Prostate Cancer: Symptoms, Diagnosis and Current Treatment Options

What is prostate cancer?

The great majority of prostate cancers are adenocarcinomas. How aggressive the tumour is depends on the Gleason score (ISUP grade group) on biopsy, the PSA level and the stage; patients are divided into low, intermediate and high risk groups [2].

What causes prostate cancer? Risk factors

The most important risk factor is age. Men whose father or brother has had prostate cancer, men of African ancestry and carriers of certain inherited gene alterations, above all BRCA2, belong to the high-risk group [3].

How common is prostate cancer?

According to World Health Organization data, prostate cancer was the fourth most common cancer in the world in 2024, with about 1.5 million new cases [1].

What are the symptoms of prostate cancer?

It usually causes no symptoms in the early stage. As it progresses, the following complaints may appear:

• Frequent urination, especially at night
• A weak urine stream or stop-start urination
• Blood in the urine or semen
• Back, hip or bone pain (if there is spread to the bone)

The most common cause of urinary complaints is benign prostate enlargement; therefore symptoms alone do not establish the diagnosis [2].

How is prostate cancer diagnosed?

A raised PSA in the blood or hardness found on rectal examination are the first clues. Because PSA can also rise in benign prostate enlargement and prostatitis, it cannot establish the diagnosis on its own [3]. Suspicious areas are identified with multiparametric prostate MRI and the definitive diagnosis is made by biopsy. To assess spread, CT, bone scintigraphy and, in selected patients, PSMA PET-CT are used [2].

Genetic tests

In metastatic disease, testing of BRCA1/2 and other DNA repair genes in the tumour and/or blood determines the suitability of treatments such as a PARP inhibitor; the result can also be important for family members [2][5].

How is prostate cancer treated?

The treatment is chosen by evaluating the risk group, age, accompanying diseases and the patient’s preferences together. Assoc. Prof. Dr. Ali Oğul’s approach is to evaluate patient files in a multidisciplinary tumour board with specialists in urology, radiation oncology, nuclear medicine, radiology and pathology.

Localised disease

In low-risk disease, active surveillance, that is close follow-up with PSA, MRI and repeat biopsy when needed, is one of the preferred options. In intermediate- and high-risk disease, radical prostatectomy or radiotherapy is performed; a period of hormone therapy is often added to radiotherapy [2].

Metastatic hormone-sensitive disease

The mainstay of treatment is androgen deprivation therapy (ADT), which suppresses testosterone. Adding next-generation hormonal drugs such as abiraterone, enzalutamide, apalutamide or darolutamide to ADT is the standard approach; in selected patients, docetaxel chemotherapy can also join the combination [4].

Castration-resistant disease

In disease that progresses despite hormone therapy, the options include different hormonal drugs, docetaxel or cabazitaxel chemotherapy, PARP inhibitors (e.g. olaparib) in those with a DNA repair gene alteration such as BRCA [5], and lutetium-177 PSMA radioligand therapy in PSMA-positive tumours [6]. In bone metastases, radium-223 and drugs that protect bone health can be used [2].

Latest regulatory updates for this cancer type: Prostate Cancer: Latest Developments

Side effects and follow-up during treatment

After surgery and radiotherapy, urinary incontinence and erectile problems may occur. Hormone therapy can cause hot flushes, reduced sexual desire, loss of muscle and bone, weight gain and metabolic changes; regular exercise and monitoring of bone health are recommended [4]. Follow-up is done with regular PSA measurements.

Can prostate cancer be prevented?

There is no proven method of prevention. Screening with PSA can allow early diagnosis; however, because it can also lead to the detection of tumours of no clinical importance and to unnecessary treatment, the decision should be made after discussing the benefits and risks with a physician [3].