Prostate Cancer

When prostate cancer is suspected, several initial tests may be performed, including:

• Digital rectal exam (DRE)
• Blood test for prostate-specific antigen (PSA)
• Transrectal ultrasound (TRUS)

A definitive diagnosis requires a prostate biopsy, typically performed under ultrasound guidance. In recent years, multiparametric MRI has been increasingly used to better evaluate suspicious areas seen on PSA testing or ultrasound, allowing for targeted biopsy and improving diagnostic accuracy.

Once prostate cancer is confirmed histologically, clinical staging is determined based on biopsy results and imaging studies such as CT scans or MRI. To check for bone metastasis, a bone scan may be performed. More recently, PSMA-PET/CT, a nuclear medicine test targeting the prostate-specific membrane antigen (PSMA) expressed on prostate cancer cells, has been used for more precise detection of metastatic disease.

Treatment options for prostate cancer vary depending on the stage, grade, patient age, and overall health. Common approaches include:

• Active surveillance (close monitoring with delayed treatment if the cancer progresses)
• Surgery (radical prostatectomy)
• Radiation therapy or proton therapy
• High-intensity focused ultrasound (HIFU)
• Hormone therapy (androgen deprivation therapy) or chemotherapy

The choice of treatment is individualized, balancing cancer stage and aggressiveness with the patient’s health status and preferences.

Prognosis and Complications of Prostate Cancer

The outlook for prostate cancer depends on the stage at diagnosis and the tumor’s grade (degree of differentiation):

• Localized, well-differentiated tumors: Prostate cancer often grows slowly; 5-year survival rates are high, ranging from 70–90%.
• Regional spread (e.g., lymph nodes): Survival decreases to 30–50%.
• Distant metastases (e.g., bone or lung): Survival drops further to 20–30%.

After treatment, regular PSA monitoring is essential to detect recurrence. When recurrence is suspected, further evaluation may include biopsy of suspicious areas, bone scans, CT/MRI, or PSMA-PET/CT to assess for local or distant relapse.