manageable.

Novel hormonal agents

Abiraterone, enzalutamide, apalutamide and darolutamide block the cancer's response to any remaining androgens. Added to standard hormone therapy at the right time, they extend survival significantly in advanced and high-risk disease.

Chemotherapy

Docetaxel is the standard first chemotherapy, used either early in metastatic disease (alongside hormone therapy) or later when the cancer becomes castration-resistant. Cabazitaxel follows for selected patients. Read more about chemotherapy →

Targeted and radioligand therapy

For men with BRCA1/2 or other DNA-repair mutations, PARP inhibitors (olaparib, rucaparib) are highly active. Lutetium-PSMA radioligand therapy targets cancer cells directly with internal radiation — a major advance for advanced disease.

What the outlook honestly looks like

For localised prostate cancer (low and intermediate risk), 10-year survival is well over 95%. For high-risk localised disease treated with modern combined therapy, 10-year survival exceeds 80%. Even metastatic prostate cancer, once a short illness, now has median survivals of 5 years or more thanks to layered hormonal and chemotherapy strategies.

Screening — a nuanced picture

• Discuss PSA testing from age 50 — earlier (from age 45) if there is a family history of prostate cancer or known BRCA mutations.
• An informed conversation is more important than a fixed rule. PSA screening saves lives but also leads to some over-treatment; the right decision depends on age, health and preferences.
• A single PSA is rarely the whole answer — trends over time, with MRI for clarification, give the best information.

Life during treatment

Side effects of hormone therapy — hot flushes, fatigue, weight gain, mood changes, loss of libido, bone thinning — are real, but most can be eased with exercise, simple medications and attention to diet. Regular weight-bearing exercise is one of the most powerful interventions for men on long-term hormone therapy.

After treatment — survivorship

PSA is followed for life after curative treatment. A rising PSA after surgery or radiation is called biochemical recurrence; not all rising PSAs need immediate further treatment. Read about survivorship care →