What it is
The prostate sits below the bladder and produces some of the fluid in semen. Cancer develops when some prostate cells grow abnormally. Some tumours progress slowly; others need treatment. Benign prostate enlargement is a different condition. [1].
Symptoms and reasons for assessment
There may be no symptoms at first. Difficulty urinating, a weak stream, frequent urination or blood in urine or semen should be assessed, but they can also have non-cancerous causes. Discuss persistent changes and your family history. If you have no symptoms, ask about the benefits and limitations of PSA testing for your circumstances. [2].
How it is investigated
Assessment brings together your history, examination and previous results. Benign enlargement or inflammation can raise PSA; a single result does not decide whether you need a biopsy. Medicines and recent events may also affect it. Screening may find cancer before symptoms appear, but can lead to unnecessary tests and treatment. [3].
MRI can identify suspicious areas and help guide tissue sampling. An MRI with no suspicious lesions does not exclude all cancer: your specialist considers your overall risk and agrees on follow-up or biopsy. A biopsy takes tissue for examination under a microscope. [4].
Understanding the result
If cancer is found, the report describes its features. The Gleason score and Grade Group help estimate how it may behave; the stage describes how far it has spread. These findings are considered alongside PSA, imaging and how much sampled tissue is involved. Further tests may be needed. [5].
Care options
- Active surveillance: for selected patients, treatment can be deferred with scheduled checks and reconsidered if findings change. Checks may include PSA, MRI and further biopsies.
- Watchful waiting: focuses on treating symptoms if they develop, taking overall health and care goals into account. It is a different plan from active surveillance. [6].
- Surgery or radiotherapy: may aim to control or eliminate localised disease. Benefits need to be weighed against effects on bladder control, sexual function and quality of life. Radiotherapy may also cause bowel symptoms. [1].
- Treatments that act throughout the body: hormone therapy and other medicines are used according to the cancer’s extent and features, sometimes alongside other treatments. They have side effects and require follow-up. [7].
The choice is not based on a technique alone. Discuss treatment goals, recovery and the changes that matter most to you.
Preparing for your consultation
Bring PSA results with their dates, available imaging reports and images, any biopsy report, and your medication list. You do not need to arrange new tests yourself to prepare your questions.
- What do we know, and what still needs to be clarified?
- What do the grade and stage mean in my case?
- Could active surveillance suit me? What checks would it involve?
- What are the benefits and side effects of each option for me?
- How will my urinary function, sexual function and fertility be addressed?
The specialist discusses this topic
Watch Dr. Hegel’s conversation on Sanando Dudas, published by Telever. The video is in Spanish.