This updated article explains prostate anatomy and how prostate cancer is detected with PSA testing and digital rectal exam. It distinguishes localized disease (managed with active surveillance, surgery, or radiation) from metastatic disease (managed with androgen-deprivation therapy, androgen-receptor inhibitors, chemotherapy, targeted agents, and radioligand therapy). The piece highlights side effects, the role of shared decision-making, and modern options that have improved outcomes compared with older treatments.

Quick anatomy and why it matters

The prostate is a small, muscular gland in the male reproductive system, roughly the size of a walnut. It sits below the bladder and surrounds the urethra. Its secretions contribute to semen. Because of its location, prostate changes can affect urination and sexual function.

How prostate cancer is found

Two common ways to detect prostate cancer are the prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE). PSA screening reduces the chance of finding advanced disease but also detects many low-risk cancers that may never cause harm. Current practice emphasizes shared decision-making about PSA testing, especially for men aged roughly 55-69, and individualized care afterwards.

Staging and the principle of localized vs metastatic disease

If cancer is confined to the prostate (localized), treatment aims at cure or long-term control. Once cancer spreads beyond the gland to lymph nodes or distant sites (bone, liver, lung), treatment focuses on disease control and preserving quality of life.

Common treatments for localized prostate cancer

  • Active surveillance: for many low-risk cancers, careful monitoring with PSA tests, periodic biopsies, and imaging avoids or delays treatment-related side effects.
  • Surgery (radical prostatectomy): removal of the prostate can cure localized cancer. Approaches include open, laparoscopic, and robot-assisted procedures. Risks include urinary incontinence and erectile dysfunction; nerve-sparing techniques reduce but do not eliminate those risks.
  • Radiation therapy: external beam radiation (including IMRT or stereotactic approaches) and brachytherapy (radioactive seed implants) are effective alternatives to surgery.
  • Focal therapies: cryotherapy and high-intensity focused ultrasound (HIFU) are options in selected cases, often when patients seek tissue-sparing approaches.

Treatments for advanced or metastatic disease

When cancer spreads, systemic therapies are used. Androgen-deprivation therapy (ADT) reduces the testosterone that fuels many prostate cancers. ADT can be achieved surgically (orchiectomy) or medically with drugs:
  • GnRH agonists (e.g., leuprolide) and GnRH antagonists (e.g., degarelix, oral relugolix) lower testosterone; antagonists avoid an initial testosterone "flare."
  • Androgen-receptor pathway inhibitors (bicalutamide, enzalutamide, apalutamide) further block androgen signaling.
Other options for metastatic disease include chemotherapy (docetaxel, cabazitaxel), newer hormonal agents (abiraterone), targeted therapies for specific mutations (PARP inhibitors for BRCA-mutated tumors), and radioligand therapy for PSMA-positive disease. These treatments have extended survival and improved symptom control compared with historic outcomes.

Side effects and survivorship

Treatments can affect urinary, sexual, and bowel function, and ADT has metabolic and bone effects. Decisions balance expected cancer control against these risks, and many men maintain good long-term quality of life with careful management.

Key takeaway

Prostate cancer covers a spectrum from indolent to aggressive disease. Modern care ranges from active surveillance for low-risk tumors to multimodal systemic therapy for advanced disease. Shared decision-making with a urologist and/or oncologist is essential to choose the right approach.

FAQs about Treatment For Prostate Cancer

What are the main ways prostate cancer is detected?
Prostate cancer is commonly detected with the PSA blood test and a digital rectal exam (DRE). Decisions about PSA screening should involve a discussion of benefits and risks, particularly for men aged about 55-69.
When is active surveillance appropriate?
Active surveillance is appropriate for many men with low-risk, localized prostate cancer. It involves regular PSA testing, imaging, and occasional biopsies to monitor for signs of progression and avoid or delay treatment side effects.
What side effects should I expect from treatment?
Surgery and radiation can cause urinary incontinence, erectile dysfunction, and sometimes bowel symptoms. Androgen-deprivation therapy (ADT) can cause hot flashes, fatigue, weight gain, bone loss, and metabolic changes. Side effects are managed proactively.
What treatments are available for metastatic prostate cancer?
Metastatic disease is treated systemically: ADT, androgen-receptor inhibitors, chemotherapy, targeted therapies for certain mutations (e.g., PARP inhibitors for BRCA mutations), and radioligand therapies for PSMA-positive tumors. These options have improved survival and symptom control.