Prostate Cancer – Diagnosis and Treatment

Diagnosis

Screening tests look for prostate cancer before symptoms show up. These tests can catch the disease early. The PSA blood test and the finger rectal exam are the two most common ways to screen.

Most medical groups suggest talking about screening around age 50. Some men—especially Black men, those with a family history, or other big risk factors—might want to start earlier.

Doctors and patients usually make this decision together, weighing when to start or stop screening.

Some men might skip screening, especially if they don’t expect to live another ten years. It’s worth having an honest talk with your provider about the pros and cons.

Physical Finger Test for the Prostate

During a digital rectal exam, the doctor puts on a glove, adds lubricant, and gently inserts a finger into the rectum to feel the prostate. It’s a quick test, done right in the office.

The doctor checks for size, shape, or any lumps. Sometimes this test finds things that other tests miss.

Doctors often use it with the PSA blood test. They may suggest it if you have urination issues or a family history of prostate cancer.

PSA Blood Level Test

The PSA test measures the amount of prostate-specific antigen in your blood. The prostate gland makes this protein.

High PSA levels can signal prostate cancer, but other things—like infections or an enlarged prostate—can bump up PSA too.

If your PSA is high, your doctor might repeat the test. If it stays high, further tests like imaging or a biopsy could be next.

Sound Wave Test of the Prostate

A transrectal ultrasound uses sound waves to create images of your prostate. The doctor gently puts a slim probe into your rectum for this.

The probe sends out sound waves, which bounce off the prostate and form a picture on a screen. This test can spot lumps and guide the doctor if you need a biopsy.

Doctors might order this if your PSA or finger exam seems off.

Magnetic Scan of the Prostate

MRI scans use magnets and radio waves to take pictures inside your body. For the prostate, MRIs can help spot unusual areas that might be cancer.

Sometimes doctors use special MRI types, like mpMRI, for sharper images. Some MRIs need a dye injection or a coil in the rectum for clearer pictures.

These scans help doctors decide if a biopsy is needed and can make the biopsy more accurate by aiming right at suspicious spots.

Taking a Sample (Biopsy) of the Prostate

During a prostate biopsy, the doctor collects tiny pieces of prostate tissue with a needle. This is the only way to confirm if cancer cells are there.

The needle goes through the rectum or the skin between the scrotum and anus. Doctors often use ultrasound or MRI to guide the needle to the right spot.

The samples go to a lab, where experts check for cancer under a microscope.

There are a couple of ways to do a biopsy:

Biopsy Method	Where the Needle Goes	Guided by What
Transrectal biopsy	Through the rectum	Ultrasound
Transperineal biopsy	Through the skin below scrotum	MRI/Ultrasound

Your doctor will help decide which method is best for you.

Understanding Cancer Grade and Groups

After finding cancer, doctors study the cells to see how much they differ from normal ones. This helps predict how fast the cancer might grow.

The Gleason score rates cancer cells from 6 to 10. Lower numbers (like 6) mean the cells look more normal.

• Low numbers (6) mean cells look closer to normal.
• High numbers (8–10) suggest the cells are more abnormal and may grow faster.

Doctors also use grade groups from 1 to 5. Lower numbers mean a better outlook, and these scores help guide treatment decisions.

Gleason Score	Grade Group	What it Means
6	1	Low risk, slow-growing
7 (3+4 or 4+3)	2 or 3	Moderate risk
8–10	4 or 5	High risk, may spread faster

Genetic and Protein Marker Tests

Some tests look at DNA or certain proteins in the cancer cells. These can offer clues about which treatments might work and the chances of the cancer coming back.

Genomic tests use biopsy tissue to spot gene changes tied to more aggressive cancer. Biomarker tests help doctors decide on treatment plans or whether to just keep an eye on things.

If you’re diagnosed young or have close relatives with prostate cancer, your doctor may suggest genetic counseling. Some families carry gene types that raise prostate cancer risk.

Pictures to Find Out if Cancer Has Left the Prostate

Imaging scans help doctors check if prostate cancer has spread beyond the prostate. They might use several types of tests:

• Bone Scan: Checks if cancer has spread to the bones.
• CT Scan: Looks for cancer in lymph nodes or nearby organs.
• MRI: Gives detailed images of cancer spread.
• PET Scan: Detects cancer using special tracers.

Your doctor will choose tests based on your PSA, Gleason score, and how likely the cancer is to have spread.

Cancer Spread Levels (Staging)

Doctors group prostate cancer into stages based on how big the tumor is and if it’s spread nearby or far away (like to bone). Most use the TNM system:

• T (Tumor): Size and extent of the tumor.
• N (Nodes): If cancer is in lymph nodes.
• M (Metastasis): If cancer has spread far from the prostate.

Prostate cancer stages look like this:

Stage	Meaning
Stage I	Small, only in prostate, slow growing
Stage II	Bigger, but still only inside prostate
Stage III	Cancer has grown through the prostate capsule or into nearby tissues
Stage IV	Cancer spread to distant organs (like bone or lymph nodes)

Outlook for the Future (Prognosis)

Prognosis means your doctor’s best guess about how things might go. It depends on a few things:

• PSA levels
• Gleason score
• Cancer stage
• Health, age, and other medical issues

If doctors catch prostate cancer early, it usually grows slowly and might not shorten your life. If it’s aggressive or found late, you’ll probably need more treatment.

Genomic tests can give extra info to help predict how the cancer might behave. Talking with your care team helps you understand your risks and next steps.

Some folks just need regular checkups for a while. Others will need active treatment.

Expected Survival (Prognosis Numbers)

Survival rates show your odds of living after diagnosis, but these are just averages. They don’t predict exactly what’ll happen for you.

Most men with early prostate cancer live for years. Here’s a rough idea:

Cancer Stage	Five-Year Survival Rate (approximate)
Localized	Nearly 100%
Regional	Nearly 100%
Metastatic	Around 32%

These numbers can change as treatments get better. Doctors use several pieces of information to estimate your outlook, but every case is different. Staying healthy and sticking with your treatment plan really matters.

Treatment

Active observation—sometimes called monitoring or watchful waiting—makes sense when prostate cancer is slow-growing and not causing trouble.

Instead of jumping into treatment, doctors keep tabs on the cancer with regular blood tests, scans, and sometimes prostate biopsies.

These check-ups track any changes in the cancer’s behavior. Men with early-stage prostate cancer, especially if it’s not expected to spread fast or if they have other health problems, often go this route.

Treatment can wait unless tests show the cancer is getting worse. Some men on active monitoring never need more treatment.

Prostate Removal Surgery

Surgery is a go-to treatment when cancer stays inside the prostate. The main operation is called a prostatectomy.

You’ve got a few options for how it’s done:

Type of Prostatectomy	How It Works	Features
Laparoscopic	Small cuts in the belly, tools remove the prostate	Less bleeding, faster recovery
Robotic-Assisted	Surgeon controls robotic arms via a console	Higher precision, smaller incisions
Open (Retropubic)	One large cut below the belly	Rarer, may be better for some situations

Most surgeries these days are robotic or laparoscopic. Removing the prostate can treat cancer that hasn’t spread or has only reached nearby lymph nodes.

Possible Side Effects:

• Short-Term: Bleeding, infection, pain, blood clots
• Long-Term: Leaking urine, trouble getting an erection
  Usually, these problems get better over time, but sometimes they stick around.

Radiation Using External Beams

External radiation therapy uses high-energy beams to kill cancer cells in the prostate. You lie on a table while a machine aims X-rays or protons at the cancer.

This is usually done five days a week for a few weeks. Newer methods might use bigger doses over fewer sessions.

Doctors use external radiation for cancer still in the prostate or to treat cancer that’s spread to spots like the bones.

Sometimes, they use it after prostate surgery to lower the risk of the cancer coming back or to shrink cancer if surgery isn’t an option.

Potential Side Effects:

• Bowel problems (diarrhea, bleeding, needing to go often)
• Urinary issues (frequent urination, pain, trouble starting)
• Difficulties with erections

When cancer is advanced, external radiation can ease pain and slow things down a bit.

Placing Radiation Seeds Inside the Prostate

With internal radiation, or brachytherapy, the doctor puts tiny radioactive seeds right into the prostate. These seeds give off radiation slowly over several weeks or months.

There are two main types of brachytherapy:

• Permanent (Low Dose Rate): The seeds stay in the prostate and release a low, steady dose over time.
• Temporary (High Dose Rate): The doctor places radioactive material for a short period, then removes it.

Doctors usually recommend this treatment for cancer that’s still inside the prostate. It doesn’t work if the cancer’s already spread elsewhere.

Common Side Effects:

• Trouble urinating or needing to go more often
• Blood in the urine
• Bowel problems
• Issues with erections

Destroying Prostate Cancer Cells With Cold or Heat

Ablation treatments use intense cold or heat to kill cancer cells. These procedures aren’t as common but sometimes make sense for men who can’t have surgery or radiation.

Types of Ablation:

• Cryotherapy (Cryoablation): The doctor inserts thin needles through the skin to freeze prostate tissue. After freezing, the tissue thaws, and they may repeat the cycle to destroy cancer cells.
• High-Intensity Focused Ultrasound (HIFU): A probe in the rectum sends sound waves that heat up parts of the prostate, damaging the cancer.

Doctors mostly use ablation for smaller, localized cancers or when other options are too risky.

Blocking Male Hormones to Slow Cancer

Hormone treatment, or androgen deprivation therapy, aims to lower the body’s levels of male hormones like testosterone. Prostate cancer cells usually need these hormones to grow, so cutting them off can slow things down.

Doctors might use hormone therapy by itself or combine it with other treatments. It’s often the go-to for cancer that’s spread or returned after earlier treatments.

Ways to Lower or Block Male Hormones:

• Medicines that stop the body from making hormones.
• Medicines that block hormones from reaching cancer.
• Surgery to remove the testicles (rare these days).

Possible Side Effects:

• Hot flashes
• Loss of sex drive
• Weight gain
• Weak bones
• Mood changes

Most people take hormone therapies for months or even years, depending on how the cancer reacts.

Anti-Cancer Drugs for Prostate Cancer

Chemotherapy uses drugs to attack cancer cells. Doctors usually turn to chemo if prostate cancer spreads and doesn’t respond to hormones.

Doctors give these medicines through a vein or as pills. Chemo isn’t usually the first step for prostate cancer, but it can help with advanced or aggressive cases.

Typical Side Effects:

• Tiredness
• Nausea
• Hair loss
• Higher risk of infections

Common chemo drugs include docetaxel and cabazitaxel.

Drugs That Target Cancer’s Weaknesses

Targeted treatments go after specific changes in cancer cells that help them survive. For prostate cancer, doctors sometimes use these drugs when other treatments stop working.

Some targeted therapies block the signals or nutrients cancer needs. Others try to fix certain cell mistakes that make the cancer stronger.

Doctors often use targeted treatments alongside other drugs. You might get them as pills or infusions.

Common Side Effects:

• Fatigue
• Anemia
• Nausea
• Changes in blood counts

Before starting, a health professional will usually check if your cancer has certain gene changes.

Boosting the Immune System Against Cancer

Immunotherapy helps the immune system spot and attack cancer cells. Doctors may try this if prostate cancer keeps growing after other treatments.

Types of Immunotherapy:

• Checkpoint Inhibitors: These drugs help the immune system recognize and destroy cancer.
• Cancer Vaccines:
  These are made from your own cells and are designed to boost your immune response against prostate cancer.

Immunotherapy tends to help more with advanced cancers. It usually has fewer side effects than chemo, but you might still feel tired, get rashes, or notice changes in how some organs work.

Radioactive Drugs to Treat Advanced Prostate Cancer

Radiopharmaceuticals are special drugs that send radiation right to cancer cells. Doctors mainly use these for prostate cancer that’s spread to the bones.

The doctor injects the medicine into your blood, and it travels to bone areas with cancer. This approach can ease bone pain and may slow down the cancer’s spread.

Radiopharmaceutical Option	How It’s Used	Main Benefit
Radium-223, Strontium-89, etc.	Injected into a vein; targets the bones	Reduces bone pain; may help prolong life

Possible Side Effects:

• Lower blood cell counts
• Nausea
• Diarrhea

Where to Learn More About Prostate Cancer Treatments

If you want more details or support, there are a few helpful resources:

• Cancer support groups. These groups connect you with others going through similar experiences.

• Doctor or care team. Always talk with your healthcare team to get answers that fit your situation.

Tip: Keep a list of questions for your medical team. Bring a friend or family member to appointments—they can help you remember what’s said.

Alternative Medicine

Alternative or complementary therapies won’t cure prostate cancer, but they can help you handle some side effects. After a diagnosis, it’s normal to feel sad, anxious, or have trouble sleeping. Some people try methods like:

• Art therapy
• Dance and movement therapy
• Exercise
• Meditation
• Music therapy
• Relaxation techniques
• Spiritual activities

These practices might make it easier to manage stress or anxiety. But always talk to a healthcare professional before starting anything new, just to be safe. 

Coping and support

Dealing with the emotional side of prostate cancer is a process. Shock, worry, or sadness can hit hard after a diagnosis. Over time, most people figure out what helps them cope.

Learning about prostate cancer and the treatment options can help. Asking your doctor, nurse, or care team for reliable info makes it easier to know what to expect. Understanding your choices can also boost your confidence in making decisions.

Talking to someone helps. Family and friends can listen when you need to vent, or just share your hopes. Others might talk with a counselor, spiritual leader, or social worker for extra support.

Connecting with others who have prostate cancer can ease feelings of isolation. Support groups and community organizations let people share experiences and find comfort. 

Looking after your physical health matters:

Healthy Habits	Examples
Eating well	Meals with plenty of fruits and veggies
Regular activity	Light exercise most days, like walking or stretching
Good sleep patterns	Sleeping enough to feel refreshed in the morning

Staying close to loved ones is important, even if side effects from treatment pop up. If erectile dysfunction becomes an issue, there are still ways to be close with your partner.

Physical closeness—like hugs, holding hands, or gentle touching—can help keep the emotional bond strong.

Taking small steps toward healthy habits and sharing your feelings with others can make living with prostate cancer more manageable. Everyone’s got their own way to cope, and it might take some trial and error to find what works.

Exploring different kinds of support can really help with both mental and physical well-being.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Getting prepared can really make a difference at your medical visit. Check any instructions given when you schedule—sometimes you’ll need to avoid certain foods or do other prep before tests.

Make a list of symptoms, even those that seem unrelated. Jot down any physical or emotional changes you’ve noticed lately.

Gather key personal info too. Major stresses or life changes might matter more than you’d think.

Bring a list of all medicines, vitamins, and supplements you use. This helps your doctor spot possible side effects or drug interactions.

Having a friend or family member along can be a big help. They might remember details or ask questions you forget.

Write down questions for your doctor. Consider asking about:

• Whether cancer is likely
• The size and location of the problem
• If there’s any sign of spreading
• Test results like PSA or Gleason score
• Whether you’ll need more tests
• Available treatment options
• Pros and cons of waiting versus starting treatment
• The most common side effects
• Expected success rates for each treatment
• What your doctor would suggest if it were their own family member
• If you should see a specialist, possible costs, and insurance coverage

Bring a notebook or use your phone to take notes. If something’s confusing, ask for clarification.

Table: Items to Bring to Your Visit

Item	Reason
Symptom list	Share all health issues.
List of medications & supplements	Avoid drug interactions.
Key personal or life changes	Give complete health context.
Written questions	Get the answers you need.
Support person (if possible)	Extra support and better recall.
Insurance card & records	Make check-in smoother.

Questions Your Doctor Might Ask

Doctors usually use the appointment to figure out what’s going on with your health. They’ll probably ask when your symptoms started and how long they stick around.

You might get questions about whether your symptoms come and go. Expect to talk about how bad things feel and if anything makes them better or worse.

Be prepared to mention any medicines you’re taking and any changes in your health lately. Honestly, it’s helpful to jot down a quick list before you go in.

Your doctor might do a physical exam to check your prostate or look for other signs. Sometimes, they’ll order tests like blood work, a urine test, or maybe even a scan.

Usually, the doctor explains what’s happening before and during these tests. If anything feels unclear, don’t hesitate to ask for more details.

Being open and detailed with your answers gives your doctor the best shot at figuring things out.