Prostate cancer – symptoms, diagnosis and treatment methods

Content author: lek. Jakub Gondek, urologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Jakub Gondek · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of an educational nature and does not replace a urological consultation or discussion of the results with the attending physician. It is not intended for independent interpretation of research. Sudden weakness of the lower limbs, numbness, impaired sensation in the perineum, loss of control over urination or defecation, severe increasing spine pain and urinary retention require immediate medical attention.

The most important information at a glance

• Prostate cancer is a very diverse disease - from very slow to aggressive forms that require quick treatment.
• Early prostate cancer usually has no symptoms. Urinary problems most often result from benign growth, not cancer.
• The most important risk factors are age, family history and genetic mutations, including BRCA2.
• PSA is not a "cancer" test - it is specific for the prostate as an organ, not for cancer.
• Modern diagnostics is based on the sequence: clinical assessment, magnetic resonance imaging, and only then targeted biopsy.
• The diagnosis is made only by a pathologist based on microscopic examination of the biopsy material.
• The procedure is determined by the risk category determined by three elements: degree of malignancy, PSA value and local advancement.
• With the lowest risk, active surveillance is the standard - planned observation, not withdrawal from treatment.
• The main methods of radical treatment are surgery and radiotherapy; both have comparable targets and different side effect profiles.
• Treatment may affect urinary continence, erection and fertility - these should be discussed before, not after, the decision.
• Treatment options have changed significantly in recent years; information from a decade ago does not reflect today's realities.
• Bone pain and neurological symptoms in a patient with prostate cancer require urgent evaluation.

Find out more about the specialist

Doctor. Jakub Gondek is a urologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the urogenital system, including symptoms of prostate diseases, problems with urination, as well as discussing test results and qualification for further urological diagnostics.

Meet the doctor. Jakuba Gondka

What is prostate cancer and why is it so unusual

The prostate, or prostate gland, is an organ the size of a chestnut located under the urinary bladder, surrounding the initial section of the urethra. Its role is to produce part of the seminal fluid. Prostate cancer most often develops from glandular epithelial cells, usually in the peripheral zone of the organ - i.e. in the area that the doctor can feel during a rectal examination.

What distinguishes this cancer from most others is the huge range of its course. Under one name there are diseases of an extremely different nature: from lesions that grow so slowly that they would not cause any symptoms throughout life, to aggressive forms that require quick and intensive treatment.

This has a practical consequence that may be surprising to patients. In this disease diagnosis alone is not sufficient to make a decision. It is crucial to determine how aggressive the change is and how advanced it is - because two men with the same diagnosis may receive completely different recommendations, and both will be treated correctly.

The second consequence concerns diagnostics. Since some cancers would never pose a threat to the patient, the goal is not to detect every lesion, but to detect those that are clinically significant. This is why modern diagnostic procedures have changed so significantly in recent years.

Risk factors

It is worth paying attention to what is not included in this table. Benign prostatic hyperplasia is not a risk factor for cancer - it is two separate diseases of the same organ that can coexist, but one does not progress to the other. There is also no evidence that sexual activity, vasectomy or cycling increase the risk of developing the disease.

Family burden deserves a separate sentence because it has a direct impact on the proceedings. A man whose father or brother suffered from prostate cancer should talk about tests earlier than the age of fifty - and it is worth reporting it to a doctor on his own initiative.

Symptoms - and why early cancer doesn't have them

This is one of the most important misconceptions on this topic. Many men assume that prostate cancer causes problems with urination. In fact, it's the other way around.

Prostate cancer most often develops in the peripheral zone of the gland, i.e. away from the urethra. Therefore, it does not compress the urethra for a long time and does not make urination difficult. Benign prostatic hyperplasia, on the other hand, develops in the transition zone, directly around the urethra - and it is responsible for most of the symptoms with which men report to a urologist.

The practical conclusion is twofold and is worth remembering both ways. Symptoms of urination most often do not mean cancer — but the lack of symptoms does not mean that there is no cancer. This is why early detection is based on tests and not on the observation of well-being.

Symptoms requiring immediate attention

In patients with diagnosed prostate cancer or with suspected advanced disease, several symptoms require urgent action:

• Sudden weakness or numbness of the lower limbs - may indicate compression of the spinal cord by a metastasis to the spine; is an emergency condition in which hours count,
• Sensory disturbances in the perineum area and the inner surface of the thighs,
• Sudden loss of control over urination or stool,
• Strong, increasing pain in the spine, especially at night,
• Urinary retention - inability to urinate despite the urge,
• Abundant hematuria with clots,
• Fever with chills in a patient undergoing oncological treatment,
• Sudden, unilateral swelling of the lower limb with pain - suspected thrombosis.

The first point is the most important. Spinal cord compression is a complication in which the speed of treatment implementation determines whether the patient will be able to walk. Neurologic symptoms in a man with prostate cancer should never wait until the next follow-up visit.

Step-by-step diagnostic path

The sequence of tests has changed in recent years and it has great practical significance - it has reduced the number of unnecessary biopsies and improved the detection of clinically significant lesions.

Two comments to this table. First of all, PSA is not a "cancer" test - it is specific for the prostate as an organ, and its concentration is also increased by mild hyperplasia, inflammation, infection or ejaculation before the test. Secondly, performing an MRI before the biopsy is a significant change: it allows us to precisely indicate the place where the material is taken, and some men are spared the procedure.

The diagnosis is made only by a pathologist. Neither PSA, nor MRI, nor digital rectal examination allow for a diagnosis - they are used to decide whether to perform a biopsy.

Risk groups - how the doctor orders the results

After diagnosis, a question arises that determines the entire further procedure: how dangerous this particular disease is. The answer comes from the combination of three elements.

• Grade of malignancy - ISUP group resulting from the Gleason sum, i.e. assessment of the aggressiveness of cells under a microscope.
• PSA value — the higher it is, the greater the probability of a more advanced disease.
• Local advancement — whether the lesion is limited to the prostate or whether it infiltrates beyond its capsule.

On this basis, the patient is assigned to a risk category: low, intermediate or high. It is this, and not a single number from the result, that determines the scope of further tests and possible treatment methods.

In case of intermediate and high risk, tests are performed to assess whether the disease extends beyond the prostate. The scope depends on the situation and may include imaging of the abdomen and pelvis as well as an assessment of the skeletal system. In recent years, modern imaging methods with higher sensitivity have become more and more widely used. Their validity in a specific case is decided by the attending physician.

A detailed discussion of how to read an MRI and biopsy result - including what the ISUP group means and why the Gleason score starts with a six - is beyond this article, and we cover them separately.

Treatment methods - overview

There is no one method that is best for everyone. The choice depends on risk category, age, life expectancy, comorbidities, urinary symptoms, and patient preferences regarding tolerable side effects.

It is worth understanding the difference between the last two lines and active surveillance - it can be confusing. Active surveillance assumes that if there are signs of disease progression, we will implement radical treatment. Expectant management does not assume this intention and focuses on symptom control. These are two different strategies, selected for completely different situations.

The decision on treatment is made in consultation with the participation of a urologist, oncologist and radiotherapist. The patient has the right to learn about all options appropriate to his or her situation, not just those available at a given center.

Active surveillance - why "we don't treat" is sometimes the right decision

For many patients, this is the most difficult part of the conversation to accept. Hearing the diagnosis of cancer and the suggestion of observation instead of treatment sounds like abandonment. In fact, it's the other way around.

Active surveillance is a planned program: regular PSA testing, follow-up visits, medical examination, and follow-up imaging tests and biopsies according to a set schedule. The goal is to catch the moment when the disease begins to progress - and implement radical treatment when it is really needed.

The rationale is simple. Some prostate cancers develop so slowly that they would never pose a threat to the patient. Immediate radical treatment, however, is associated with a real risk of permanent consequences - erectile dysfunction and urinary incontinence. Active surveillance allows us to postpone these risks in time, maintaining the possibility of treatment.

Qualification is not automatic and does not result solely from the ISUP group. It depends on the PSA, the number and extent of biopsies, the MRI image, age, comorbidities and the patient's readiness for regular check-ups. This last condition is real: active surveillance requires discipline, and waiving follow-up visits makes it useless.

Side effects of treatment - what you need to know in advance

This is a conversation that needs to be had before making a decision, not after the treatment. Radical treatment methods have comparable oncological goals, but differ in the profile of consequences - and this difference can be decisive for the patient.

Urinary continence. After prostatectomy, urinary incontinence is common in the first period after the procedure and improves gradually in most men. The percentage of patients with a persistent problem is much smaller, but not zero. Pelvic floor muscle exercises are important here and it is worth starting them before surgery.

Erection. Both surgery and radiotherapy can affect erections. During surgery, this depends, among other things, on the possibility of sparing the neurovascular bundles, which is not always possible without worsening the oncological outcome. After radiotherapy, the deterioration may be later and progressive. There are methods to help return function, and it's worth talking about them early.

Ejaculation and fertility. After removal of the prostate and seminal vesicles, semen ejaculation does not occur. This is important for men planning children - a conversation about fertility protection should be held before starting treatment, not after it. This is a topic that is sometimes overlooked, but it is irreversible.

Consequences of hormone therapy. Decreased testosterone is associated with hot flashes, decreased libido, loss of muscle mass, increase in fat tissue, decreased bone density and an impact on the metabolic profile and mood. This treatment is effective, but burdensome - so it is used when the benefits outweigh the costs.

Sequelae of radiotherapy. Bladder and intestinal symptoms are possible, usually transient and less often permanent. The severity depends on the technique and dose.

We do not provide percentages here because they vary between centers, techniques and patient groups and are misleading when read in isolation. It is worth discussing the specific risks in your case with your treating doctor.

Life after treatment and follow-up

After radical treatment, regular follow-up is required, mainly based on PSA measurement. After removal of the prostate, PSA should drop to very low values ​​- its subsequent increase is a signal requiring evaluation, but does not in itself mean a relapse of the disease requiring immediate action.

After radiotherapy, the PSA drops slower and does not drop to zero because the prostate remains in the body. The interpretation of the results is therefore carried out according to different principles than after surgery - this is a frequent source of unnecessary anxiety in patients comparing their results with those of others.

In addition to oncological control, care for the consequences of treatment is important: rehabilitation of the pelvic floor muscles, management of erectile dysfunction, assessment of bone density and metabolic profile in patients treated with hormones, and psychological support, if needed. This part of care is sometimes neglected, but it actually determines the quality of life.

It is also worth saying something that patients miss: the treatment options for prostate cancer have changed significantly in recent years - this applies to both surgical techniques and radiotherapy, as well as systemic treatment. Information found on the Internet from a decade ago does not reflect today's realities.

Early detection and prevention

There is no way to completely prevent prostate cancer. However, you can influence two things: the moment of detection and the general health condition, which translates into the course of treatment.

Talk about research. It usually begins around the age of 50, earlier - around 45 - in the case of prostate cancer in the father or brother, and even earlier in BRCA2 mutation carriers. It is not about automatically performing a PSA, but rather an informed decision after discussing the benefits and limitations of the test.

Modifiable factors. Maintaining normal body weight, regular physical activity, Mediterranean diet, limiting alcohol and quitting smoking. They do not provide a guarantee, but they improve the overall prognosis and treatment tolerance.

What to avoid. Supplements advertised as "prostate protection" taken instead of tests. High doses of some preparations have no proven protective effect and may delay diagnosis.

And the most important thing: detecting the disease at an early stage gives the widest choice of treatment methods, including those that have the least impact on everyday functioning. This is the only real way to influence your own situation.

The most common myths

• "Prostate cancer causes problems with urination." Not at an early stage. These symptoms most often result from benign growth.
• "Enlarged prostate turns into cancer." No. These are two separate diseases that can coexist.
• "A normal PSA rules out cancer." No. Some tumors produce little PSA, so digital rectal examination remains important.
• "Elevated PSA means cancer." No. The most common cause is benign hyperplasia, inflammation or infection.
• "Recognition means immediate surgery." No. At the lowest risk, active surveillance is the standard.
• "Biopsy spreads cancer." This is a persistent myth that can cause dangerous delays.
• "Treatment always means impotence and diapers." No. There is a risk, but it depends on the method, advancement and experience of the team.
• "Prostate supplements protect against cancer." No. They do not replace research and have no proven protective effect.

Do you have an elevated PSA, family history or questions about prostate tests?

A urological consultation allows you to compare the results with your age, symptoms and family history and determine what tests are justified in your case.

Prostate diagnostics at the Island of Friendly Medicine in Gdańsk

At the Island of Friendly Medicine doctor. Jakub Gondek consults men with prostate symptoms, elevated PSA and test results that require discussion. The visit includes an interview, assessment of risk factors, examination and planning of diagnostics appropriate to the situation.

The aim of the consultation is to determine whether the symptoms result from benign hyperplasia, inflammation or require further oncological diagnostics. If a diagnosis requiring oncological treatment is confirmed, the patient is referred to a center providing such treatment. The current scope of tests, doctor availability and prices must be confirmed during registration.

Urological consultation doctor. Jakub Gondek Difficulty in peeing

What to ask the doctor?

• What risk category does my case fall into and what does it mean?
• What is my ISUP group and PSA value?
• Is the disease limited to the prostate?
• What assessment tests are needed in my situation?
• What treatment methods are available to me and why these?
• Am I eligible for active surveillance?
• What are the side effects of each proposed method?
• How will treatment affect urinary continence and erection?
• Should I protect my fertility before starting treatment?
• Can my decision wait a few weeks or does it require a hurry?
• Is it worth getting a second opinion and where?
• What will the follow-up look like after treatment?

FAQ - Prostate cancer

What are the first symptoms of prostate cancer?

Early prostate cancer usually has no symptoms because it develops in a part of the gland away from the urethra. Urinary symptoms most often result from benign prostatic hyperplasia.

Is an enlarged prostate cancer?

No. Benign hyperplasia and prostate cancer are two separate diseases of the same organ. They can coexist, but the growth does not progress to cancer.

Does PSA detect prostate cancer?

PSA is specific for the prostate as an organ, not for the cancer. An elevated result may be due to hyperplasia, inflammation, infection, or other causes. The diagnosis is made only by histopathological examination.

When to start prostate examination?

The conversation about tests usually begins around the age of 50, in the case of prostate cancer in a father or brother around the age of 45, and in carriers of the BRCA2 mutation earlier. The decision should be conscious and discussed with your doctor.

Is a biopsy always necessary?

No. Performing magnetic resonance imaging before the biopsy allows some men to avoid it, and for others to precisely indicate the place where the material was taken. The decision is made by the doctor based on the entire picture.

Can a biopsy spread the cancer?

This is a persistent myth. Biopsy is a standard diagnostic procedure, and postponing it for this reason leads to a delay in diagnosis.

Does diagnosis mean immediate surgery?

No. At low risk, active surveillance is the standard, i.e. planned observation with the possibility of implementing treatment if there are signs of disease progression.

What is the difference between active surveillance and expectant management?

Active surveillance involves the implementation of radical treatment if the disease begins to progress. Expectant management does not assume such an intention and focuses on controlling symptoms in patients for whom radical treatment would bring more harm than benefit.

Surgery or radiotherapy – which is better?

Both methods have comparable oncological goals in many situations, but differ in their side effect profile and treatment course. The choice depends on the advancement, age, comorbidities and patient preferences.

Will I have erection and urinary continence problems after treatment?

This risk exists with both radical treatment methods, but its severity depends on the advancement, technique and individual situation. This is a topic that should be discussed before deciding on treatment.

Does treatment affect fertility?

Yes. After removal of the prostate and seminal vesicles, semen ejaculation does not occur and hormone therapy affects fertility. A conversation about its protection should be held before starting treatment.

What does the follow-up look like after treatment?

It is based primarily on regular PSA measurement, according to the scheme established by the attending physician. The rules of interpretation are different after surgery and after radiotherapy, so the results should not be compared with someone else's.

Which symptoms require immediate attention?

Sudden weakness or numbness in the legs, loss of sensation in the perineum, loss of control over urination or defecation, severe increasing spine pain and urinary retention. Neurological symptoms cannot wait until the follow-up visit.

Who consults on prostate diseases at WMP?

On the WMP website, MD. Jakub Gondek is described as a urologist dealing with the diagnosis and treatment of diseases of the urogenital system, including symptoms of prostate diseases. The scope of research and availability of dates are confirmed by registration.

Sources

• Island of Friendly Medicine, MD. Jakub Gondek: https://www.wyspamedycynyPrzyjaznej.pl/pl/jakub-gondek
• Wyspa Medycyny Przyjaznej, urological consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-urologiczna
• Wyspa Medycyny Przyjaznej, difficulties in peeing: https://www.wyspamedycynyPrzyjaznej.pl/pl/trudnosci-w-sikaniu
• European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer: https://uroweb.org/guidelines/prostate-cancer
• NICE, Prostate cancer: diagnosis and management (NG131): https://www.nice.org.uk/guidance/ng131
• NICE, Suspected cancer: recognition and referral (NG12): https://www.nice.org.uk/guidance/ng12
• NICE, Metastatic spinal cord compression in adults (NG234): https://www.nice.org.uk/guidance/ng234
• NHS, Prostate cancer: https://www.nhs.uk/conditions/prostate-cancer/
• NHS, PSA test: https://www.nhs.uk/tests-and-treatments/psa-test/
• NHS, Benign prostate enlargement: https://www.nhs.uk/conditions/prostate-enlargement/
• National Cancer Institute, Prostate Cancer Treatment (PDQ) - Patient Version: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq
• National Cancer Institute, Prostate-Specific Antigen (PSA) Test: https://www.cancer.gov/types/prostate/psa-fact-sheet
• Patient.gov.pl, prostate cancer: https://pacjent.gov.pl/artykul/rak-prostaty