Prostate cancer is one of the most common cancers affecting men, yet there is still considerable confusion surrounding the disease.
Some men assume prostate cancer will cause obvious urinary symptoms. Others believe every prostate cancer diagnosis requires immediate treatment. Neither is necessarily true.
Understanding the basics can help men make more informed decisions about screening, diagnosis, and treatment.
What Is the Prostate?
The prostate is a small gland located below the bladder and in front of the rectum. It surrounds part of the urethra—the tube that carries urine out of the body—and produces fluid that forms part of semen.
As men age, the prostate commonly becomes enlarged. This condition, known as benign prostatic hyperplasia, or BPH, can cause urinary symptoms, but it is not prostate cancer.
Prostate cancer develops when cells within the prostate begin to grow abnormally.
What Are the Symptoms of Prostate Cancer?
The answer may surprise many patients: There may not be any.
Early-stage prostate cancer frequently causes no noticeable symptoms. That is why waiting for symptoms is not an effective way to detect the disease early.
Some men experience urinary symptoms such as:
- Difficulty starting urination
- A weak or interrupted urinary stream
- Frequent urination
- Getting up several times during the night to urinate
- A feeling that the bladder has not emptied completely
These symptoms should be evaluated, but they are more commonly associated with BPH or another noncancerous condition than with prostate cancer.
More advanced prostate cancer may cause blood in the urine or semen, unexplained weight loss, persistent fatigue, or pain in the back, hips, or pelvis. These symptoms can have many possible causes, but they should always be discussed with a physician.
How Is Prostate Cancer Detected?
Prostate cancer screening commonly involves a prostate-specific antigen, or PSA, blood test. Depending on a man’s age, family history, previous PSA results, and other individual risk factors, a digital rectal examination may also be part of the evaluation.
An elevated PSA does not automatically mean that cancer is present. PSA levels can also be affected by an enlarged prostate, inflammation, infection, and other factors.
If a result is concerning, we may recommend repeating the PSA or obtaining additional blood or urine tests. A prostate MRI may also be used to identify suspicious areas and help determine whether a biopsy is necessary.
When appropriate, a prostate biopsy is performed to confirm the diagnosis.
What Does the Stage of Prostate Cancer Mean?
After prostate cancer is diagnosed, we evaluate whether it is confined to the prostate or has spread elsewhere in the body. In general, prostate cancer may be described as:
Localized: The cancer appears confined to the prostate.
Locally advanced: The cancer has grown beyond the prostate into nearby tissues or structures.
Metastatic: The cancer has spread to distant parts of the body, such as the lymph nodes or bones.
Depending on the cancer’s characteristics, imaging such as MRI, CT, bone scan, or PSMA PET/CT may be used to determine its extent. Staging helps us understand how the cancer is behaving and which treatment options may be appropriate.
Are All Prostate Cancers Equally Aggressive?
No. This is one of the most important concepts for patients to understand.
Some prostate cancers grow very slowly and may never cause serious health problems. Others have a greater likelihood of growing or spreading.
To assess the cancer, we consider several factors, including:
- PSA level
- Biopsy findings
- Grade Group or Gleason score
- Imaging results
- The extent or stage of the cancer
- The patient’s age, overall health, and individual risk factors
Together, this information allows us to classify the cancer and develop a treatment plan based on the individual patient—not simply the diagnosis.
Does Every Prostate Cancer Require Immediate Treatment?
No. For appropriately selected men with low-risk prostate cancer, active surveillance may be recommended. Instead of beginning treatment immediately, we monitor the cancer closely through PSA testing, examinations, imaging, and follow-up biopsies when needed. Treatment can then be considered if there are signs that the cancer is progressing.
When treatment is necessary, options may include surgery, radiation therapy, hormone therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of treatments.
There is no single best treatment for every patient. The right approach depends on the characteristics of the cancer as well as the patient’s age, overall health, priorities, and personal preferences.
Specialized Care for Advanced Prostate Cancer
Men with high-risk, recurrent, metastatic, or treatment-resistant prostate cancer may benefit from a more specialized level of care.
The Advanced Urologic Cancer Center is dedicated to caring for patients with aggressive and complex prostate cancer. The Center provides advanced diagnostic testing, genetic evaluation, personalized treatment planning, and coordinated care with medical oncologists, radiation oncologists, and other specialists.
Treatment options may include hormone therapy, chemotherapy, targeted therapies such as PARP inhibitors, and radioligand therapy when appropriate. This multidisciplinary approach allows each patient to receive care tailored to his diagnosis while maintaining a strong focus on quality of life.
Why Early Detection Matters
When clinically significant prostate cancer is identified before it has spread, patients generally have more treatment options and a greater opportunity for successful cancer control.
The challenge is that early prostate cancer usually does not announce itself through symptoms. Screening is not something men should consider only when something feels wrong. It is an opportunity to understand risk and potentially identify clinically significant cancer at an earlier stage.
Take the Next Step
If you are unsure whether you should be screened for prostate cancer, speak with an AUCNY urologist about your age, family history, previous PSA results, ancestry, and other individual risk factors.
If you or someone you love has been diagnosed with high-risk, recurrent, or metastatic prostate cancer, the Advanced Urologic Cancer Center offers specialized guidance and coordinated care for complex diagnoses.
About the Author
Matthew P. Mené, DO, FACOS
Dr. Matthew Mené is a board-certified urologist with extensive experience in general urology, minimally invasive treatments, and urologic trauma. He is recognized for his academic contributions, research background, and commitment to delivering high-quality, patient-centered care.
