Prostate cancer is one of the most important cancers affecting men.
Early prostate cancer often causes no symptoms. This is why appropriate risk assessment and early detection can be important.
What is prostate cancer?
The prostate is a gland located below the urinary bladder.
Prostate cancer occurs when abnormal prostate cells grow in an uncontrolled manner.
Some prostate cancers grow slowly and may never cause significant problems, while others can be aggressive.
Therefore, the goal is not simply to find prostate cancer, but to identify clinically significant cancer and choose an appropriate treatment strategy.
What is PSA?
PSA (prostate-specific antigen) is a protein produced by prostate cells.
A PSA blood test is commonly used when evaluating the possibility of prostate cancer.
However, PSA is not cancer-specific.
PSA can also increase because of:
- Benign prostate enlargement
- Prostatitis/inflammation
- Urinary infection
- Other prostate-related conditions
The EAU notes that PSA is organ-specific but not cancer-specific.
Therefore, an elevated PSA does not automatically mean cancer.
What happens if PSA is elevated?
Your urologist may consider:
- Repeating PSA
- Clinical examination
- Prostate volume
- PSA density
- Family history
- Age and overall health
- Multiparametric MRI
- Risk calculators or biomarkers in selected patients
- Prostate biopsy when indicated
The current EAU diagnostic pathway incorporates MRI and risk assessment into decisions regarding further investigation in appropriate patients.
What is prostate MRI?
Multiparametric MRI (mpMRI) provides detailed imaging of the prostate.
It can help identify areas that may be suspicious for clinically significant prostate cancer and can assist in planning targeted biopsy.
MRI does not replace clinical judgment, and not every abnormal MRI represents cancer.
What is a prostate biopsy?
A biopsy involves taking small tissue samples from the prostate.
The tissue is examined under a microscope by a pathologist.
A biopsy is generally required to establish a definitive tissue diagnosis in suspected prostate cancer.
How is prostate cancer treated?
Treatment depends on:
- Cancer grade
- PSA
- Stage
- MRI findings
- Biopsy findings
- Patient's age
- Life expectancy
- General health
- Patient preferences
Possible approaches include:
Active surveillance
Some men with low-risk disease may not require immediate definitive treatment.
Instead, they undergo carefully planned monitoring.
Surgery
For appropriately selected patients with localized prostate cancer, radical prostatectomy removes the prostate and seminal vesicles.
Modern approaches include robotic-assisted surgery.
Radiation therapy
Radiotherapy is another important treatment option for selected patients.
Hormonal and systemic treatments
Men with higher-risk or advanced disease may require androgen-deprivation therapy and/or other systemic treatments.
Treatment should be individualized according to disease risk and patient factors.
Can prostate cancer be cured?
Many men diagnosed with localized prostate cancer can be treated successfully.
The outlook depends strongly on the stage and biological characteristics of the cancer.
Who should discuss PSA testing?
There is no single PSA-testing schedule appropriate for every man.
Age, family history, genetic risk, race/ethnicity, life expectancy and personal preferences should be considered.
The EAU recommends a risk-adapted approach rather than treating one PSA threshold as an automatic diagnosis of cancer.
Final message
Prostate cancer may be silent in its early stages.
If you are concerned about your prostate cancer risk or have an elevated PSA, consult a urologist rather than interpreting the PSA value alone.
A structured evaluation can help determine whether further testing, MRI, biopsy, surveillance or treatment is appropriate.