Prostate Cancer

Overview

Prostate cancer is the most frequently diagnosed cancer in men in Western countries. It represents a broad spectrum of disease — from very slow-growing tumours that may never cause harm during a man’s lifetime to aggressive cancers that can spread beyond the gland if not treated promptly.

The prostate gland is a walnut-sized structure that sits below the bladder and produces seminal fluid. Cancer develops when cells within the gland begin to grow and divide in an uncontrolled way. The vast majority of prostate cancers are adenocarcinomas arising from the glandular cells.

Understanding the nature of a particular prostate cancer — its grade, stage, and behaviour — is central to choosing the appropriate management. Decision-making is best made within a multidisciplinary team (MDT) that includes urology, oncology, radiology, and pathology.

Symptoms

Early-stage prostate cancer frequently causes no symptoms at all. This is one of the reasons PSA testing plays an important role in detection.

When symptoms do occur, they may include:

• Lower urinary tract symptoms similar to those caused by BPH (weak stream, frequency, nocturia, urgency) — these arise because the cancer develops close to the urethra
• Haematuria (blood in the urine)
• Haematospermia (blood in semen)

In more advanced disease, additional symptoms may arise from cancer that has spread:

• Bone pain (particularly in the back, hips, or pelvis) from skeletal metastases
• Unexplained weight loss or fatigue
• Leg swelling from lymph node involvement

Many men with prostate cancer are identified through an elevated PSA test before symptoms develop.

Diagnosis

Diagnosis involves a stepwise approach:

1. PSA blood test — the most common trigger for further investigation
2. Multiparametric MRI (mpMRI) of the prostate — an MRI scan with specific sequences that assesses the probability of clinically significant cancer and guides biopsy planning; reported using the PI-RADS scoring system
3. Prostate biopsy — recommended when MRI findings or PSA levels suggest a significant probability of cancer; the preferred approach is transperineal biopsy under local or general anaesthesia, which carries a lower infection risk than transrectal biopsy
4. Histopathology — the biopsy cores are examined under the microscope; cancer, if present, is graded using the Gleason score and ISUP grade group system

Additional staging investigations (bone scan, CT, PSMA PET scan) are arranged when the biopsy confirms cancer and helps determine whether it is localised or has spread.

Treatment

Treatment depends on staging and risk stratification, as well as the individual’s age, health, and preferences.

Staging categories

• Localised — cancer confined within the prostate gland
• Locally advanced — cancer has grown outside the capsule of the prostate or into adjacent structures
• Metastatic — cancer has spread to lymph nodes, bones, or other organs

Treatment options for localised prostate cancer

• Active surveillance — structured monitoring for low-risk disease with the aim of avoiding or deferring treatment (see FAQ below)
• Radical prostatectomy — surgical removal of the prostate; performed by open, laparoscopic, or robotic-assisted technique
• External beam radiotherapy — high-energy radiation targeted at the prostate, often combined with hormone therapy
• Brachytherapy — radioactive seeds implanted directly into the prostate
• Focal therapy — treatment directed at the tumour focus only, using techniques such as HIFU; suitable for carefully selected cases

Treatment for advanced disease

• Hormone therapy (androgen deprivation therapy) reduces testosterone levels and slows cancer growth
• Systemic treatments (novel hormonal agents, chemotherapy) are used for metastatic or castration-resistant disease
• These treatments are coordinated through an oncology MDT

Dr Hadjipavlou performs diagnostic procedures including prostate biopsy and may offer assessment for focal therapy for selected men with localised prostate cancer. Decisions regarding radical treatment and systemic therapy are made within a multidisciplinary framework.