Prostate Cancer Guide: Screening & the Latest Treatments (2025)

Prostate cancer is one of the most common cancers in men. The good news is that when caught early, it is also one of the most treatable. In this guide, we will cover who should get screene Prostate cancer is one of the most common cancers in men. The good news is that when caught early,d, what modern tests are available, and the latest treatments that are improving survival and quality of life.

What is Prostate Cancer?

The prostate is a small gland found just below the bladder in men. It helps produce semen. Sometimes, cells in the prostate start to grow in an uncontrolled way, leading to prostate cancer.Most prostate cancers grow slowly, but some can be aggressive, which is why early detection matters.

Who is at Higher Risk?

While any man can develop prostate cancer, some are at higher risk:

• Age: Risk increases after 50 years.

• Family History: Men with a father or brother who had prostate cancer are more likely to get it.

• Genes: Mutations in genes such as BRCA1, BRCA2, and Lynch syndrome can raise risk.

• Race: Black men have a higher risk and often develop more aggressive cancers.

• Lifestyle: Obesity, smoking, and poor diet can worsen outcomes.

👉 If you fall into a high-risk group, you may need to start screening earlier.

Traditional Tests

1. PSA Test (Prostate-Specific Antigen): A simple blood test that measures PSA levels. High PSA does not always mean cancer—it can also rise due to infection or prostate enlargement.

2. DRE (Digital Rectal Exam): A physical exam where a doctor feels the prostate for any abnormalities. Today, DRE alone is not enough for early detection.

Newer & Better Options

• Advanced PSA-based tests like PHI, 4Kscore, and SelectMDx can reduce unnecessary biopsies.

• Prostate MRI (mpMRI): Helps identify suspicious areas before biopsy.

• Targeted Biopsies: MRI-guided or transperineal biopsies increase accuracy and reduce infection risks.

• PSMA PET Scan: A highly sensitive imaging test that can detect cancer spread even at very low PSA levels.

When Should You Get Screened?

Different guidelines vary, but here’s a simple breakdown:

• Men aged 55–69 (average risk): Discuss PSA screening with your doctor. If you choose it, testing is usually done every 1–2 years.

• Men at higher risk (Black men, BRCA carriers, strong family history): Consider starting discussions around age 40–45.

• Men 70 and older: Routine screening is generally not recommended unless you are very healthy with a long life expectancy.

👉 The key idea is shared decision-making—talk to your doctor about your personal risk and preferences.

What Happens if Your PSA is High?

1. Your doctor may repeat the test to confirm.

2. Other causes like infection or recent exercise are ruled out.

3. Advanced tests (MRI, biomarkers) may be suggested before biopsy.

4. If needed, a biopsy is performed to confirm cancer.

5. Results are then used to decide the best treatment plan.

Treatment Options for Prostate Cancer

Treatment depends on the stage and aggressiveness of the cancer. Let’s break it down:

1. Very Low-Risk and Low-Risk Cancer

• Active Surveillance: No immediate treatment. Instead, regular PSA tests, MRIs, and biopsies are done to monitor the cancer.

• This approach avoids unnecessary side effects for cancers that may never cause harm.

2. Intermediate-Risk Cancer

• Surgery (Radical Prostatectomy): Removal of the prostate, often done with robotic assistance.

• Radiation Therapy:

  • External Beam Radiation (EBRT): Daily sessions for a few weeks.

  • SBRT (Stereotactic Body Radiation Therapy): High-dose radiation in just 5 sessions.

  • Brachytherapy: Radioactive seeds implanted inside the prostate.

• Sometimes, short-term hormone therapy (ADT) is added to improve results.

3. High-Risk or Locally Advanced Cancer

• Surgery with lymph node removal or

• Radiation plus long-term hormone therapy (18–36 months).

• Some men benefit from a combination of radiation techniques.

4. Cancer That Returns (Recurrence)

• After surgery: Radiation therapy to the prostate area.

• After radiation: Salvage surgery or systemic therapy.

• PSMA PET scans are very useful to detect where the cancer has come back.

5. Advanced & Metastatic Cancer (Spread outside prostate)

Here’s where the most exciting new treatments have emerged:

• Hormone Therapy (ADT): Still the backbone.

• Next-generation drugs (ARPIs): Enzalutamide, Apalutamide, Abiraterone, and Darolutamide—these improve survival when combined with ADT.

• Chemotherapy: Docetaxel or cabazitaxel in advanced stages.

• Targeted Therapy (PARP inhibitors):

  • Drugs like Olaparib and Talazoparib work especially well for men with BRCA mutations.

• Radioligand Therapy (PSMA-Targeted):

  • The drug Pluvicto (Lu-PSMA-617) delivers radiation directly to prostate cancer cells.

  • In 2025, it is now approved for use earlier (before chemotherapy) in men with PSMA-positive cancer.

Side Effects: What to Expect

Every treatment has side effects, but many are temporary or manageable.

• Surgery: Risk of urinary leakage and erectile dysfunction.

• Radiation: Can cause urinary frequency, bowel issues, or fatigue.

• Hormone Therapy (ADT): Hot flashes, weight gain, bone loss, reduced sexual function.

• Targeted Therapies: Can cause fatigue, anemia, or nausea.

• Radioligand Therapy: May cause dry mouth, fatigue, or low blood counts.

👉 Regular follow-ups, lifestyle changes, and supportive care can help manage side effects.

Key Takeaways for Men

• Know your risk. If you are 40–45+ with family history or Black ancestry, discuss screening earlier.

• Don’t panic over PSA. A high result doesn’t always mean cancer—confirm with further tests.

• Low-risk cancers don’t always need treatment. Active Surveillance is safe for many men.

• Advanced options are improving outcomes. From PARP inhibitors to PSMA therapy, treatment is more personalized than ever.

• Talk openly with your doctor. Decisions should balance survival, side effects, and quality of life.

Conclusion

Prostate cancer care has changed dramatically in the past decade. Instead of a “one-size-fits-all” approach, men today benefit from personalized screening, smarter imaging, and highly targeted treatments. The most important step is starting the conversation with your doctor about your risk and screening options. Early knowledge truly saves lives.

consult with dr saurabh bansal at the clinics by surgeons house book your appointment now.