Prostate Cancer

01

Causes and risk factors

The exact cause is not always known. Prostate cancer develops when cells acquire genetic changes. Some patients may have inherited genetic risk, while most cancer-causing changes occur after birth.

• Age: risk rises with age, with most cases diagnosed after 50 years.
• Ethnic background: prostate cancer is more common among men of African-Caribbean and African descent than in Asian men.
• Family history: risk may increase if a father or brother developed prostate cancer before age 60, or if there is related breast or ovarian cancer history in the family.
• Obesity: balanced diet and regular exercise may lower overall risk.
• Geography: prostate cancer is rarer in Asia, Africa and South America.
• Smoking: smokers have higher risk and poorer prognosis after diagnosis.

02

Symptoms and signs

Prostate cancer may not cause symptoms until it reaches a more advanced stage or becomes large enough to affect urination. Symptoms may overlap with benign prostate enlargement.

• Difficulty starting urination or emptying the bladder.
• Weak or intermittent urinary stream.
• Feeling that the bladder has not emptied properly.
• Dribbling after urination.
• Frequent urination, especially at night.
• Sudden urgency, urinary retention or blood in urine.
• Advanced disease may cause lower abdominal pain, renal failure, rectal bleeding, back or bone pain, or lower limb weakness.

03

Screening and diagnosis

Screening may be considered with a Prostate-Specific Antigen blood test. PSA results should be interpreted with age, prostate size, clinical examination and other health factors.

04

Treatment options

Treatment depends on the stage, grade, PSA, patient age, general health and personal priorities.

05

Benefits of da Vinci robotic surgery

• Better cancer control in suitable patients.
• Faster return of erectile function in selected nerve-sparing cases.
• Better chance for return of urinary continence.
• Less blood loss and lower transfusion requirement.
• Less pain, lower wound complication risk and shorter hospital stay.
• Faster recovery and return to normal activities.

06

Post-treatment care

After treatment, follow-up looks for recurrence or spread. PSA tests are often recommended every 3-6 months for the first five years and at least yearly after that, depending on the clinical situation.

07

Active surveillance in detail

Active surveillance means living with a carefully selected prostate cancer without immediate surgery, radiation or systemic treatment. It is considered only when the disease appears low risk and the patient can reliably follow a monitoring plan.

The purpose is to avoid or delay treatment side effects while keeping curative options available if the cancer shows signs of becoming more aggressive.

• Follow-up commonly includes PSA blood testing and clinical review every 3-6 months.
• Repeat imaging or prostate biopsy may be advised to confirm that the cancer has not changed grade or stage.
• It may suit men with very low-risk disease, slow-growing cancer, limited life expectancy or major medical comorbidities.
• It is not passive observation; missed follow-up can allow progression to go unnoticed.
• Some prostate cancers can be undergraded initially, which is why repeat assessment matters.

08

Surgery and robotic radical prostatectomy

Radical prostatectomy removes the prostate gland and surrounding tissues, often including lymph nodes. The removed tissue allows accurate pathological staging and helps determine whether additional treatment is needed.

Robotic-assisted surgery is performed through small incisions using surgeon-controlled instruments. The robotic system improves vision and fine movement inside the pelvis, which is important around the bladder neck, urethra, rectum and nerve structures.

• Potential advantages include accurate staging, strong local cancer control and easier detection of recurrence using PSA.
• Robotic surgery may reduce blood loss, pain, hospital stay and wound-related complications in suitable patients.
• Nerve-sparing may be considered when cancer location and safety allow.
• Urinary continence and sexual function recovery vary by age, baseline function, cancer stage and surgical factors.

09

Radiation therapy and possible side effects

Radiation therapy uses high-dose energy to treat prostate cancer without removing the prostate. It may be used as primary treatment in selected patients or after surgery when pathology suggests a higher risk of recurrence.

• Types include external beam radiation therapy, brachytherapy, IMRT and IGRT.
• Potential side effects include frequent urination, painful urination, blood in urine, urinary leakage and fatigue.
• Some patients develop bowel symptoms such as abdominal cramping, painful bowel movements, rectal bleeding or rectal leakage.
• Sexual function can decline over time after radiation.
• Salvage treatment after radiation recurrence can be more complex than treatment after surgery.

10

Advanced and metastatic prostate cancer

When prostate cancer has spread beyond the prostate, treatment aims to control disease, reduce symptoms and maintain quality of life. The overall plan depends on disease burden, symptoms, PSA behavior, scan findings and fitness.

• Hormone therapy, also called androgen deprivation therapy, reduces or blocks testosterone signals that fuel many prostate cancer cells.
• Medical castration uses injections given monthly, three-monthly or six-monthly depending on the selected medicine.
• Surgical castration may be considered in selected metastatic cases when appropriate.
• Chemotherapy may be used for fit patients with advanced disease or hormone-resistant cancer.
• Palliative TURP can relieve urinary retention or repeated catheterization in non-curative situations.
• Follow-up often includes PSA monitoring and imaging such as PSMA PET CT when clinically indicated.