Prostate Cancer

The prostate is a gland that is a part of the male reproductive system that wraps around the male urethra at its exit from the bladder. A malignant tumor of the prostate, the gland that produces some of the components of semen. It is often first detected as a hard nodule found during a routine rectal examination. The PSA blood test is a screening test for prostate cancer. Diagnosis of prostate cancer is established when cancer cells are identified in prostate tissue obtained via biopsy. In some patients, prostate cancer is life threatening. In many others, prostate cancer can exist for years without causing any health problems.

Symptoms of prostate problems (and prostate cancer) include urinary problems such as: Decreased force of urine stream; difficulty starting (hesitancy); the need to strain to urinate; stopping/starting of the urine stream (intermittency); frequent urination; dribbling; pain or burning during urination, erectile dysfunction; painful ejaculation; blood in urine or semen and/or deep back, hip, pelvic or abdominal pain; other symptoms may include weight loss, bone pain and lower extremity swelling.

The exact causes of prostate cancer are not known.

Diagnosis of Prostate Cancer is made by Digital rectal examination (DRE), Prostate specific antigen (PSA) blood test, Prostate biopsy.


The Gleason score and the extent of involvement of the biopsy core expressed as a percentage, as well as the PSA level as well as your general state of health and otherwise estimated life expectancy, all help to allow doctors to make their best recommendations for you regarding how your cancer should be treated.

The NCCN treatment recommendations based on risk stratification are as follows:

Very low risk

  • Life expectancy < 10 years — observation
  • Life expectancy 10-20 years — active surveillance
  • Life expectancy > 20 years — active surveillance, EBRT, brachytherapy, or RRPX

Low risk

  • Life expectancy < 10 years — observation
  • Life expectancy > 10 years — active surveillance, EBRT, brachytherapy, or RRPX

Intermediate risk

  • Life expectancy < 10 years — observation; EBRT +/- ADT (four to six months), +/- brachytherapy; brachytherapy
  • Life expectancy > 10 years — RRPX +/- lymph node dissection EBRT +/- ADT (four to six months) +/- brachytherapy; brachytherapy

High risk

  • EBRT + ADT (two to three years); EBRT + brachytherapy +/- ADT; RRPX in select individuals

Very high risk

  • EBRT + long-term ADT; EBRT + brachytherapy +/- long-term ADT; RRPX + lymph node dissection ADT or observation in select patients