Prostate Cancer
Prostate cancer is the most common cancer in men in many high-income countries. It arises from the glandular cells of the prostate and has a highly variable natural history — ranging from indolent tumours that may never require treatment to aggressive cancers that spread rapidly. Understanding this spectrum is central to making sound decisions about investigation and treatment.
Risk factors
Age is the dominant risk factor — prostate cancer is rare before 50 but becomes increasingly common thereafter, with the majority of diagnoses occurring in men over 65. A family history of prostate cancer (particularly in a first-degree relative diagnosed before 65), Black African or Caribbean ancestry, and mutations in BRCA1/2 genes all significantly raise risk. There is evidence that diet — particularly one high in red meat and dairy and low in vegetables — may be a contributing factor.
Symptoms
Early prostate cancer is frequently asymptomatic. Symptoms, when they occur, typically result from local growth of the tumour compressing the urethra: difficulty initiating or maintaining urinary flow, increased urinary frequency (particularly at night), urgency, a weak stream, and a feeling of incomplete emptying. Blood in the urine or semen may occur. Advanced disease can cause bone pain (most often in the back, hips, or pelvis), unexplained weight loss, and fatigue.
Diagnosis
Diagnosis involves a PSA blood test (elevated PSA is not specific to cancer but prompts further investigation), a digital rectal examination, multiparametric MRI of the prostate (now recommended before biopsy in most guidelines), and transperineal or transrectal prostate biopsy with histopathological analysis. The Gleason score — which grades the aggressiveness of the cancer cells — guides treatment decisions.
Choosing where to be treated
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