Prostate Cancer: A Clear Guide to Diagnosis, Staging and Treatment

Prostate cancer begins in the prostate, a gland below the bladder. Most cases are adenocarcinomas, cancers arising from glandular cells. Some grow slowly; others behave more aggressively. The diagnosis alone does not determine the treatment needed. [2]

How Is Prostate Cancer Diagnosed?

Assessment may include a prostate-specific antigen (PSA) blood test, examination, MRI and biopsy. A biopsy usually confirms the diagnosis by allowing a pathologist to examine tissue. [1]

PSA comes from prostate tissue and can rise with benign enlargement or inflammation as well as cancer. An elevated result does not establish cancer; a low result does not exclude every cancer. [1]

What Do Gleason Score and Grade Group Mean?

These describe the cancer’s appearance under the microscope. The Gleason score combines tissue growth patterns. Grade Groups translate those scores into five categories: [1]

A score of 3 + 4 and a score of 4 + 3 are both seven, but indicate different Grade Groups. Grade describes biological aggressiveness; it does not show where cancer has spread. [1]

Prostate Cancer Staging and Risk Groups

The TNM system describes the primary tumor (T), regional lymph nodes (N) and distant metastases (M). Risk classification also considers PSA and biopsy grade. [1]

Cancer confined to the prostate differs from locally advanced disease or cancer that has spread to distant sites. Regional lymph-node involvement is not the same as distant metastasis. [1]

Staging scans are selected according to risk and clinical circumstances. PSMA PET/CT can improve detection of spread in appropriate settings, but a negative scan cannot exclude microscopic disease. [1]

When Is Active Surveillance Appropriate?

Active surveillance is a structured option for suitable low-risk and selected favorable intermediate-risk cancers. It uses follow-up tests to identify changes that may warrant treatment while preserving the opportunity for cure. [1]

What Did the ProtecT Trial Show?

ProtecT randomly assigned 1,643 men with PSA-detected localized prostate cancer to active monitoring, surgery or radiotherapy. [3]

After a median 15-year follow-up, prostate cancer deaths were uncommon, with no statistically significant difference between groups. Metastases occurred in 9.4% assigned to monitoring, 4.7% to surgery and 5.0% to radiotherapy. [3]

How Is Prostate Cancer Treated?

For localized disease, options can include surveillance, prostate-removal surgery or radiotherapy. Some settings require combined treatment. [2]

For metastatic disease, androgen deprivation therapy (ADT) reduces testosterone or its production. Additional medicines that block androgen signaling, and sometimes chemotherapy, are considered according to fitness and disease characteristics. Later options may include selected targeted medicines or radiopharmaceuticals. [1] [2]

Treatment can aim to cure localized disease or control advanced disease. The intended goal should be discussed explicitly.

Which Biomarkers Can Affect Treatment?

In selected settings, testing for DNA-repair alterations, such as BRCA changes, can inform targeted treatment. Inherited testing and tumor testing answer different questions; results do not automatically establish eligibility for a drug. [1]

Why Treatment Side Effects Matter

Surgery can affect urinary control and erections. Radiotherapy can affect bowel, urinary and sexual function. ADT can affect sexual function, energy, metabolism and bone health. Risks depend on the treatment and the individual. [1]

Questions for Your Clinical Team

Key Takeaways

• PSA, biopsy grade and stage provide different information.
• Surveillance is a planned strategy for selected patients.
• Trial averages do not predict an individual outcome.
• Treatment choices should account for benefits, harms and personal priorities.

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Scientific Sources