What Is Prostate Cancer?

For many men, the subject first comes up in a perfectly ordinary appointment — a blood test result that needs a second look, or a routine examination that leads to a conversation nobody was expecting that morning. Prostate cancer is cancer that starts in the prostate, the small gland below the bladder that surrounds the first part of the urethra and contributes fluid to semen. It is one of the most common cancers in men, and it covers a wide range: some prostate cancers grow so slowly that they may never cause harm, while others behave more aggressively and need prompt treatment. Much of the journey described below is really about working out which kind a particular man is dealing with.

The short explainer at the top of this page, "What is Prostate Cancer?" (about two minutes), puts it the way patients often hear it first: this is a common cancer, it can often be treated successfully, and knowing what to expect helps you cope with what comes next. This guide follows that same path in order — what happens first, what the tests can and cannot tell you, and how treatment decisions are actually made. For wider background, our cancer condition hub gathers related guides and videos in one place.

The first step: why the prostate gets checked at all

Early prostate cancer usually causes no symptoms at all. That's worth pausing on, because the urinary symptoms men often associate with the prostate — getting up at night, a weaker stream, difficulty starting — are far more often caused by benign enlargement of the gland, a separate, non-cancerous condition. Our guide to TURP surgery for an enlarged prostate covers that condition and its treatment; the important point here is that symptoms alone can't separate the two, which is why testing exists.

The test most men meet first is PSA — prostate-specific antigen — a protein made by the prostate that can be measured in a blood sample. A raised PSA level is a prompt for a closer look, not a diagnosis: the level can also rise with benign enlargement, infection or inflammation of the prostate, and other everyday causes. An examination of the prostate, and sometimes an MRI scan, may add to the picture. Whether and when to have a PSA test is a personal decision with genuine arguments on both sides, and it's one to make with your own clinician, who knows your history and your family background — a close relative with prostate cancer is one of the things that can change that conversation.

If more checks are needed: scans and the biopsy decision

When the early results suggest a closer look is warranted, the next step is often an MRI scan of the prostate. Imaging can show areas that look suspicious and, just as usefully, can sometimes show that nothing concerning is visible. The scan also helps target any sampling that follows, rather than taking tissue blindly.

The only way to confirm prostate cancer is a biopsy: small samples of prostate tissue, taken with a fine needle — usually guided by ultrasound, and often aimed using the MRI images — and examined under a microscope. It is a short procedure, and your team will explain how it is done at your centre, what it feels like, and what after-effects to expect, such as blood in the urine or semen for a while. If the idea of tissue sampling is new to you, our general guide to what a biopsy is and how results are read explains how laboratories turn small samples into a diagnosis. Waiting for that result is, for most men, the hardest stretch of the whole journey — and it's normal for it to feel that way.

Making sense of a diagnosis: grade and stage

If cancer is found, two questions shape everything that follows. The first is how the cancer cells look under the microscope — their grade. Pathologists score how different the cells look from normal prostate tissue; cancers made of near-normal-looking cells tend to behave slowly, while more disordered patterns suggest a faster-moving disease. The second question is the stage: whether the cancer appears confined to the prostate, has reached nearby tissue or lymph nodes, or has travelled further. Scans and the PSA level feed into that staging picture.

It helps to hear, plainly, why clinicians spend so much time on these two questions before talking about treatment at all. A small, slow-looking cancer confined to the gland is a genuinely different problem from one that has spread — and the right response to each is different too. If you'd like to understand that second situation better, "Spread of Prostate Cancer" (just under three minutes) features a radiation oncologist explaining the three routes by which this cancer can travel — local growth, the lymphatic system, and the bloodstream.

Choosing a path: monitoring is a real option, and so is treatment

Here's the part that surprises many people: for a low-risk, slow-growing cancer, the recommended path may be active surveillance rather than immediate treatment. That is not "doing nothing" — it means regular PSA checks, examinations, scans and sometimes repeat biopsies, with treatment held in reserve and started if the picture changes. The reasoning is straightforward: treatment has real side-effects, and a cancer that may never cause harm doesn't automatically justify paying that price today.

When treatment is advised — or chosen — the main paths are these. Surgery (radical prostatectomy) removes the whole prostate, sometimes with robotic assistance, and aims to remove the cancer with the gland. Radiotherapy directs radiation at the prostate from outside the body, or via small radioactive sources placed in the gland, and can be combined with hormone therapy. Hormone therapy lowers or blocks testosterone, which prostate cancer cells use as a growth signal, and it plays a role at several stages — alongside radiotherapy, or as the main treatment when cancer has spread. For cancer that has travelled beyond the prostate, chemotherapy and newer systemic medicines may also be offered by oncology teams. Each option carries its own pattern of side-effects — urinary, sexual and bowel effects are the ones men ask about most — and weighing those against the cancer's behaviour is the real substance of the decision. There is rarely one obvious answer, which is why these choices are made with a specialist team, and why a second opinion is a reasonable thing to ask for.

Life after the decision: follow-up and the long view

Whichever path is taken, follow-up becomes part of life. After surgery or radiotherapy, PSA monitoring takes centre stage — because the prostate has been removed or treated, the level should fall very low, and a later rise can be an early signal that more treatment is worth discussing. On active surveillance, follow-up is the treatment, and sticking to the schedule matters even when you feel completely well.

The practical and emotional side deserves a mention too. Adjusting to changed urinary or sexual function, dealing with fatigue during treatment, and living with periodic result anxiety are all common experiences — and support exists for each, from specialist nurses to patient organisations and peer groups. Simply asking what is available locally is often the most useful step. Men comparing notes with partners and friends may also find our guide to what colorectal cancer is a useful companion read.

References & further reading

• MedlinePlus — Prostate Cancer: https://medlineplus.gov/prostatecancer.html
• National Cancer Institute — Prostate Cancer: https://www.cancer.gov/types/prostate
• NHS — Prostate cancer: https://www.nhs.uk/conditions/prostate-cancer/

Frequently Asked Questions

Does a raised PSA level mean I have prostate cancer?

No. PSA can rise for several non-cancerous reasons, including benign enlargement of the prostate and infection or inflammation. A raised level is a reason for further checks — which may include repeat testing, examination, or a scan — not a diagnosis in itself.

Can prostate cancer be present without any symptoms?

Yes. Early prostate cancer commonly causes no symptoms, and the urinary symptoms often blamed on it are more often caused by benign enlargement. That is why the condition is usually first suspected through testing rather than through how a man feels.

If I am offered active surveillance, does that mean my cancer is being ignored?

No. Active surveillance is a structured plan of regular PSA tests, examinations, scans, and sometimes repeat biopsies, with treatment started if the cancer's picture changes. It is offered for cancers judged low risk, precisely to avoid treatment side-effects unless and until they are justified.

How is prostate cancer confirmed for certain?

Only by tissue examination. A biopsy takes small samples from the prostate, and a pathologist examines them under a microscope. Blood tests and scans guide the process and help stage the cancer, but they do not replace the biopsy result.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about prostate cancer, not medical advice and not a diagnosis. Decisions about PSA testing, investigation and treatment belong with your own clinical team, who can examine you and review your results.