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# Prostate cancer

[Prostate](https://durgical.com/en/anatomy/prostate/) cancer is a cancer of the prostate gland; some grow so slowly they never cause harm, while others are aggressive and spread to bone.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Prostate](https://durgical.com/en/anatomy/prostate/)
- [Peripheral zone](https://durgical.com/en/anatomy/peripheral-zone-of-prostate/)
- [Seminal vesicles](https://durgical.com/en/anatomy/seminal-gland/)
- [Rectum](https://durgical.com/en/anatomy/rectum/)
- [Pelvic plexus and cavernous nerves](https://durgical.com/en/anatomy/inferior-hypogastric-plexus/)
- [Obturator nodes](https://durgical.com/en/anatomy/obturator-nodes/)
- [External iliac nodes](https://durgical.com/en/anatomy/external-iliac-nodes/)
- [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/)

## In biochemistry

- [Tumour markers: principles of use](https://durgical.com/en/biochemistry/topics/tumour-markers-principles-of-use/)
- [Prostate-specific antigen (PSA)](https://durgical.com/en/biochemistry/topics/prostate-specific-antigen/)
- [17α-Hydroxylase/17,20-lyase (CYP17A1)](https://durgical.com/en/biochemistry/enzymes/17-hydroxylase-17-20-lyase/)

## In histology

- [Epididymis, vas deferens, seminal glands and prostate](https://durgical.com/en/histology/epididymis-vas-deferens-seminal-glands-and-prostate/)

## In the clinical exam

- [Digital rectal examination](https://durgical.com/en/clinical-exam/digital-rectal-examination/)

## In physiology

- [Testosterone and its actions](https://durgical.com/en/physiology/testosterone-and-its-actions/)

## Why it happens

- [Translocations, amplifications and epigenetic changes in cancer](https://durgical.com/en/general-pathology/translocations-amplifications-and-epigenetic-changes-in-cancer/)
- [Tumour markers: serum and tissue, and what each one is for](https://durgical.com/en/general-pathology/tumour-markers-serum-and-tissue-and-what-each-one-is-for/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [Grading and staging: what TNM means](https://durgical.com/en/general-pathology/grading-and-staging-what-tnm-means/)
- [Cancer epidemiology: age, environment, predisposing conditions (and Colombia)](https://durgical.com/en/general-pathology/cancer-epidemiology-age-environment-predisposing-conditions/)
- [From specimen to report: fixation, margins and the pathology report](https://durgical.com/en/general-pathology/from-specimen-to-report-fixation-margins-and-the-pathology-report/)

## Show 3 more

- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [Immunohistochemistry: the principle and the markers to know](https://durgical.com/en/general-pathology/immunohistochemistry-the-principle-and-the-markers-to-know/)
- [Genomic instability: mismatch repair, BRCA and xeroderma pigmentosum](https://durgical.com/en/general-pathology/genomic-instability-mismatch-repair-brca-and-xeroderma-pigmentosum/)

## What it is

A malignant tumour of the prostate, mostly acinar adenocarcinoma arising in the [peripheral zone](https://durgical.com/en/anatomy/peripheral-zone-of-prostate/). It ranges from slow-growing disease that never causes harm to aggressive cancer that spreads to bone.

## Who gets it

One of the most frequently diagnosed cancers in men worldwide and in Colombia, and a leading cause of male cancer death in Latin America. Risk rises with age and is higher in men of African descent.

## Causes

- Adenocarcinoma of the glandular epithelium
- Growth depends on androgen-receptor signalling
- Inherited or acquired gene changes (e.g. BRCA2, HOXB13, mismatch-repair genes)
- Precursor: high-grade prostatic intraepithelial neoplasia

## Risk factors

- Older age
- Father or brother with prostate cancer
- Hereditary syndromes (BRCA1/2, Lynch)
- African ancestry
- Possibly obesity and diet (evidence mixed)

## Pathophysiology

Most tumours start in the posterior peripheral zone, where they can be felt on rectal exam, and are often multifocal. Spread is local (capsule, [seminal vesicles](https://durgical.com/en/anatomy/seminal-gland/), bladder neck), to pelvic lymph nodes, and through the blood mainly to bone, producing osteoblastic lesions in the [spine](https://durgical.com/en/anatomy/region/spine/) and [pelvis](https://durgical.com/en/anatomy/region/pelvis/).

## Classification

- Gleason score and ISUP grade groups 1–5 (group 1 = Gleason 6; group 5 = Gleason 9–10)
- TNM staging
- Risk groups (very low to very high) combining PSA, grade group and stage; criteria vary between guidelines
- Castration-sensitive vs castration-resistant disease

## Symptoms and signs

- Usually none in early disease (found by PSA or exam)
- Lower urinary tract symptoms, often from coexisting BPH
- Blood in urine or semen
- Bone pain, weight loss or anaemia in metastatic disease
- Hard, nodular or asymmetric prostate on rectal exam

## Red flags

- New back pain with leg weakness, numbness or bladder or bowel problems (metastatic spinal cord compression: emergency)
- Bone pain or pathological fracture
- Urinary retention or bilateral hydronephrosis
- Very high PSA

## Diagnosis

**Clinical**
Digital rectal exam. PSA screening is offered after shared decision-making about benefits (fewer deaths) and harms (false positives, overdiagnosis, overtreatment).

**Tests**
PSA, repeated to confirm; biopsy (transperineal or transrectal, often MRI-targeted) gives the Gleason score and ISUP grade group; testosterone and alkaline phosphatase.

**Imaging**
Multiparametric MRI before biopsy; staging with CT and bone scan or PSMA PET in higher-risk disease.

## Differential diagnosis

- Benign prostatic hyperplasia
- Prostatitis
- Urinary tract infection (raises PSA)
- Other causes of bone lesions
- Bladder cancer

## Goal of treatment

Cure localised, clinically significant cancer while avoiding overtreatment of low-risk disease, and control advanced disease with good quality of life.

## Treatment

**Follow-up**
Active surveillance (PSA, exam, repeat MRI and biopsy) for low-risk disease; watchful waiting for older or frail men.

**Surgical**
Radical prostatectomy (open, laparoscopic or robotic), with pelvic lymph node dissection when indicated.

**Procedure**
Radiotherapy (external beam or brachytherapy), often with androgen deprivation in intermediate- and high-risk disease.

**Medical**
Androgen deprivation therapy (GnRH agonists or antagonists, or orchiectomy) for advanced disease, often combined with androgen-receptor pathway inhibitors or taxane chemotherapy.

**Medical**
Castration-resistant disease: taxanes, androgen-receptor pathway inhibitors, PARP inhibitors (with DNA-repair mutations), radioligand therapy and bone-protecting agents.

**Acute**
Suspected [spinal cord](https://durgical.com/en/anatomy/spinal-cord/) compression: urgent corticosteroids, MRI and radiotherapy or surgery.

## Drugs for this condition

- [Leuprorelin](https://durgical.com/en/pharmacology/leuprorelin/)
- [Abiraterone](https://durgical.com/en/pharmacology/abiraterone/)
- [Bicalutamide](https://durgical.com/en/pharmacology/bicalutamide/)
- [Enzalutamide](https://durgical.com/en/pharmacology/enzalutamide/)
- [Flutamide](https://durgical.com/en/pharmacology/flutamide/)
- [Degarelix](https://durgical.com/en/pharmacology/degarelix/)
- [Goserelin](https://durgical.com/en/pharmacology/goserelin/)
- [Triptorelin](https://durgical.com/en/pharmacology/triptorelin/)
- [Docetaxel](https://durgical.com/en/pharmacology/docetaxel/)

## Complications

- Bone metastases, fractures and spinal cord compression
- Urinary obstruction
- After treatment: urinary incontinence and erectile dysfunction
- Radiation proctitis or cystitis
- Androgen deprivation effects: hot flushes, bone loss, metabolic and cardiovascular risk

## Prognosis

Localised disease has very good long-term survival. Outlook worsens with higher grade group and metastases, although many men with advanced disease live for years with treatment.

## Test yourself

Think of the answer, then tap the question to see it.

## In which zone of the prostate do most cancers arise?

The peripheral zone, posterior and palpable on digital rectal exam.

## How do the Gleason score and ISUP grade groups relate?

ISUP groups 1–5 regroup Gleason scores: group 1 is Gleason 6 and group 5 is Gleason 9–10.

## How is PSA screening approached?

By shared decision-making, weighing fewer cancer deaths against false positives, overdiagnosis and overtreatment.

## Where does prostate cancer most often metastasise?

To bone, with osteoblastic lesions, mainly in the spine and pelvis.

## Which oncological emergency must be recognised in metastatic prostate cancer?

Spinal cord compression: back pain with leg weakness, numbness or sphincter problems.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/prostate-cancer/)

## Related conditions

- [Benign prostatic hyperplasia](https://durgical.com/en/conditions/benign-prostatic-hyperplasia/)
- [Prostatitis](https://durgical.com/en/conditions/prostatitis/)
- [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/)
- [Bladder cancer](https://durgical.com/en/conditions/bladder-cancer/)
- [Erectile dysfunction](https://durgical.com/en/conditions/erectile-dysfunction/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Prostate Cancer](https://www.ncbi.nlm.nih.gov/books/NBK470550/) (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/prostate-cancer/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/prostate-cancer/