Prostate Cancer
Prostate Carcinoma · PCa
2nd most common cancer in men — ~1.4 million new cases/year
Prostate cancer ranges from indolent, low-risk disease (many men die with it rather than from it) to highly aggressive metastatic disease. Risk stratification using PSA, Gleason grade group, and clinical stage determines management — from active surveillance to immediate systemic therapy. Androgen receptor (AR) signalling drives almost all prostate cancer; BRCA2, CDK12, and ATM mutations define a subset with distinct biology and PARP inhibitor eligibility.
4
Subtypes
10
Diagnostic Tests
12
Treatment Options
For Informational Purposes Only
Content on this page is for educational purposes only and does not constitute medical advice.
🗺 What Do I Do Next? — Your Roadmap
Just diagnosed with Prostate Cancer? Here are your essential next steps.
Get the Full Diagnostic Workup
Before any treatment begins, you need 10 key tests — imaging, blood markers, biopsy, and molecular profiling. See the Diagnostic Workup section below. Do NOT start treatment without molecular testing — it determines which therapies work for your specific subtype.
Know Your Molecular Subtype
Prostate Cancer is not one disease — it has 4 distinct subtypes defined by biomarkers (PSA, Gleason Grade Group, BRCA1, BRCA2, and more). Your subtype determines which treatments apply to you. See Subtypes & Mutations below.
Assemble Your Care Team
You need a multidisciplinary team: oncologist (medical, surgical, radiation), pathologist, radiologist, and ideally a molecular tumour board review. Seek a second opinion at a major cancer centre for any Stage III-IV diagnosis.
Review All Treatment Options
Treatment for Prostate Cancer spans Surgery, Chemotherapy, Radiation, Targeted Therapy, Immunotherapy, Hormonal, Other. See the full Treatment Options section below. Ask your oncologist which options apply to your specific subtype and stage.
Ask About Clinical Trials
Many of the most effective treatments started as clinical trials. Ask your oncologist about eligibility. Search clinicaltrials.gov with your cancer type + molecular profile. Academic centres have the most trials.
Key Biomarkers & Mutations
Subtypes & Molecular Profiles
Tumour still responds to castration (surgical or medical). Standard treatment is androgen deprivation therapy (ADT). Modern trials show adding an ARPI (enzalutamide, apalutamide, darolutamide) or docetaxel to ADT significantly improves OS in high-volume or high-risk metastatic HSPC.
KEY THERAPIES FOR THIS SUBTYPE
Diagnostic Workup
10 testsBLOOD & TUMOUR MARKERS
PSA (Prostate-Specific Antigen)
At diagnosis, then every 3 months during active treatmentScreening and monitoring. Elevated PSA triggers biopsy decision. Serial PSA used to monitor treatment response and detect recurrence.
Testosterone Level
Every 3–6 months on ADTConfirm castrate level (< 50 ng/dL) in patients on ADT. Required to define CRPC.
IMAGING
MRI Prostate (mpMRI — multiparametric)
Before biopsy and at diagnosisPI-RADS scoring — identifies suspicious lesions for targeted biopsy. Preferred before biopsy. Assesses extracapsular extension and seminal vesicle invasion.
CT Abdomen / Pelvis
Intermediate-high risk at diagnosis; rising PSA post-treatmentLymph node metastases and pelvic organ involvement. Less sensitive than PSMA-PET for early nodal disease.
PSMA-PET CT (Ga-68 or F-18 PSMA)
High-risk at diagnosis; biochemical recurrence post-prostatectomySuperior to conventional CT + bone scan for nodal, bone, and soft tissue metastases. Now first-line staging for intermediate-high risk prostate cancer.
Bone Scan (Tc-99m)
High-risk at diagnosis; symptomatic bone painDetect bone metastases when PSMA-PET not available. Still standard in many centres.
BIOPSY & PATHOLOGY
Transrectal / Transperineal Prostate Biopsy
At diagnosisTissue for histology and Gleason grade group (1–5). Targeted biopsy to MRI lesions + systematic cores. Transperineal approach reduces infection risk.
GENETIC & MOLECULAR
Germline DNA Repair Gene Testing (BRCA1/2, ATM, PALB2)
Metastatic disease — all patients; high-risk localisedBRCA2 identifies PARP inhibitor eligibility and family cancer risk. Recommended for all metastatic prostate cancer and high-risk localised disease.
Somatic Tumour Testing (Foundation One / tissue NGS)
Metastatic CRPC before initiating second systemic therapyMSI-H (pembrolizumab eligibility), TMB-H, somatic BRCA2, CDK12 mutations, AR splice variants in CRPC.
AR-V7 Liquid Biopsy (EPIC Sciences)
CRPC progressing on or considering ARPIAR splice variant 7 in circulating tumour cells predicts resistance to enzalutamide/apalutamide — directs to taxane chemotherapy instead.
Treatment Options
12 optionsSURGERY
Radical Prostatectomy (RARP / Open)
Localised prostate cancer (any risk group). Robotic-assisted radical prostatectomy (RARP) now standard in most centres. +/- pelvic lymph node dissection.
CHEMOTHERAPY
Docetaxel + Prednisone
High-volume mHSPC (+ ADT, CHAARTED trial) or mCRPC. 6 cycles.
RADIATION
External Beam Radiotherapy (EBRT)
Localised or locally advanced prostate cancer — equivalent survival to surgery. Combined with ADT for intermediate/high risk.
Brachytherapy (LDR / HDR)
Low and intermediate-risk — permanent seed implant (LDR) or temporary high-dose rate. Excellent local control.
TARGETED THERAPY
Olaparib (Lynparza)
BRCA1/2-mutant mCRPC after ARPI — PROfound trial. Also combination with abiraterone (PROpel) in unselected CRPC.
IMMUNOTHERAPY
Pembrolizumab
MSI-H / TMB-H mCRPC — FDA approved tumour-agnostic. Rare in prostate cancer (~3%) but highly responsive.
HORMONAL
ADT (LHRH Agonist / Antagonist)
Metastatic disease, high-risk localised with radiation, or recurrence. Medical castration — reduces testosterone to castrate levels.
Enzalutamide (Xtandi)
mHSPC (+ ADT) or mCRPC — next-generation androgen receptor inhibitor. ARCHES, PROSPER, PREVAIL trials.
Abiraterone + Prednisone (Zytiga)
mHSPC or mCRPC — CYP17A1 inhibitor blocks adrenal androgen synthesis. LATITUDE, COU-AA-302 trials.
OTHER
Active Surveillance
Very low and low-risk localised prostate cancer (Gleason Grade Group 1, PSA < 10). PSA every 6 months, MRI and repeat biopsy per protocol. Avoids overtreatment.
177Lu-PSMA-617 (Pluvicto)
PSMA-positive mCRPC after ARPI and docetaxel — VISION trial. Radioligand therapy delivering targeted radiation to PSMA-expressing cells.
Radium-223 (Xofigo)
Bone-predominant mCRPC — alpha particle radiation to bone metastases. Improves OS and reduces skeletal events (ALSYMPCA trial).