Localised Prostate Cancer
Cancer is confined to the prostate. Depending on risk, treatment options can include active surveillance, surgery or radiation therapy.
Prostate cancer treatment is planned according to the individual cancer's risk and extent, including the PSA level, biopsy findings, Grade Group, tumour stage, imaging results, overall health and personal treatment priorities.
Depending on the diagnosis, treatment may range from active surveillance for selected localised cancers to surgery, radiation therapy, hormone therapy, chemotherapy, targeted treatment, radiopharmaceutical therapy or other systemic approaches for advanced disease.
Prostate cancer develops in the prostate gland, a small gland located below the bladder and in front of the rectum. Most prostate cancers are adenocarcinomas arising from glandular cells.
Prostate cancer can behave very differently from one person to another. Some cancers grow slowly and may be safely monitored for a period of time, while others are more likely to grow or spread and require active treatment.
This is why a prostate cancer diagnosis should not be interpreted from the PSA result alone. The biopsy grade, Grade Group, tumour extent, imaging findings and other clinical factors are considered together when planning treatment.
The same treatment is not appropriate for every prostate cancer. Doctors assess the complete clinical picture before recommending surveillance, local treatment or systemic therapy.
PSA is a blood marker produced mainly by the prostate. PSA can be elevated because of prostate cancer as well as conditions such as benign prostate enlargement or inflammation.
The biopsy shows the microscopic characteristics of the cancer and provides the Gleason score and corresponding Grade Group.
Doctors assess whether the cancer remains within the prostate, has extended into nearby structures or has spread elsewhere.
MRI and, when appropriate, other imaging tests can provide information about tumour location and possible spread.
Age, life expectancy, other medical conditions and fitness can influence which treatments are appropriate.
Possible effects on urinary control, sexual function, bowel function and quality of life are important when discussing treatment choices.
The biopsy is examined by a pathologist to determine how abnormal the prostate cancer cells look. The Gleason score is used to derive the Grade Group, which ranges from 1 to 5.
Gleason score 6 or less
Gleason score 3+4=7
Gleason score 4+3=7
Gleason score 8
Gleason score 9–10
Grade Group is only one part of risk assessment. PSA, tumour stage, biopsy findings, imaging and other clinical information also contribute to treatment planning.
Cancer is confined to the prostate. Depending on risk, treatment options can include active surveillance, surgery or radiation therapy.
Cancer has extended beyond the prostate or involves nearby structures. Treatment may involve combinations of local and systemic therapies.
Cancer may return after previous surgery, radiation or other treatment. The location and nature of recurrence guide further evaluation and treatment.
Cancer that has spread to distant sites requires systemic treatment. Hormone-based treatment and other therapies may be combined according to the disease characteristics and previous treatment.
Treatment planning may involve more than one cancer specialist, particularly when surgery, radiation and systemic treatment all need to be considered.
Assessment of whether surgery may be appropriate and discussion of the potential urinary, sexual and other functional effects of treatment.
Evaluation of hormone therapy, chemotherapy, targeted medicines, immunotherapy and other systemic options when indicated.
Assessment of external-beam radiation, brachytherapy in selected settings and radiation-based approaches for recurrent or advanced disease.
A specialist consultation can help put your PSA, biopsy, Grade Group and imaging findings into context and explain the treatment options appropriate for your situation.
Book an Oncology ConsultationProstate cancer can develop without noticeable symptoms, particularly in its earlier stages. When symptoms do occur, they may overlap with common non-cancerous prostate conditions such as benign prostatic hyperplasia (BPH) or prostatitis. Symptoms alone therefore cannot confirm or exclude prostate cancer.
Difficulty starting urination, a weak or interrupted urine stream, increased urinary frequency, urgency or needing to urinate more often at night may occur with prostate problems.
Blood in the urine or semen should be assessed by a doctor. It can have several causes and does not by itself mean prostate cancer.
Erectile difficulties or painful ejaculation can occur with several prostate and genitourinary conditions and warrant appropriate evaluation when persistent.
Persistent pain in the lower back, hips or pelvis may occur in more advanced prostate cancer, although these symptoms have many other possible causes.
Increasing difficulty passing urine or a feeling that the bladder is not emptying properly should be assessed, particularly if symptoms are worsening.
Many early prostate cancers do not cause symptoms. An abnormal PSA or examination may sometimes lead to further assessment before symptoms develop.
Persistent urinary changes, blood in the urine or semen, unexplained pelvic or back pain, difficulty passing urine, or other ongoing prostate-related symptoms should be discussed with a doctor. Sudden inability to pass urine requires prompt medical attention.
Prostate symptoms are not specific to cancer. BPH, prostatitis, urinary infection and other conditions can produce similar symptoms. :chatgpt-content-reference{index="0"}
Risk factors can increase the likelihood of developing prostate cancer, but having a risk factor does not mean that cancer will develop. Conversely, prostate cancer can occur in men without an obvious family or genetic risk factor.
Prostate cancer screening is different from investigating symptoms or an already abnormal test. Screening aims to look for cancer before symptoms appear. PSA testing may help detect prostate cancer earlier, but it also has limitations and can lead to additional tests or treatment for cancers that may never have caused problems.
PSA, or prostate-specific antigen, is a substance produced mainly by prostate tissue. A raised PSA can occur with prostate cancer, but also with BPH, inflammation or other prostate conditions.
A digital rectal examination allows a clinician to assess the prostate for abnormalities. It may form part of an overall assessment, but it cannot diagnose prostate cancer by itself.
A high PSA does not automatically mean cancer, while a lower PSA does not completely exclude it. Results need to be interpreted alongside age, prostate findings, previous PSA results and other clinical information.
PSA is useful, but it is not specific to cancer. A raised result may need further evaluation rather than an immediate assumption that cancer is present.
Enlargement of the prostate can increase PSA levels and can also cause urinary symptoms.
Inflammation or infection involving the prostate can increase PSA and may cause urinary or pelvic symptoms.
Prostate cancer can raise PSA, but PSA level alone cannot establish the diagnosis. Further evaluation may include examination, prostate MRI and biopsy when indicated.
An oncology consultation can help you understand what your PSA, symptoms and previous reports may mean and whether further evaluation is appropriate.
Diagnosing prostate cancer involves bringing together PSA results, clinical examination, prostate imaging and, when indicated, biopsy findings. Once cancer is confirmed, doctors assess the Grade Group and extent of disease to determine the stage and understand how aggressive the cancer may be.
PSA is an important part of prostate cancer assessment, but there is no single PSA value that by itself proves or excludes cancer. Doctors may consider the absolute PSA level, changes over time, prostate volume, PSA density and other clinical findings.
PSA is a protein produced mainly by prostate tissue. An elevated PSA can occur with prostate cancer as well as BPH, inflammation and other prostate conditions.
A previous PSA result can provide useful context. A doctor may look at whether PSA is stable, rising or changing over time rather than relying on a single measurement.
PSA density considers the PSA level in relation to prostate volume. It may contribute to decisions about whether further investigation is appropriate.
Multiparametric MRI (mpMRI) provides detailed images of the prostate and surrounding structures. It can help identify areas that are more suspicious for clinically significant prostate cancer and can help guide biopsy decisions.
MRI can show the location and characteristics of prostate lesions and may help assess whether a suspicious area is confined to the prostate or appears to extend beyond it.
MRI findings are commonly reported using the PI-RADS system, which assigns a category reflecting the likelihood that a lesion represents clinically significant prostate cancer.
When MRI identifies a suspicious lesion, the imaging can be used to help target that area during biopsy, often alongside systematic sampling according to the clinical situation.
MRI can identify suspicious areas, but imaging alone does not establish a definitive diagnosis of prostate cancer. When tissue diagnosis is indicated, biopsy and pathological examination provide the definitive evidence.
A prostate biopsy removes small tissue samples for microscopic examination. Biopsy is used to confirm cancer and provides important information about tumour grade and other pathological features that influence treatment planning.
If MRI identifies a suspicious lesion, biopsy samples may be directed towards that specific area using MRI-targeting techniques or image-fusion guidance.
Additional systematic samples may be taken from different regions of the prostate, depending on the clinical assessment and biopsy strategy being used.
The pathologist evaluates the tissue for cancer and reports features including Gleason patterns, Grade Group and the extent of tumour in the sampled cores.
The Gleason grading system describes the microscopic appearance of prostate cancer cells. The modern Grade Group system translates Gleason patterns into five groups and helps clinicians communicate tumour aggressiveness and plan treatment.
| Grade Group | Typical Gleason Pattern | General Meaning |
|---|---|---|
| Grade Group 1 | Gleason 3+3=6 | Lower-grade cancer with cells that are more similar to normal prostate tissue. |
| Grade Group 2 | Gleason 3+4=7 | Intermediate-grade cancer with a smaller component of pattern 4. |
| Grade Group 3 | Gleason 4+3=7 | Intermediate-grade cancer with pattern 4 predominating. |
| Grade Group 4 | Gleason 8 | Higher-grade prostate cancer. |
| Grade Group 5 | Gleason 9–10 | Highest-grade category, associated with a greater risk of aggressive disease. |
Grade Group ranges from 1 to 5 and is based on Gleason patterns seen in the biopsy tissue. Lower Grade Groups generally represent less aggressive microscopic features. ([NCI](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/grade-group?utm_source=chatgpt.com))
Staging determines how far prostate cancer has spread. Doctors combine clinical examination, PSA, Grade Group, MRI and other imaging findings to determine whether disease is confined to the prostate, has extended locally, involves nearby lymph nodes or has spread to distant sites.
Cancer is confined to the prostate and generally has lower-risk characteristics.
Cancer remains within the prostate but has features associated with a higher risk compared with stage I.
Cancer may have higher PSA or Grade Group features and/or may have extended beyond the prostate into nearby structures.
Cancer has spread to nearby lymph nodes or to distant sites such as bone or other organs, depending on the specific stage classification.
PSMA PET/CT is an advanced molecular imaging test that uses a tracer targeting prostate specific membrane antigen (PSMA). It can help identify prostate cancer deposits in lymph nodes, bones or other parts of the body.
PSMA PET/CT may be considered in selected patients with higher-risk or more advanced newly diagnosed prostate cancer when more precise staging could influence treatment.
When PSA rises after treatment, PSMA PET may help identify where recurrent prostate cancer is located and whether it has spread.
The findings may help clinicians decide whether local treatment, systemic treatment or a combination of approaches is appropriate.
The need for PSMA PET/CT depends on the patient's risk category, clinical stage, PSA, Grade Group, previous treatment and the question that needs to be answered. It is an additional staging tool rather than a routine test for every person with suspected prostate cancer.
PSMA PET uses a tracer that binds to PSMA on prostate cancer cells and can help detect recurrent or metastatic disease and guide treatment planning. ([NCI](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/psma-pet-scan?utm_source=chatgpt.com))
The most useful prostate cancer assessment is not based on PSA, MRI, biopsy grade or imaging alone. These results are brought together to estimate the overall risk and extent of disease before treatment options are discussed.
Helps assess disease risk and contributes to staging and treatment planning.
Helps evaluate tumour location, local extension and, in selected situations, possible spread beyond the prostate.
Confirms the diagnosis and provides microscopic information about tumour aggressiveness.
Bring your PSA reports, MRI findings, biopsy report and previous treatment records for a structured oncology assessment and treatment discussion.
Prostate cancer treatment is selected according to the cancer's risk category, Grade Group, PSA, stage, imaging findings, overall health and personal priorities. Some prostate cancers can be monitored safely for a period of time, while others require surgery, radiation, hormone therapy or systemic treatment.
Active surveillance involves regular monitoring rather than immediate treatment. PSA tests, clinical assessment, imaging and sometimes repeat biopsy are used to look for evidence that the cancer is changing.
Radical prostatectomy removes the prostate and seminal vesicles and may include pelvic lymph-node assessment. It can be considered for appropriate patients with cancer that remains suitable for local treatment.
External-beam radiation and, in selected patients, brachytherapy can treat prostate cancer. Hormone therapy may be combined with radiation when the cancer has a higher risk of recurrence.
Hormone therapy lowers androgen stimulation of prostate cancer cells. It may be used with radiation or as part of treatment for recurrent or metastatic disease.
Depending on the disease setting, systemic treatment may include androgen-receptor pathway medicines, chemotherapy and other therapies selected according to the cancer's biology and previous treatment.
Some patients may be candidates for biomarker-directed treatments, PARP inhibitors or radiopharmaceutical approaches such as PSMA-directed radioligand therapy.
Active surveillance is not the same as ignoring cancer. It is a structured approach in which treatment is deferred while the cancer is monitored closely, with treatment started if there are signs that the disease is becoming more clinically significant.
Active surveillance is commonly considered for selected men with lower-risk localised prostate cancer and may be appropriate for some men with carefully selected intermediate-risk disease.
Follow-up can include PSA testing, clinical assessment, MRI and repeat biopsy according to the surveillance protocol and the individual's risk profile.
Evidence of disease progression, a change in Grade Group, concerning MRI findings or other clinically important changes may lead to discussion of definitive treatment.
For appropriate low-risk cancers, surveillance can avoid or delay treatment-related effects such as urinary, sexual or bowel complications while preserving the option of later treatment if the cancer changes.
Watchful waiting is different from active surveillance. It is generally considered when the main goal is to maintain quality of life and manage symptoms rather than to pursue immediate curative treatment.
Watchful waiting may be appropriate for some older men or those with significant medical conditions when the risks of definitive treatment outweigh likely benefits.
Treatment is introduced when symptoms or clinically important disease progression requires intervention rather than simply because cancer has been diagnosed.
Depending on the situation, hormone therapy, radiation or other measures may be used to control urinary symptoms, pain or other effects of the cancer.
When prostate cancer is confined to the prostate and the patient is suitable for definitive treatment, surgery or radiation-based treatment may be considered. Some lower-risk cancers may instead be managed with active surveillance.
Options may include active surveillance, surgery or radiation depending on Grade Group, PSA, tumour extent, age, health and personal preference.
Surgery or radiation may be considered. Some patients receiving radiation may also require a period of androgen deprivation therapy depending on their risk category.
Treatment often requires a more intensive local approach. Radiation combined with hormone therapy is one established approach, while surgery may be considered in appropriately selected patients as part of a planned multimodal strategy.
Surgery and radiation can both provide effective local treatment for appropriately selected prostate cancer. The decision should consider cancer control as well as the potential effects on urinary function, sexual function, bowel function and overall quality of life.
When prostate cancer extends outside the prostate but has not spread to distant organs, treatment often requires more than one modality. The exact combination depends on the location and extent of disease and the patient's overall health.
External-beam radiation is commonly combined with androgen deprivation therapy for appropriately selected higher-risk or locally advanced disease.
Radical prostatectomy may be considered for selected patients, usually with an understanding that additional treatment such as radiation or hormone therapy may become necessary depending on pathology and subsequent PSA behaviour.
Locally advanced disease is often best considered through a coordinated plan involving surgical, radiation and medical oncology expertise.
Prostate cancer can recur after surgery, radiation or other initial treatment. A rising PSA may be the first indication of recurrence, while imaging such as PSMA PET/CT may help determine where recurrent disease is located.
Depending on PSA behaviour, pathology and imaging, salvage radiation with or without hormone therapy may be considered in appropriately selected patients.
Management may include surveillance, systemic hormone therapy or selected local salvage approaches depending on where the recurrence is found and previous treatment.
A rising PSA does not automatically mean widespread metastatic disease. The timing and rate of PSA increase, previous treatment and imaging findings help guide the next step.
When prostate cancer has spread to distant lymph nodes, bones or other organs, treatment usually focuses on controlling the cancer throughout the body, delaying progression, relieving symptoms and maintaining quality of life.
ADT lowers testosterone stimulation of prostate cancer cells and remains a core component of treatment for metastatic hormone-sensitive disease.
Medicines such as abiraterone, enzalutamide, apalutamide or darolutamide may be added to ADT in appropriate patients according to disease setting and treatment goals.
Docetaxel may be used in metastatic disease and can be incorporated into combination treatment for selected patients, particularly when disease burden and overall health support an intensive approach.
Genetic testing can identify some DNA-repair alterations that may make certain patients eligible for PARP-inhibitor treatment in appropriate advanced disease settings.
Radiopharmaceutical treatments may be considered for selected patients with advanced disease, including PSMA-directed radioligand therapy or bone-targeted treatment in appropriate clinical circumstances.
Pain management, bone-health strategies, radiation for painful metastases and other supportive measures may be incorporated into treatment when needed.
For metastatic hormone-sensitive prostate cancer, ADT alone is no longer the only systemic approach used for many patients. Combination treatment with another systemic agent, and chemotherapy for selected patients, may improve disease control. The choice depends on disease volume, symptoms, previous treatment, comorbidities and patient preferences.
Modern treatment options for advanced prostate cancer include androgen-directed therapies, chemotherapy, targeted therapies and radiopharmaceutical approaches. ([NCI](https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet?utm_source=chatgpt.com))
Some prostate cancers eventually continue to grow despite testosterone being suppressed to very low levels. This is called castration-resistant prostate cancer (CRPC). It does not mean that every hormone treatment stops being useful; treatment is selected according to the disease's previous therapies, genomic findings, symptoms and imaging.
Androgen deprivation generally remains part of treatment even when prostate cancer has become castration-resistant.
Depending on previous treatment, options can include androgen-receptor pathway medicines, chemotherapy and other systemic approaches.
Testing for alterations in DNA-repair genes and other clinically relevant biomarkers may identify patients who could benefit from targeted treatment.
Prostate cancer treatment continues to evolve. Clinical trials are evaluating new drug combinations, radioligand therapies, targeted treatments and strategies for recurrent and advanced disease.
Studies are evaluating combinations of hormone therapy, chemotherapy and newer systemic treatments to improve disease control.
PSMA-targeted radioligand approaches continue to be studied in different stages of advanced prostate cancer.
Research is increasingly focused on matching treatment to genetic and molecular characteristics of individual tumours.
The final treatment plan should bring together cancer-control goals and the patient's individual circumstances. Two men with the same broad stage can still receive different treatment recommendations.
PSA, Grade Group, tumour stage, lymph-node status, metastatic sites and molecular findings can all influence treatment selection.
Age alone does not determine treatment. Other medical conditions, functional status and expected longevity are also important.
Urinary control, sexual function, bowel function, treatment convenience and willingness to undergo different treatment schedules can all be part of shared decision-making.
A personalised oncology consultation can help you understand your risk category, treatment choices and the potential benefits and side effects of each approach.
Surgery is one of the definitive treatment options for appropriately selected men with prostate cancer that can be treated with a local or locally directed approach. The main operation is radical prostatectomy, which removes the prostate and seminal vesicles. Depending on the risk and stage of the cancer, nearby lymph nodes may also be assessed.
The prostate gland and seminal vesicles are removed, with the bladder then connected to the urethra so that urine can continue to pass normally.
Pelvic lymph-node dissection may be performed when the estimated risk of lymph-node involvement is sufficiently high to make the information clinically useful.
Where oncologically appropriate, the surgical plan may consider preservation of nerves involved in erectile function while maintaining adequate cancer control.
During radical prostatectomy, the surgeon removes the prostate and seminal vesicles. The urethra is then reconnected to the bladder. The exact operation is adapted to the location and extent of the tumour and the patient's anatomy.
PSA, biopsy Grade Group, MRI findings, clinical stage and overall health are reviewed before surgery. The team also discusses urinary and sexual function and expected recovery.
The prostate is removed together with the seminal vesicles. The surgical specimen is sent to pathology for detailed examination.
If the tumour location and cancer-control requirements allow, one or both neurovascular bundles may be preserved to improve the possibility of postoperative erectile function.
After prostate removal, the bladder is connected to the urethra. A urinary catheter is usually left temporarily while the connection heals.
Nerve-sparing surgery is considered only when it is compatible with safe removal of the cancer. If the tumour is close to a neurovascular bundle, removing that tissue may be necessary to achieve an appropriate cancer margin.
Radical prostatectomy can be performed using different surgical approaches. The choice depends on the surgeon's expertise, available technology, patient factors and the specific clinical situation.
The prostate is removed through a larger surgical incision. Open surgery remains an established approach and can provide direct access to the operative field.
Small incisions are used with specialised instruments and a camera. Recovery can be different from open surgery because the incisions are smaller.
Robotic systems allow the surgeon to control specialised instruments through small incisions. The robot assists the surgeon; it does not perform the operation independently.
Prostate cancer can spread to pelvic lymph nodes. Lymph-node dissection may therefore be considered in selected patients who have a sufficiently significant risk of nodal disease.
Removing and examining lymph nodes can provide important pathological staging information and may influence subsequent treatment planning.
No. Lymph-node dissection is generally reserved for patients in whom the expected likelihood of nodal involvement makes the procedure appropriate.
The pathology report can identify whether cancer cells are present in the sampled lymph nodes and, if so, how extensively they are involved.
The prostate removed during surgery undergoes detailed pathological examination. The final pathology can provide more precise information about the extent and characteristics of the cancer than the original biopsy alone.
| Pathology Feature | Why It Matters |
|---|---|
| Grade Group / Gleason pattern | Confirms the tumour's microscopic grade and may identify differences from the biopsy assessment. |
| Tumour extent | Shows how far the tumour has extended within or beyond the prostate. |
| Surgical margins | Indicates whether cancer cells are present at the edge of the removed specimen. |
| Seminal vesicle involvement | Helps determine the pathological stage and future risk assessment. |
| Lymph-node status | Shows whether sampled pelvic lymph nodes contain prostate cancer. |
A positive surgical margin means cancer cells are present at the edge of the removed tissue and can increase the risk of recurrence. It does not by itself establish that cancer remains elsewhere in the body. PSA monitoring and the complete pathology report help determine whether additional treatment should be considered.
Temporary urinary leakage is common after catheter removal following prostatectomy. Recovery varies considerably between individuals and can continue over several months.
Some men experience urinary leakage when coughing, sneezing, standing or exercising during the early recovery period.
Pelvic-floor exercises and guidance from an appropriately trained professional may help improve urinary control during recovery.
Ongoing or troublesome urinary incontinence should be discussed with the treating team because additional assessment and treatment options may be available.
The nerves responsible for erections run close to the prostate. Prostatectomy can therefore affect erectile function, even when the operation is successful in controlling the cancer.
When cancer location permits, preserving the neurovascular bundles may improve the likelihood of recovering erectile function.
Erectile recovery may take considerably longer than urinary recovery and can continue to improve over many months or longer.
Depending on the individual's situation, medicines, devices and other sexual-health interventions may be considered as part of postoperative rehabilitation.
The priority during cancer surgery is complete and safe removal of the tumour. Nerve preservation is considered only when it does not compromise oncological control.
As with any major operation, radical prostatectomy has potential risks. Your surgical team should explain the risks relevant to your individual health and planned procedure before surgery.
Bleeding, infection, blood clots and anaesthetic complications are possible with major surgery, although preventive measures are routinely used.
Temporary or persistent urinary leakage can occur after prostatectomy. Most patients improve over time, but the degree and speed of recovery vary.
Erectile function can be affected because of the prostate's close relationship with the erectile nerves.
Radical prostatectomy results in loss of natural fertility because the prostate and seminal vesicles are removed and the normal pathway for semen is interrupted.
Bowel complications are less prominent than with pelvic radiation, but temporary bowel or abdominal symptoms can occur around the time of surgery.
When lymph-node dissection is performed, complications such as lymphocele or leg swelling can occur and are discussed as part of the surgical consent process.
The initial recovery period focuses on pain control, mobilisation, catheter care, prevention of complications and return to normal eating and activity as appropriate.
A urinary catheter is usually kept temporarily after surgery and removed according to the surgeon's assessment of healing.
The final surgical pathology is reviewed to establish the pathological stage and determine whether additional treatment or closer monitoring may be appropriate.
PSA monitoring after radical prostatectomy is an important part of follow-up because the prostate has been removed and PSA should fall to a very low or undetectable level in successful treatment.
Discuss the potential benefits, risks, functional outcomes and alternatives with an oncology team before deciding on treatment.
Prostate cancer treatment may involve radiation therapy, hormone treatment, chemotherapy, targeted medicines or radiopharmaceuticals depending on the cancer's stage, Grade Group, PSA pattern, imaging findings, previous treatment and overall health. Some patients need one treatment modality, while others benefit from a carefully planned combination.
Radiation therapy uses high-energy radiation to damage cancer cells. It can be used as a definitive treatment for selected localised or locally advanced prostate cancers, as part of treatment for higher-risk disease, or as salvage treatment when cancer returns after surgery.
External beam radiation directs radiation towards the prostate and, when necessary, nearby tissues at risk of containing cancer.
Intensity-modulated radiation therapy (IMRT) allows radiation dose to be shaped around the target. Image-guided techniques can help improve treatment positioning and accuracy.
These approaches are commonly considered when radiation is selected for prostate cancer.
SBRT delivers a higher radiation dose per treatment over a smaller number of sessions. It may be appropriate for selected patients, depending on tumour characteristics, anatomy, urinary function and treatment goals.
Brachytherapy places radioactive sources directly within or close to the prostate. It may be used in selected localised cancers, either as a treatment approach on its own or in combination with external beam radiation in appropriate higher-risk settings.
Prostate cancer cells commonly depend on androgen hormones such as testosterone for growth. Hormone treatment reduces androgen stimulation or blocks the cancer cell's ability to use androgen signals.
ADT lowers testosterone production or suppresses androgen signalling. It is commonly used in advanced prostate cancer and may also be combined with radiation for selected higher-risk or locally advanced cancers.
Medicines such as abiraterone, enzalutamide, apalutamide and darolutamide interfere with androgen production or androgen-receptor signalling.
Their role depends on whether the cancer is hormone-sensitive or castration-resistant and on the overall disease setting.
Because androgen deprivation affects normal hormone levels, patients may experience physical and metabolic changes during treatment. Monitoring and supportive care are an important part of long-term prostate cancer management.
Sexual health, urinary symptoms, fatigue, emotional wellbeing and daily functioning should be discussed rather than treated as secondary concerns. Supportive measures can be incorporated into the cancer treatment plan.
Chemotherapy is not required for every person with prostate cancer. It is mainly considered in selected advanced or metastatic settings, often alongside hormone-based treatment depending on disease characteristics and treatment goals.
Docetaxel is a chemotherapy medicine that may be used in selected patients with metastatic hormone-sensitive prostate cancer and in certain other advanced settings.
Suitability depends on overall health, disease burden, symptoms, previous treatment and treatment objectives.
Cabazitaxel may be considered for selected patients with advanced prostate cancer that has progressed after previous treatment, including docetaxel and an androgen-receptor pathway inhibitor.
Some prostate cancers contain inherited or tumour-specific genetic alterations that can influence treatment choices. Genetic and molecular testing can therefore become particularly relevant in advanced, metastatic or high-risk disease.
PARP inhibitors may be useful in selected advanced prostate cancers with alterations affecting homologous recombination DNA-repair pathways, including certain BRCA1 or BRCA2 alterations.
Eligibility depends on the specific genetic alteration, disease setting and treatment history.
Radiopharmaceutical treatments deliver radiation through a medicine that travels to specific sites or molecular targets associated with prostate cancer. They are generally considered in selected advanced disease rather than as routine treatment for newly diagnosed localised prostate cancer.
Lutetium-177 PSMA-directed therapy may be considered for selected patients with advanced prostate cancer whose disease demonstrates appropriate PSMA expression and who meet treatment-specific eligibility criteria.
Radium-223 is a radiopharmaceutical that may be considered in selected patients with symptomatic bone-predominant metastatic prostate cancer without known visceral metastases.
Some prostate cancers eventually progress despite testosterone being suppressed to a very low level. This is known as castration-resistant prostate cancer (CRPC).
Progression may be identified through a rising PSA, new findings on imaging, worsening symptoms or a combination of these findings. Treatment is then selected according to previous therapies, disease location, symptoms, molecular findings and overall health.
Advanced prostate cancer is often managed as a changing disease. PSA trends, testosterone levels, symptoms, blood tests and imaging may be reviewed to determine whether the current treatment remains effective.
Cancer treatment is not limited to controlling the tumour. Supportive care can help patients manage symptoms, maintain function and preserve quality of life throughout treatment.
Patients receiving long-term hormone treatment or those with bone-metastatic disease may need assessment of fracture risk, bone density, calcium and vitamin D intake, exercise and other bone-directed measures when appropriate.
Urinary symptoms, erectile dysfunction and changes in sexual wellbeing can occur because of the cancer itself or its treatment. These concerns should be addressed proactively.
Pain, particularly from bone metastases, can often be managed with a combination of cancer-directed treatment, medicines, radiation and other supportive approaches.
Anxiety, treatment fatigue, changes in work or family responsibilities and concerns about sexual health are common issues. Addressing these concerns is part of comprehensive cancer care.
Prostate cancer care is not a single treatment pathway. The plan is built around the cancer's risk group, Grade Group, PSA pattern, MRI and other imaging findings, stage, previous treatment, overall health and personal priorities. The treatment plan may also be reviewed and adjusted as new information becomes available.
PSA, clinical assessment, prostate MRI and biopsy findings are brought together to confirm whether prostate cancer is present and to understand its grade and extent.
Grade Group, PSA, tumour stage, lymph-node status and evidence of distant spread help determine the risk category and available treatment approaches.
Depending on the disease setting, options may include active surveillance, surgery, radiation, hormone treatment or systemic therapies.
The selected approach is planned around cancer control while also considering urinary function, sexual health, bowel function, general health and the patient's priorities.
PSA, testosterone where relevant, symptoms, examination, blood tests and imaging may be used to assess how the cancer responds to treatment.
Follow-up helps identify recurrence or progression when present, manage treatment effects and support long-term health and quality of life.
Prostate cancer can involve several treatment disciplines. A multidisciplinary approach allows different specialists to consider the same clinical information and coordinate treatment when more than one modality is required.
Surgical assessment focuses on whether prostatectomy or another surgical approach is appropriate, while considering cancer control and preservation of urinary and sexual function where possible.
Meet Dr. Bharath GMedical oncology supports systemic treatment decisions including hormone therapy, chemotherapy, targeted treatment and selected treatments for advanced or metastatic disease.
Meet Dr. Vivek BelathurRadiation oncology evaluates external beam radiation, brachytherapy and radiation-based treatment in localised, locally advanced and recurrent disease.
Meet Dr. S. D. ShamsundarA second opinion can be useful when the diagnosis is complex, when more than one treatment approach appears reasonable, or when you want to understand the expected benefits and potential side effects before starting treatment.
Reviewing the biopsy, Grade Group, MRI and stage can help clarify whether surveillance, surgery, radiation or another approach is appropriate.
A second opinion may help you compare surgery and radiation or understand whether additional staging or testing is needed.
When PSA rises or imaging shows progression, reviewing previous treatments and available systemic or radiation-based options can help inform the next step.
Bringing previous records can make the consultation more useful and reduce the need to repeat investigations unnecessarily.
Follow-up depends on the treatment received and the patient's risk of recurrence or progression. PSA is an important part of monitoring after definitive treatment and during many forms of advanced disease management.
PSA is monitored because the prostate has been removed. A detectable or subsequently rising PSA may prompt further assessment and, in selected cases, consideration of salvage treatment.
PSA generally falls gradually after radiation rather than becoming immediately undetectable. The pattern over time is interpreted in the context of the treatment received and the patient's clinical situation.
PSA, testosterone, symptoms, blood tests and imaging may be used together to assess treatment response and detect progression.
Patients receiving prostate cancer treatment should follow the individual instructions provided by their oncology team. Prompt medical assessment may be needed for new or rapidly worsening symptoms.
Regular appointments allow PSA results, treatment effects, urinary and sexual health, bone health and other concerns to be reviewed before they become more difficult to manage.
If you have a new diagnosis, rising PSA, recurrent prostate cancer or need help understanding treatment options, an oncology consultation can help put your reports, stage and treatment choices into context.
Book an Oncologist AppointmentUnderstanding the diagnosis, Grade Group, stage and available treatment options can make prostate cancer decisions easier to navigate. These answers provide general information and do not replace an individual assessment by an oncology team.
Prostate cancer develops in the prostate gland, a small gland located below the bladder and in front of the rectum. Most prostate cancers are adenocarcinomas. Their behaviour can vary considerably, which is why treatment depends on factors such as PSA, Grade Group, tumour stage and imaging findings.
Early prostate cancer often causes no symptoms. When symptoms occur, they may include difficulty starting or maintaining urine flow, increased urinary frequency, blood in the urine or semen, difficulty emptying the bladder, erectile or ejaculatory changes, or pelvic, hip or lower-back discomfort. These symptoms can also occur with non-cancerous prostate conditions.
No. PSA is not specific to prostate cancer. PSA can also rise because of benign prostate enlargement, inflammation or infection and other prostate-related factors. A raised PSA may require further assessment, which can include clinical evaluation, repeat PSA testing, prostate MRI and, when appropriate, biopsy.
A prostate biopsy removes small tissue samples from the prostate for examination by a pathologist. It can confirm whether cancer is present and provides important information about tumour grade, including the Gleason pattern and Grade Group.
The Gleason system describes the microscopic appearance and pattern of prostate cancer cells. The Grade Group system translates this information into five groups, from Grade Group 1 through Grade Group 5. Higher Grade Groups generally indicate more aggressive tumour characteristics.
Grade Group 1 corresponds to Gleason score 6 or less; Grade Group 2 to 3+4=7; Grade Group 3 to 4+3=7; Grade Group 4 to Gleason score 8; and Grade Group 5 to Gleason scores 9–10.
Multiparametric MRI can help identify areas of the prostate that are suspicious for clinically significant cancer, assess local tumour extent and guide biopsy planning. MRI does not by itself confirm prostate cancer; tissue diagnosis may still be required.
Active surveillance is a structured monitoring approach for selected men with prostate cancer that appears suitable for observation rather than immediate definitive treatment. Monitoring may include PSA, clinical assessment, MRI and repeat biopsy when appropriate. Treatment can be started if evidence suggests the cancer is becoming more significant.
No. Active surveillance involves planned and regular monitoring. It is different from simply leaving the cancer untreated without follow-up. The purpose is to avoid or delay treatment-related effects when immediate treatment is not necessary while retaining the option to treat if the cancer shows signs of progression.
Depending on the stage and risk group, treatment may include active surveillance, radical prostatectomy, external beam radiation, brachytherapy, hormone therapy, chemotherapy, targeted treatment and radiopharmaceutical or radioligand treatment. Not every patient needs all of these treatments.
No. Surgery is one possible treatment for selected localised or locally advanced prostate cancers. Depending on the cancer's risk, radiation, active surveillance or other approaches may also be appropriate. Treatment should be based on the individual clinical situation rather than a single treatment being suitable for everyone.
Yes. Radiation therapy can be a definitive treatment for selected localised and locally advanced prostate cancers. External beam radiation, including modern image-guided techniques, and brachytherapy may be considered depending on cancer risk, anatomy, urinary function and other factors.
Hormone therapy reduces androgen stimulation of prostate cancer. Androgen deprivation therapy lowers testosterone production or suppresses androgen signalling, while medicines such as abiraterone, enzalutamide, apalutamide and darolutamide interfere with androgen pathway activity. The appropriate treatment depends on the disease setting.
Side effects depend on the treatment used. Surgery can affect urinary control and sexual function. Radiation may cause urinary, bowel or sexual side effects. Hormone treatment can cause hot flushes, fatigue, sexual changes, body-composition changes and longer-term bone or metabolic effects. Chemotherapy and systemic medicines have their own potential side effects.
Yes. Prostate cancer can recur after surgery or radiation, although the risk varies according to the original cancer characteristics and treatment. PSA monitoring is an important part of follow-up. If PSA rises, additional assessment may help determine whether further treatment is appropriate.
Metastatic prostate cancer is cancer that has spread beyond the prostate to distant sites. Common locations include lymph nodes and bones, although other organs can also be affected. Treatment usually involves systemic therapy, with the specific combination depending on disease characteristics and previous treatment.
Castration-resistant prostate cancer is prostate cancer that progresses despite testosterone being suppressed to a very low level. Progression may be recognised through PSA changes, imaging findings or clinical symptoms. Several treatment options may be considered depending on previous therapy, disease location and molecular characteristics.
Genetic or molecular testing may be considered particularly in selected patients with high-risk, metastatic, recurrent or advanced prostate cancer. Testing can identify alterations that may influence treatment options, clinical-trial eligibility or assessment of inherited cancer risk.
Yes. Metastatic prostate cancer can often be treated even when it cannot be removed completely with surgery. Treatment may include androgen deprivation, androgen-receptor pathway inhibitors, chemotherapy, targeted medicines and selected radiopharmaceutical or radioligand treatments. The treatment plan depends on the extent and biology of the cancer.
A second opinion can be helpful when the diagnosis is complex, when there are several reasonable treatment choices, before major treatment, or when prostate cancer has returned or progressed. Reviewing the biopsy, imaging and previous treatment records can help clarify the available options.
Bring your PSA reports, biopsy results, MRI or other imaging and previous treatment records for an individual oncology assessment.
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