Know the signs, know your options
What is prostate cancer?
Prostate cancer happens when cells in the prostate (a small gland below the bladder that helps make semen) grow out of control. Many prostate cancers grow slowly, and some never cause problems. Others can grow faster and need treatment.
Causes and risk factors (what raises risk)
Doctors usually cannot point to one single “cause.” Prostate cancer risk is mostly linked to:
Older age (risk increases as men get older).
Family history and inherited genes (genetics plays a major role).
Black ancestry (higher risk compared with White men).
BRCA gene mutations (especially BRCA2) and some other inherited cancer genes.
Symptoms (many people have none at first)
Early/localized prostate cancer often causes no symptoms.
When symptoms happen, they may include:
Urinary symptoms: needing to urinate often, weak stream, trouble starting, getting up at night to urinate, or trouble emptying the bladder.
Blood in urine or pain (less common).
Erection problems.
Symptoms that can suggest spread (metastasis) include:
Bone or back pain.
Emergency warning signs of spinal cord compression: new severe back pain with leg weakness/numbness or trouble controlling urine/bowels—seek emergency care.
Assessment (how prostate cancer is checked and diagnosed)
- Early detection (for people without symptoms). The usual first test is a PSA blood test (PSA = prostate-specific antigen).
A digital rectal exam (DRE) may be used as part of risk assessment, but it is not the main test by itself.
PSA testing decisions should be shared decision-making (you and your clinician talk through possible benefits and harms).
- If prostate cancer is suspected typical steps may include:
PSA test ± DRE and risk assessment.
Prostate MRI (mpMRI) before biopsy to better decide who needs biopsy and to target suspicious areas.
Prostate biopsy (taking small samples) is usually needed to confirm the diagnosis.
Treatment (depends on risk level, stage, and your preferences)
Treatment is based on how “aggressive” the cancer looks (PSA level, biopsy grade/“Grade Group,” and stage), plus your overall health and life expectancy.
A) Localised (only in the prostate)
Active surveillance (monitoring, not immediate treatment)
Often recommended for low-risk prostate cancer, and sometimes for selected patients with slightly higher risk.
This includes planned follow-up testing (commonly PSA checks and repeat MRI/prostate biopsies) and switching to treatment if the cancer shows signs of becoming more aggressive.
Surgery (radical prostatectomy)
Removal of the prostate is one curative option for localised cancer.
Radiation therapy
Radiation (external beam or brachytherapy in some cases) is another curative option.
B) More aggressive localised/locally advanced disease. Treatment may include radiation plus hormone therapy (androgen deprivation therapy, ADT).
C) Metastatic prostate cancer (has spread). The backbone of treatment is androgen deprivation therapy (ADT) (lowering testosterone, which fuels many prostate cancers).
For newly diagnosed metastatic disease, adding additional medicines (such as newer androgen-receptor pathway drugs) improves survival for many patients.
Common side effects to discuss before choosing treatment
Because different treatments can affect quality of life, ask your team about:
Urinary control problems
Sexual side effects (erection problems)
Bowel problems (more common with radiation).
These risks should be part of shared decision-making when choosing between surveillance, surgery, or radiation.
When to contact your clinician urgently?
Seek urgent medical care if you have:
New, severe back/bone pain, especially with leg weakness, numbness/tingling, or new trouble controlling urine or bowels.
Inability to urinate (urinary retention), severe pain, or heavy bleeding in urine.
This guide is not a substitute for professional medical advice. If symptoms worsen or you have new concerns, contact your doctor or seek emergency care.
