Loading
The prostate is a small gland about the size of a walnut. It sits under the bladder and in front of the rectum. The prostate is only present in people who are biological males. It is not essential for life, but it is important for reproduction, because it supplies fluids needed for sperm to survive. Sperm are not made in the prostate; they are made in the testes and travel to the prostate through the vas deferens. The seminal vesicles are glands behind the upper end of prostate that store and secrete a large portion of the ejaculate.
The neurovascular bundle is a collection of nerves and blood vessels that run along each side of the prostate, helping to drive erectile function and help with maintenance of urinary control. They travel from the lower spine forward through the pelvis to the penis. Because this bundle sits very close to the prostate, it is often disturbed during prostate cancer treatment and is sometimes directly invaded by more aggressive cancers.
The urethra , a narrow tube that connects to the bladder, runs through the middle of the prostate and along the length of the penis, carrying both urine and semen out of the body.
The rectum is the lower part of the intestines that connects to the anus, and it sits right behind the prostate.
Prostate cancer is a disease where cells in the prostate gland—a small gland in men that produces seminal fluid—start to grow uncontrollably. It is one of the most common types of cancer in men.
Most prostate cancers grow slowly and may not cause problems for years, but some can be aggressive and spread quickly.
Incidence: Prostate cancer is projected to become the most diagnosed cancer in men worldwide. Annual cases are expected to rise from 1.4 million in 2020 to 2.9 million by 2040 , with a significant increase in low- and middle-income countries due to aging populations and improved life expectancy.
Mortality: The number of deaths is anticipated to increase by 85%over the next two decades, from 375,000 in 2020 to nearly 700,000 by 2040 , largely due to late-stage diagnoses in resource-limited settings.
Always consult a doctor for any persistent symptoms.
Staging helps decide the most appropriate treatment plan.
The treatment options for prostate cancer depend on the patient’s age and general health, PSA level, Gleason score (a grade of how aggressive prostate cancer cells look), and the stage of the cancer and personal preferences.
Localised (confined to the prostate) prostate cancer is treated with either active surveillance, surgery or radiotherapy . Your doctor will select treatment options for you based on a risk stratification scale that is determined by looking at your:
Metastatic (spread beyond the prostate) prostate cancer is treated with androgen-deprivation therapy (ADT) and/or chemotherapy and novel antiandrogen.
Who is suitable for Active Surveillance?
Patients with small, low Gleason score prostate cancers which are at low risk of progressing or spreading.
What is Active Surveillance?
Active Surveillance is not a “treatment”. Instead, the physician will monitor the prostate cancer via regular PSA blood tests, digital rectal exams, as well as prostate biopsies.
The goal of surveillance is to avoid treatment-related complications in men who are at low risk of prostate cancer progression. That is because prostate cancer can be slow-growing and might not cause medical problems.
Thus, no medical treatment will be administered unless there is signs or risk of progression of cancer. Curative-intent (Intent to cure) treatment will be delivered if there is clinical progression.
What is Surgery for prostate cancer?
Radical prostatectomy (removal of the prostate gland) can be performed either via a minimally invasive surgery (robotic or laparoscopic/key-hole) or an open surgery. All prostate tissue is removed during surgery, and the experience of the surgeon is important for the best surgical outcome.
Potential complications of surgery include urinary incontinence and erectile dysfunction.
What is Radiotherapy for prostate cancer?
Radiotherapy uses radiation to kill cancer cells. There are two types of radiotherapy that can be used in treatment:
External beam radiotherapy (EBRT) utilises an external source of radiation to treat the prostate gland and a margin of adjacent normal tissue.
It is for Early-Stage and Locally advanced prostate cancer.
Stereotactic Ablative Body Radiotherapy (SABR): For early-stage cancer.
Image from Cancer Research UK
Brachytherapy directly implants a radioactive seed source within the prostate to treat the cancer, thus providing the highest dose of radiation over a very limited distance.
Image from Prostate Cancer Foundation of Aus
Potential Complications
Early complications (within a day to a week) include inflammation of rectum, urinary frequency, urgency and dysuria which typically resolves
Late complications (after a few months to a year) can include urinary incontinence, erectile dysfunction and narrowing of the urethra.
Metastatic prostate cancer typically involves the bones. The cornerstone of treatment is androgen-deprivation therapy (ADT), either in the form of surgical castration or medical castration using gonadotrophin-releasing hormone agonist or antagonist. It lowers levels of male hormones (androgens) that fuels cancer growth thus depriving prostate cancer cells of testosterone stimulation, the majority of the cancerous cells will regress. In some situations, novel antiandrogen or chemotherapy may be added to ADT right at the start of treatment, if the patients have metastatic disease at presentation.
If the cancer progresses after ADT, other treatment options include the use of novel antiandrogen, chemotherapy, bone targeting alpha-emitting radioisotope or PSMA radioligand.
There is still ongoing research in terms of:
The physician will work closely with the patient to determine the ideal treatment plan that suits the patient’s needs.
After treatment, regular check-ups and PSA tests are essential to monitor for recurrence or manage side effects.
Multimodal AI Integration: A study published in January 2025 demonstrated that combining MRI and ultrasound images using AI outperforms traditional methods in detecting clinically significant prostate cancer. This approach achieved higher sensitivity and specificity compared to radiologists, potentially reducing unnecessary biopsies.
VERDICT MRI Technique: A new MRI technique called VERDICT (Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumour) can identify men who do not have prostate cancer, potentially reducing unnecessary biopsies by 90%. This method provides additional information about the prostate's cell structure without the need for new equipment.
Akeega (Niraparib and Abiraterone Acetate): Approved in August 2023, this combination therapy targets BRCA-positive metastatic castration-resistant prostate cancer. It offers a dual-action approach, inhibiting tumour growth and androgen receptor signalling, providing a new treatment option for patients with specific genetic mutations.
JANX007 by Janux Therapeutics: In a Phase I trial, this experimental treatment showed unprecedented results, with all 16 participants experiencing at least a 50% decline in PSA levels. The therapy combines T-cell activation with PSMA targeting, offering a promising approach for advanced prostate cancer.
Relugolix: Approved in 2024, this oral medication provides a convenient alternative to injectable hormone therapies for advanced prostate cancer patients. It eliminates the need for frequent clinic visits and has a favourable side-effect profile, including fewer heart-related risks.
White Button Mushroom Extract: Research from City of Hope suggests that white button mushroom extract may slow prostate cancer progression by inhibiting tumour growth and enhancing immune cells' cancer-fighting abilities. Phase II trial results showed a reduction in myeloid-derived suppressor cells and increased activity of T and natural killer cells in the blood of prostate cancer patients.
Stereotactic Ablative Body Radiotherapy (SABR): Few trials have shown SABR to be non-inferior to conventional radiotherapy in terms of toxicity and survival rates data and is now an established treatment for localised early-stage (low risk and favourable intermediate risk prostate cancer patients. This high-precision radiotherapy treatment drastically reduces the number of sessions required, offering a more convenient and effective option for patients.
MR Linac: SABR treatment delivered on MR Linac machine is further advancement of radiotherapy treatment with daily adaptive radiotherapy planning and treatment as the local anatomy of the prostate and surrounding organs changes daily. Thus, closer treatment margins to the prostate are possible leading to better sparing of the rectum, bladder and bowel with MR Linac machine.
You can search your Prostate Cancer Specialist on www.ioncosolutions.com