Author: Chioma Ezeobi, BPharm           

Reviewed by: Dr Azuka Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Prostate cancer often does not show early symptoms, making early screening important.
• PSA tests and Digital Rectal Exams (DRE) are key tests for early detection.
• Treatment options include surgery, chemotherapy, radiation therapy, and hormone therapy.
• Newer treatment options are targeted therapy, immunotherapy, and cryotherapy.
• Side effects from treatment are common, but most go away with time.
• Recovery time differs by treatment type, ranging from a few weeks to a year.
• Emotional support, healthy habits, and support groups play a major role in coping.

Introduction 

Prostate cancer is the second most common cancer among males worldwide. It is a cancer that develops in the prostate, a gland in the male reproductive system. It is shaped like a small walnut. It is located between the bladder and the rectum.Prostate cancer doesn’t show any symptoms until it becomes severe. Screening helps detect the disease early so that treatment can begin immediately, thereby reducing the death rate of prostate cancer.The American Cancer Society recommends that men start prostate screening at age 50 or earlier, at 45 if they are at a high risk, and at 40 if they have a family history of prostate cancer.

Common tests for detecting prostate cancer

Prostate cancer diagnostic tests often involve either blood tests or examinations.  They are:

• Prostate-specific antigen test (PSA).
• Ultrasound.
• Digital rectal examination (DRE).
• Prostate biopsy.
• Magnetic resonance imaging.

Prostate-specific antigen test (PSA test): 

It measures the amount of PSA in the blood. PSA is a protein produced by normal and cancerous prostate cells in the prostate. It is found mainly in the semen and in a small amount in the blood. 

During the test, a healthcare professional takes blood samples with a syringe from a vein in the arm. The sample is sent to the laboratory to measure the amount of PSA in the blood. The results are measured in nanograms per millilitre (ng/ml) of blood. A PSA level equal to or higher than 4ng/ml indicates a high risk of prostate cancer. [1][2] 

However, a high PSA can also detect other prostate conditions like:

• Benign Prostatic Hyperplasia (abnormal enlargement of the prostate).
• Prostatitis (inflammation of the prostate).
• Urinary tract infection (UTI)
• Recent ejaculation.
• Old age.
• Long bike rides.
• A recent bladder examination.
• Medications like testosterone.

PSA testing alone cannot diagnose prostate cancer. Further testing is needed for a more accurate result. [1]

Digital rectal examination (DRE)

It is a check for any bumps or hardness in the prostate. It is also used to check the size of the prostate. The doctor puts a glove on his hand and applies a lubricant. He gently puts his index finger inside the lower part of the rectum through the anus.

He checks the prostate for any bumps or lumps. It is also used to check the size of the prostate. The test may cause discomfort, but it only takes a few minutes. However, if you have any of the following, DRE may not be safe for you.

• Haemorrhoid (swollen blood vein in the anus and lower rectum).

• Anal fissure (a tear in the skin around the anus).
• An immunocompromised patient (a patient with a weak immune system).[3]

DRE is combined with PSA to diagnose prostate cancer.

Ultrasound

 It is the use of sound waves to produce an image of the prostate. Transrectal ultrasound is done through the anus and is used to detect abnormalities in the prostate gland.[4] This is usually utilised after an abnormal PSA and DRE. It is also used to aid in biopsy.

Prostate biopsy 

This is when a needle is used to take a piece of tissue from the prostate. The tissue is viewed under the microscope to check for cancer cells. It is carried out when  PSA is equal to or greater than 4ng/ml or if DRE is abnormal. [5] 

You will be given a local or general anaesthesia (painkiller) during this procedure. Prostate biopsy detects prostate cancer accurately, especially in areas that ultrasound misses. [1]

Magnetic resonance imaging (MRI)

It uses magnetic waves, radio waves, and a computer to produce a clear picture of the prostate gland. The doctor slightly puts a lubricated endorectal coil (a thin wire covered with a disposable latex glove) into the rectum. It helps to show a very clear image of the prostate.[1] Then, an MRI scanner takes a scan of the prostate.  MRI is used to:

• To detect areas of the prostate gland that may have cancer.
• To check how quickly a cancer can grow.
• To direct the needle during prostate biopsy to the area.
• To check how much the cancer cell has spread.

It is advised not to come for an MRI scan with jewellery and accessories. They could react with the waves to cause burns to the patient and damage to the picture. Also, let your doctor know if you have any metal implants or have had recent surgery.

How is Prostate Cancer treated?

Treatment options for prostate cancer differ for different patients. Your doctor considers how the cancer grows and spreads [6], your health status, and preferences.

Active surveillance (watchful waiting)

It is the close monitoring of patients who are not yet placed on treatment. The idea is to minimise the risk of side effects of treatment on patients with slow-growing cancer.[7] 

It involves regular follow-up on PSA tests, DRE, and prostate biopsies. 

Treatment starts immediately if the test results show the cancer is growing. 

Active surveillance is recommended for men who: 

• Have a slow-growing, low-risk tumour. 

• Have other serious health conditions that may affect treatment. 

• Over 75 years old and not expected to live for over 10 years. 

Surgery (Prostatectomy)

A surgical procedure in which a surgeon removes your prostate. This treatment option is used when the cancer is only in the prostate gland. Prostatectomy can be done in the following way:

• Simple Prostatectomy: To remove part of the prostate.
• Radical Prostatectomy: To remove the entire prostate.

Radiation therapy

• It uses high-energy rays or other radiation to kill cancer cells or stop them from growing. It may be used as a first treatment option or in combination with other treatments, like hormone therapy, to treat cancer that is in the prostate. 

Different types of radiation therapy are: 

• External radiation therapy: A radiation machine sends radiation to the part of the body with cancer to kill or stop it from growing.

• Internal radiation therapy (Brachytherapy): A small radioactive material is placed inside the prostate gland to kill the cancer cells. 

Hormone therapy

This is a treatment that stops the production of testosterone (male sex hormones) or prevents it from getting to the prostate cancer cells. 

Testosterone is a substance made mainly by the testicles and a small amount in the adrenal gland, and it circulates in the blood. The hormones support the growth of prostate cancer cells. 

Hormone therapy is provided as

•  Injections,

•  Tablets 

• Surgery.

 Hormone therapy for prostate cancer involves: 

• Use of luteinizing hormone-releasing hormone(LHRH) agonists: These drugs prevent the testicles from producing testosterone. Examples are buserelin and goserelin.

• Use of antiandrogens: They’re drugs that prevent androgen from producing testosterone. Examples are bicalutamide and flutamide.

• Orchiectomy: It is a surgical procedure to remove both testicles. 

Chemotherapy 

This is the use of drugs to treat prostate cancer. The drug either shrinks or kills the cancer cells. They are used to treat prostate cancer that has spread to other parts of the body. The drug can be taken by mouth or injected into the veins or muscles. They include drugs like:

• Carboplatin.
• Docetaxel.
• Cabazitaxel.

Newer treatments for prostate cancer

• Targeted therapy: It uses drugs to find and attack cancer cells in the prostate without harming the healthy cells. Targeted therapy is used only in people with abnormal changes in genes like BRCA1 or BRCA2 [8]

• Immunotherapy: The immune system is the body’s soldier that fights diseases, infections, and germs. It is a form of treatment that boosts the immune system to fight cancer cells. [9]  
• Cryotherapy: It is a treatment method that uses extreme cold to freeze and kill cancer cells. [7]

What to expect during treatment 

The following are what you will likely experience during treatment for prostate cancer:

Side effects 

Different treatment approaches come with different side effects. It might be many, fewer, or none for different people. Below are some of the side effects:Surgery:

• Leaking of urine from the bladder.
• Difficulty in getting or keeping an erection.
• Loss of fertility.
• Shortening of the penis length (1-2 centimeters shorter).

Radiotherapy:

• Difficulty in getting or keeping an erection.
• Diarrhoea and nausea.
• Extreme tiredness.
• Loss of pubic hair (hair that grows around the private part).

Hormone therapy 

• Loss of desire to have sex.
• Hot flashes (a sudden feeling of heat in the face, neck, and chest).
• Mood swing.
• Gynecomastia (male breast enlargement).

Chemotherapy 

• Loss of hair in the body.
• Tiredness.
• Anaemia.
• Nausea and vomiting.

Targeted therapy 

• Diarrhoea, nausea and vomiting.
• Liver problems like hepatitis.
• Skin problems like rashes, dry skin, and itching.
• High blood pressure.

Immunotherapy 

• Fever, headache, and chills.
• Skin rashes and itching.
• Difficulty breathing.
• Damage to organs in the body, like lungs, kidneys, intestines, and liver.

Cryotherapy 

• Pain and swelling in the scrotum, rectum and penis.
• Bleeding in the bowel.
• Damage to nearby nerves.
• Urinary tract infection.

Recovery time

Recovery time is the time it takes the body to return to its normal functions after prostate cancer treatment. Most side effects go away once treatment stops. [10]

Surgery

The most common side effects of surgery are on the urinary system and sexual function. Most men recover within a year. A study shows that 60% of patients' recovery starts at 3 months and more than 90%  by 12 months.

Radiotherapy

Recovery time for radiotherapy is three to six months. However, side effects on urinary and bowel functions do not completely disappear.

Hormone therapy

Hot flashes and tiredness subside after a few months. While a low sex drive takes 3 to 12 months to go away.

Chemotherapy 

Hair loss and diarrhea disappear shortly after the treatment stops. While tiredness and weight gain take months to go.

Coping strategies 

Men react in different ways when they’re told they have cancer. You may feel scared, angry, worried, or confused.[11] All these feelings are normal. Practising the points listed below can help make this difficult time easier.

• Learn about your treatment: Ask your doctor about your disease. The available treatment options, what to expect during and after treatment, and how to cope with them. It will be easier to make decisions and prepare for the future when you have this information. While coming to see your doctor: 
  • Jot down your questions.
  • Bring along a family member or friend for support.
  • Record the conversation for future use. 
  • Ask for further explanation if you do not understand any information.
• Talk to someone: Share your feelings, fears, and experiences with your loved ones or trained counsellors.[11] Talking to someone helps lighten your mood.
• Manage side effects: Prostate cancer treatment comes with side effects that bring changes to your body. They include infertility, urinary problems, and fatigue. Your doctor can recommend kegel exercise, adequate rest, and medication like sildenafil to manage them. However, infertility can be permanent. Let your doctor know if you want to have children in the future so you can bank your sperm.
• Join a support group: Join a support group of men with cancer or cancer survivors. Here, men share their experiences, ask questions, and give helpful resources. You will feel better knowing someone understands what you’re going through.
• Maintain a healthy lifestyle: Get enough sleep and exercise regularly. A study found that men who exercise manage mental stress and fatigue well. Eat a balanced diet and reduce unhealthy food and drinks like sugar and saturated fat.
• Practice relaxation techniques: Listen to music, practice meditation, yoga, and breathing exercises. They help manage stress and make you happy.

Call to action

Early detection is the key to reducing the rate of prostate cancer. Get screened today If you’re at higher risk like [12]:

• 45 years and above.
• Have a family history of prostate cancer.
• A black man. [13]
• Have a BRCA2 gene mutation.

Don't wait for symptoms before going to the hospital. Your life matters, and the world needs you. 

Reference

1. American Cancer Society. Tests to diagnose and stage prostate cancer. [Internet]. 2025 Mar 21. Available from:https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html

2. Micheal KD, Stephen WL.Prostate-specific antigen. [Internet]. 2024 Sep 10. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557495/

3. Juan A, Abdullah A, Anup K. Rectal Exam. [Internet]. 2023 Feb 18. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537356/#

4. Andrew M, Dickon H. Transrectal ultrasound biopsy of the prostate: does it still have a role in prostate cancer diagnosis? [Internet]. 2020 Dec [cited 2020 Dec;9(6):3018–3024]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7807378/

5. Paul G, Matthew S, Rajan V, Rakesh H. Chapter 12 Prostate cancer diagnosis: biopsy approaches. [Internet]. 2022 Sep 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585968/

6. Chika J. Overview of prostate cancer. [Internet]. 2025 April 7.  Available from: https://www.dacemedcomms.com/d-ace-health-library/overview-of-prostate-cancer

7. National Cancer Institute. Prostate cancer treatment (PDQ®)–health professional version. [Internet]. 2025 Feb 13. Available from: https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq

8. American Cancer Society. Targeted drug therapy for prostate cancer. [Internet]. 2023 Nov 22. Available from: https://amp.cancer.org/cancer/types/prostate-cancer/treating/targeted-therapy.html

9. American Cancer Society.Immunotherapy for prostate cancer. [Internet]. 2023 Nov 22. Available from: https://amp.cancer.org/cancer/types/prostate-cancer/treating/vaccine-treatment.html

10. Michaelson MD, Shane EC, Patricio CG, Anthony LZ, Douglas MD, Matthew RS. Management of complications of prostate cancer treatment. [Internet]. 2010 Jul 9. Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC2900775/

11. Jason SS, Joubert HE, Haymond L, Bryony RF. Coping and adjustment in men with prostate cancer: a systematic review of qualitative studies. [Internet]. 2018 Apr. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5884891/

12. Anum S. Risk factors and prevention of prostate cancer.[Internet]. 2025 April. Available from: https://www.dacemedcomms.com/d-ace-health-library/risk-factors-and-prevention-of-prostate-cancer

13. Pamela X, Naledi M, Desiree C, Kazzem G et al. Prostate cancer genetic risk and associated aggressive disease in men of African ancestry. [Internet]. 2023 Dec. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10697980/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published May 6. 2025