Have you learned that you have prostate cancer? If that news is recent, you probably have many questions and very little experience to draw on. This overview is meant to summarise the essential facts and options, so you or your family have a reliable starting point before you sit down with a physician. The better you understand the disease, the calmer and more confident you are likely to feel when weighing treatment choices.
The unsettling truth about prostate cancer is that in its earliest phases most men notice nothing. The illness often grows quietly within the gland, causing no visible trouble until it has advanced beyond the stage where early intervention is most effective. Only later, when the tumour begins to affect neighbouring nerves, tissues, or organs, do patients report symptoms such as these:
When prostate cancer is suspected, physicians rely on a combination of tests to confirm the condition and gauge its extent. The standard investigative tools include . . .
When investigating prostate cancer, clinicians rely on a range of tests to gauge the tumour's aggressiveness, size, extent of local invasion, and the patient’s general health. Gathering the clearest possible picture sometimes means repeating certain assessments.
The first step often involves the PSA test. Prostate-specific antigen is a protein produced by prostate cells, and its concentration in blood tends to rise with age and increasing gland volume. While elevated PSA levels can occur in benign conditions, readings well above the expected range frequently prompt further exploration.
Next, patients typically undergo a digital rectal exam, or DRE. During this procedure the urologist slips on a lubricated glove and, using an index finger, palpates the prostate through the rectal wall to estimate its size, shape and consistency. Although the DRE provides only a rough evaluation, it can still reveal abnormal nodules that merit closer scrutiny.
For a more precise view, practitioners increasingly turn to magnetic resonance imaging. An MRI scanner employs powerful magnets and radio waves to generate detailed, cross-sectional images of the prostate and surrounding tissues. Radiologists review these scans to identify areas that appear suspicious for malignancy.
Finally, if these earlier tests suggest cancer is present, a prostate biopsy is usually scheduled. Guided by real-time ultrasound, the urologist inserts a thin needle through the perineum to capture small tissue samples from multiple sites within the gland. Pathologists then examine these cores under the microscope to confirm the diagnosis and provide essential information for treatment planning.
Prostate cancer begins as a series of subtle changes in prostate tissue. The future outlook for any given case almost always hinges on how far the disease has advanced by the time doctors first take note of it. Clinicians therefore rely on a system known as staging, which effectively condenses both the local size of the tumor and its patterns of spread into a single, easily understood summary.
Most men receive their diagnosis when the cancer is still confined to the prostate itself. In this scenario, physicians designate the disease as localized cancer, since it is growing only within the boundaries of the gland. However, some patients present with a more extensive form that has begun to invade adjacent structures, an indication that the disease is locally advanced. When cancer moves further still, beyond the prostate capsule, it may metastasize—an event that opens the door to lesions in lymph nodes, bones, or even distant organs. Spread can occur in three main ways:
Understanding these pathways helps doctors match each patient's disease with the most appropriate treatment strategy. Thus, staging takes into account tumor size, lymph node involvement, and any evidence of distant spread before a final category is assigned.
Stage T1
At this earliest stage, the tumour is too small to be detected either by a digital rectal exam or by any standard imaging test.
Stage T2
The cancer is still confined within the prostate gland; in other words, it has not yet spread beyond its capsule.
Stage T3
Here the cancer has extended through the outer capsule of the prostate, making it locally advanced but not yet metastatic.
Stage T4
The disease has spread to nearby organs, such as the bladder or rectum, indicating a more advanced stage of involvement.
Selecting an appropriate treatment can be a daunting task for many patients and their families. The key lies in understanding both the medical probabilities and your own personal priorities. Below are some of the most frequently recommended therapies, but they should be viewed as starting points for discussion rather than a definitive guide.
For a significant proportion of men, prostate cancer is indolent, meaning it grows slowly enough that immediate treatment is neither necessary nor beneficial. In these cases, doctors typically suggest active surveillance. This strategy involves regular monitoring through blood tests, digital rectal exams, and, when warranted, needle biopsies. If tests later indicate that the cancer is becoming more aggressive, intervention can then be reconsidered.
The TULSA Procedure offers men a minimally invasive treatment alternative for prostate cancer. Rather than opening the body, physicians perform the procedure through the urethra while simultaneously monitoring the prostate with real-time magnetic resonance imaging. High-frequency ultrasound energy is then selectively delivered to a treatment zone defined by the surgeon, who can adjust the protocol based on the individual anatomy of each patient. A closed-loop temperature-control system ensures that adjacent tissues remain protected while the targeted area is ablated without the involvement of radiation or external skin incisions.
Radical prostatectomy, whether executed by traditional open surgery or the more commonly used robotic-assisted technique, involves the complete removal of the prostate gland along with surrounding tissue. Surgeons also examine and, if necessary, excise nearby lymph nodes to determine whether the cancer has spread beyond the gland itself. Because the procedure alters normal pelvic structures, many patients report challenges with erectile function and urinary control in the months following surgery. Rehabilitative strategies are available and often depend on the extent of nerve sparing achieved during the operation.
External beam radiation therapy (EBRT) directs concentrated x-ray beams at the prostate from outside the body over several outpatient sessions. In contrast, brachytherapy delivers tiny radioactive seeds directly into or near the tumor, allowing a higher localized dose while sparing some normal structures. Both modalities intentionally damage malignant cells, yet healthy neighboring tissues inevitably receive some exposure. Physicians strive to minimize this collateral impact through careful planning and imaging. As a result, common side effects experienced after either form of radiation include not only erectile dysfunction but also gastrointestinal complaints such as diarrhea, abdominal discomfort, and rectal irritation. Most of these symptoms tend to improve over time.