In this guide
Understanding prostate cancer
Prostate cancer is abnormal cell growth within the prostate. Some cancers grow slowly; others need timely treatment. Early disease often causes no symptoms, so the absence of urinary problems does not exclude cancer.
Localised disease
Cancer appears confined to the prostate. Risk assessment helps distinguish cancers suitable for monitoring from those likely to benefit from treatment.
Locally advanced disease
Cancer extends beyond the prostate or involves nearby structures. Treatment may combine more than one approach.
Metastatic or recurrent disease
Cancer has spread to distant sites or returned after treatment. Care is guided by its location, previous therapy and current biology.
Making sense of your reports
A blood marker interpreted in context and followed over time.
Describe the cancer’s microscopic appearance. Grade Groups range from 1 to 5; a higher group generally indicates more aggressive biology.
Describes the extent of disease, informed by examination and appropriate scans.
Combines these findings with biopsy extent, health, life expectancy and personal priorities.
Urinary symptoms overlap with benign disease. Persistent bone pain, unexplained weight loss or blood in the urine should be assessed, but do not by themselves establish a cancer diagnosis.
Further reading: NCI: prostate cancer
READING YOUR BIOPSY REPORT
Grade and stage answer different questions.
Grade Group describes how the cancer looks under a microscope. Stage describes where it is. Neither should be interpreted alone.
Higher groups generally indicate more aggressive microscopic features. Overall risk also includes PSA, stage and other findings.
When monitoring is the right treatment
Active surveillance
Structured monitoring may suit low-risk and selected favourable intermediate-risk cancers. PSA, clinical review, MRI and repeat biopsy help identify changes that may justify treatment. It is a deliberate care plan, not neglect.
Watchful waiting
A different approach, usually chosen when competing health concerns or limited life expectancy make curative treatment less beneficial. Care focuses on symptoms and wellbeing.
Robotic surgery
ROBOTIC SURGERYRobotic radical prostatectomy
Robotic surgery to remove the prostate for cancer, with planning around cancer clearance, urinary recovery and sexual function. Nerve preservation is considered when oncologically appropriate.
Individual surgical planningRead the full robotic surgery guide ↗HOOD TECHNIQUEPreserving supporting structures
A tissue-preserving approach to robotic prostatectomy that aims to retain supportive structures around the urethra to aid urinary recovery. Suitability depends on anatomy and the location and extent of cancer.
Function-conscious surgeryRead the full robotic surgery guide ↗RETZIUS-SPARING TECHNIQUEAn alternative surgical approach
A robotic approach that accesses the prostate from behind while preserving anterior supporting structures. It may support earlier continence recovery in selected patients; cancer control remains central to selection.
Selection matters · Recovery variesRead the full robotic surgery guide ↗Focal & radiation treatments
HIFUFocal One focused ultrasound
High-intensity focused ultrasound uses heat to treat targeted prostate tissue. Focal treatment may be discussed for carefully selected localised cancers, alongside established alternatives and the limitations of long-term comparative evidence.
Ongoing PSA testing, imaging and repeat biopsy are part of follow-up; further treatment may be needed.
Careful selection · Structured follow-upRead the full HIFU guide ↗RADIATION THERAPYPrecision radiation options
Discussion with a radiation oncologist may include external-beam treatments such as IMRT, IGRT or SBRT, and brachytherapy in suitable cases. Hormone therapy may be combined with radiation depending on cancer risk.
Multidisciplinary treatment planningExplore radiation and advanced care ↗Advanced cancer care
THERANOSTICSPSMA-guided assessment & treatment
Theranostics links molecular imaging with targeted treatment. PSMA PET imaging can help assess eligibility for PSMA-targeted radioligand therapy, such as lutetium-177 PSMA, in selected advanced prostate cancers.
Eligibility depends on disease status, prior treatment, imaging and organ function, with nuclear medicine and oncology input.
Advanced cancer · Specialist selectionExplore radiation and advanced care ↗Patient information: NCI: prostate cancer treatments
Advanced disease & multidisciplinary care
Hormone treatment reduces androgen stimulation of cancer. For suitable patients with metastatic hormone-sensitive disease, additional androgen-receptor pathway treatment, sometimes with chemotherapy, improves the treatment strategy. Selection reflects fitness, disease extent and patient preference.
When cancer progresses despite suppressed testosterone, it is termed castration-resistant. Further options depend on prior therapy and tumour characteristics and may include chemotherapy, targeted medicines, PSMA radioligand treatment or a clinical trial.
Genomic findings can guide selected treatments; a mutation does not automatically make a particular medicine suitable. Oncology and nuclear medicine input helps coordinate complex care.
Further reading: EAU: prostate cancer treatment
Recovery, function & life after treatment
After surgery
Catheter care, activity advice and pelvic-floor rehabilitation are tailored to recovery. Review the final pathology and postoperative PSA with your surgeon.
After radiation or focal therapy
Follow-up assesses urinary, bowel and sexual effects as relevant. PSA behaves differently after different treatments; focal therapy also requires structured imaging and biopsy review.
During hormone treatment
Discuss fatigue, hot flushes, sexual changes, bone health and metabolic health. Exercise, nutrition and risk monitoring are part of ongoing care.
Follow-up continues even when you feel well. New symptoms or a concerning PSA trend may prompt further investigation. A rising PSA requires interpretation in relation to the treatment received; it does not by itself show where cancer is located.
Further reading: EAU: follow-up
Questions worth asking
Is robotic surgery automatically the best option?
No. The robot is a surgical platform. The choice between surgery, radiation, surveillance and other options depends on your cancer and priorities, alongside the treating team’s experience.
Do Hood or Retzius-sparing techniques guarantee continence?
No. These approaches aim to preserve supporting structures, but recovery varies. Cancer location, anatomy, baseline function and safe surgical margins determine suitability.
Is HIFU suitable for every localised cancer?
No. Selection requires careful imaging and biopsy review. Discuss established alternatives, the limits of long-term comparative evidence, ongoing biopsies and the possibility of additional treatment.
What should I bring to a second opinion?
Bring PSA results, biopsy report, MRI images and report, staging scans, previous treatment records and a medicine list. Write down your main goals and concerns.
New leg weakness or numbness, loss of bladder or bowel control, or severe new back pain in someone with prostate cancer requires urgent assessment.