Condition guide
Prostate Cancer
Also known as: Prostate adenocarcinoma
In brief
Prostate cancer is a cancer that starts in the prostate gland. Many prostate cancers grow slowly and may never cause harm, while others need prompt treatment. Early detection with PSA testing, MRI and, when needed, biopsy helps tell the two apart.
Medically reviewed by Dr. Atip Chatsudthipong, MD on
Written by Editorial teamPublished Updated
What is prostate cancer?
Prostate cancer develops when cells in the prostate gland grow in an uncontrolled way. It is one of the most commonly diagnosed cancers in men worldwide. Its behaviour varies widely: many cancers are low-grade and slow-growing, whereas higher-grade cancers can spread beyond the prostate if not treated.
Under the microscope, cancers are graded using the Gleason score and the related Grade Group (1 to 5). Together with the PSA level and imaging findings, the grade places a cancer into a risk group that guides treatment.
What are the symptoms of prostate cancer?
Early prostate cancer usually causes no symptoms. Urinary symptoms such as a weak stream or frequency are far more often due to benign prostate enlargement. When symptoms do occur they may include:
- Urinary symptoms that are new or progressive
- Blood in the urine or semen
- Erectile difficulties
- Bone pain, unexplained weight loss or fatigue in advanced disease
Who is at higher risk?
- Increasing age — risk rises substantially after 50
- A father or brother diagnosed with prostate cancer, especially at a younger age
- Inherited gene variants such as BRCA2 (and BRCA1), or a family history of breast, ovarian or pancreatic cancer
- African ancestry
Should I have PSA screening?
The PSA (prostate-specific antigen) blood test can detect prostate cancer before symptoms appear, but it can also lead to the diagnosis and treatment of cancers that would never have caused harm. For this reason guidelines recommend shared decision-making — an informed discussion of benefits and drawbacks with your doctor.
The AUA/SUO guideline (2023) suggests that clinicians may offer a baseline PSA test from about age 45–50, with regular screening for those aged 50–69 who choose it, and earlier testing (from about age 40–45) for people at increased risk. Screening intervals are personalised according to PSA level and risk.
Learn more in Understanding your PSA test.
How is prostate cancer diagnosed?
- PSA test and examination — an elevated or rising PSA, or an abnormal digital rectal examination, prompts further assessment. A repeat PSA is often advisable.
- Prostate MRI — multiparametric MRI helps identify suspicious areas and can reduce unnecessary biopsies.
- Prostate biopsy — small tissue samples confirm whether cancer is present and its grade. See Prostate biopsy.
- Staging — for intermediate- and high-risk cancers, further imaging (such as PSMA PET, CT or bone scan) determines whether cancer has spread.
How is prostate cancer treated?
The right approach depends on the cancer's risk group, your general health and life expectancy, and your personal priorities about potential side effects.
| Approach | What it involves | Typically considered for |
|---|---|---|
| Active surveillance | Regular PSA tests, MRI and repeat biopsy, with treatment only if the cancer shows signs of progressing | Low-risk and selected favourable intermediate-risk cancers |
| Radical prostatectomy | Surgical removal of the prostate, commonly performed robotically — see Robotic prostatectomy | Localised cancers in men fit for surgery |
| Radiation therapy | External beam radiotherapy or brachytherapy, sometimes with hormone therapy | Localised and locally advanced cancers |
| Hormone and systemic therapy | Lowering testosterone, newer hormonal agents, chemotherapy | Advanced or metastatic disease, or in combination with radiation |
Potential side effects of active treatment — including urinary leakage and erectile dysfunction — differ between options and should be discussed in detail. Decisions are often best made with input from both a urologist and a radiation oncologist.
How Dr. Atip can help
Prostate cancer is one of Dr. Atip's principal clinical interests, and he cares for men at every stage — from screening and diagnosis to treatment. He routinely performs MRI-fusion targeted prostate biopsy for accurate diagnosis and performs robotic prostatectomy at Bumrungrad International Hospital. He will explain every option — including active surveillance and radiation therapy — so you can make an informed decision. Second-opinion consultations are welcome; please bring previous PSA results, MRI images and biopsy reports.
Frequently asked questions
Is a high PSA a sign of cancer?
Not necessarily. PSA can be raised by prostate enlargement, infection or inflammation, recent ejaculation or procedures, as well as by cancer. A raised PSA is usually confirmed with a repeat test and may be followed by MRI before deciding whether a biopsy is needed.
What is active surveillance?
Active surveillance is a structured monitoring programme for lower-risk prostate cancers. It uses regular PSA tests, MRI and repeat biopsies to watch the cancer closely, with curative treatment offered if signs of progression appear. It avoids or delays the side effects of treatment for cancers that may never cause harm.
Can prostate cancer be cured?
Many prostate cancers that are found while still confined to the prostate can be treated with curative intent using surgery or radiation therapy. Outcomes depend on the cancer's grade and stage, so your specialist will explain what to expect in your situation.
References
- 1.Wei JT, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I — Prostate Cancer Screening. J Urol. 2023;210(1):46–53. (opens in a new tab)
- 2.Wei JT, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part II — Considerations for a Prostate Biopsy. J Urol. 2023;210(1):54–63. (opens in a new tab)
- 3.Eastham JA, et al. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part I — Introduction, Risk Assessment, Staging, and Risk-Based Management. J Urol. 2022;208(1):10–18. (opens in a new tab)
- 4.European Association of Urology. EAU – EANM – ESTRO – ESUR – ISUP – SIOG Guidelines on Prostate Cancer. (opens in a new tab)
- 5.National Cancer Institute. Prostate Cancer Treatment (PDQ®) — Patient Version. (opens in a new tab)
This information is for general education and does not replace a consultation with a qualified doctor. If you have severe symptoms, seek emergency care (in Thailand, call 1669). See our medical disclaimer.