Prostate cancer treatment depends on how aggressive the cancer looks on biopsy, whether it has spread, and how treatment could affect your health and daily life. Many men with low-risk, localised prostate cancer can safely start with active surveillance. Surgery or radiotherapy can treat higher-risk localised disease with the aim of cure. If the cancer has spread, treatment usually starts with testosterone-lowering therapy combined with another medicine, with later options guided by previous treatment, scans, and genetic test results. [1–3]
By Dr Raman Narang, Consultant Medical & Hemato-Oncologist, New Delhi
A raised PSA may lead to a repeat blood test, an MRI, or a biopsy. A biopsy that confirms cancer raises a different question: how likely is this cancer to cause harm, and would treating it now help? If you are seeking prostate cancer treatment in Delhi, ask our team to explain your risk group and stage before comparing surgery, radiation, or surveillance.
1. What are the symptoms of prostate cancer, and what does a raised PSA mean?
Early prostate cancer often causes no symptoms. A weak urine stream, frequent urination, or getting up at night to pass urine can occur with benign prostate enlargement and other conditions. Persistent urinary symptoms or visible blood in the urine deserve assessment. Persistent bone pain can occur in advanced prostate cancer and should be discussed with the treating team. [1]
PSA, or prostate-specific antigen, is a protein made by the prostate. The level can rise with cancer, benign enlargement, or inflammation. An elevated result may need to be repeated or interpreted alongside previous PSA readings, prostate size, examination findings, and family history. Older age, a strong family history, and certain inherited changes such as BRCA2 can increase prostate cancer risk. [1]
In someone with known or suspected advanced prostate cancer, new back pain with leg weakness, numbness, or loss of bladder or bowel control requires emergency assessment because it can indicate pressure on the spinal cord. [1]
2. How is prostate cancer diagnosed and classified?
A multiparametric MRI of the prostate is usually obtained before biopsy when localised cancer is suspected. It can show areas that need targeted sampling. A reassuring MRI may support PSA monitoring when the overall risk is low. A biopsy may still be needed if the PSA, examination, or family history raises enough concern. [1]
The biopsy usually confirms the diagnosis and identifies the type. Most prostate cancers are adenocarcinomas. Rare types, such as small-cell neuroendocrine prostate cancer, can behave differently and require a different treatment approach. [1, 3]
| Finding on the report | What it tells you |
|---|---|
| PSA | Contributes to the risk assessment and provides a baseline for follow-up. |
| Gleason score and Grade Group | Describe how aggressive the cancer looks under the microscope. Grade Groups run from 1 to 5. Gleason 3+4=7 is Grade Group 2, while 4+3=7 is Grade Group 3 because the more aggressive pattern makes up a larger share of the tumour. |
| Stage | Describes where the cancer is. It may be confined to the prostate, extend into nearby tissues, involve regional lymph nodes, or spread to distant sites such as bones. |
| Risk group | Combines PSA, Grade Group, clinical stage, and sometimes the amount of cancer in the biopsy to estimate how likely the cancer is to progress or recur. Intermediate-risk disease can be further divided into favourable and unfavourable groups. |
PSMA PET/CT can help look for spread in selected patients, particularly when the cancer is higher risk and the result could change treatment. It can also help locate recurrence after previous treatment. Many patients with low-risk disease can make a treatment decision without it. [1]
3. How is localised prostate cancer treated?
The main options are active surveillance, radical prostatectomy, and radiotherapy. The decision depends on the risk group, overall health, and priorities such as urinary control, sexual function, or avoiding the side effects of hormone therapy. [1]
| Clinical situation | What the team usually discusses |
|---|---|
| Low-risk prostate cancer | Active surveillance is preferred for many suitable men. It uses scheduled PSA tests, clinical review, and repeat MRI or biopsy according to the protocol. Treatment can be offered if reassessment shows the cancer has become more concerning. |
| Favourable intermediate-risk disease | Surgery or radiotherapy may be appropriate. Active surveillance can also be considered for selected men with a small amount of Grade Group 2 cancer and otherwise favourable findings. |
| Unfavourable intermediate-risk disease | Surgery or radiotherapy may be offered. A short course of testosterone-lowering treatment is often added when external-beam radiotherapy is chosen. |
| High-risk localised disease | Radiotherapy is often combined with a longer course of hormone therapy. Surgery may be appropriate in selected patients who understand that radiation or medicines may also be needed afterward. |
Radical prostatectomy removes the prostate and seminal vesicles, sometimes with nearby lymph nodes. Urine leakage and erectile difficulties are important potential side effects. Radiotherapy treats the prostate and, in selected cases, nearby areas. It can cause urinary irritation, bowel symptoms, or changes in sexual function. Both approaches can affect fertility, so discuss fertility preservation before treatment if it matters to you. [1]
4. What if prostate cancer extends beyond the prostate or returns after treatment?
Cancer that has grown into nearby structures or reached regional pelvic lymph nodes may still be treated with the aim of cure. A common approach is radiotherapy with long-term androgen deprivation therapy (ADT). ADT lowers testosterone, which drives the growth of most prostate cancers. For selected patients with very high-risk or regional node-positive disease, the team may discuss adding an androgen-signalling medicine such as abiraterone. [1]
After surgery, PSA is expected to fall to a very low or undetectable level. If it remains detectable or begins to rise, the team reviews the trend, surgical pathology, and any imaging that might change the plan. Early salvage radiotherapy, sometimes combined with ADT, can be appropriate for selected patients after prostatectomy. After primary radiotherapy, PSA typically falls more gradually, and the team uses different criteria to assess whether the cancer has returned. [1]
5. How is metastatic prostate cancer treated?
Metastatic hormone-sensitive prostate cancer can still respond to treatments that lower testosterone or block its effects. For many patients, treatment starts with ADT plus an androgen receptor pathway inhibitor, such as abiraterone, enzalutamide, apalutamide, or darolutamide, depending on the clinical situation. Selected patients fit for chemotherapy may benefit from a three-drug approach that also includes docetaxel. For some men whose cancer has spread to only a few sites at diagnosis, radiation to the prostate may also be appropriate. [1]
Metastatic castration-resistant prostate cancer means the cancer is progressing despite testosterone being kept at a very low level. ADT usually continues while the team selects another treatment. Depending on previous therapy, symptoms, and test results, options can include chemotherapy, a PARP inhibitor for eligible patients with certain DNA-repair alterations, or lutetium-177 PSMA radioligand therapy for selected patients with PSMA-positive disease. Eligibility depends on the exact findings, prior treatment, and the applicable prescribing indication and access in India. [1, 3]
Men with metastatic prostate cancer should be offered germline genetic testing, which looks for inherited changes that can affect treatment and may have implications for relatives. Tumour or blood-based genomic testing can also help identify treatment options when a biomarker-directed therapy is being considered. Alongside cancer treatment, the team can address bone pain and discuss how to protect bone and muscle health during long-term ADT. [1–3]
What I look for clinically before recommending treatment
I start with the dated PSA results, biopsy Grade Group, MRI, and any staging scans. In low-risk disease, I want to know whether surveillance is practical and what finding would prompt treatment. When both surgery and radiation are reasonable, I ask about urinary symptoms, sexual function, and other health conditions because the expected side effects can matter as much as the treatment schedule. If the cancer has spread, I review where it has spread, what treatments the patient has already received, and whether genetic testing could change the next choice.
How the next step is decided
| If the reports show… | The next discussion is about… |
|---|---|
| Raised PSA without a confirmed diagnosis | Whether to repeat PSA, obtain a prostate MRI, or proceed to biopsy |
| Low-risk cancer confined to the prostate | Active surveillance and the schedule for reassessment |
| Higher-risk cancer without distant spread | Surgery or radiotherapy, and whether hormone therapy or other treatment should be added |
| Rising PSA after previous treatment | Where the cancer may have returned and whether salvage treatment is appropriate |
| Newly diagnosed metastatic disease | Which treatment to add to ADT and whether genetic testing or prostate radiation could change the plan |
| Progression despite very low testosterone | The next treatment based on prior therapy, biomarkers, symptoms, and PSMA imaging where appropriate |
What to bring to a prostate cancer consultation in Delhi
- All PSA results with dates, including readings before and after any treatment.
- Prostate MRI report and original images, if available.
- Biopsy or prostatectomy pathology report, including the Gleason score and Grade Group.
- PSMA PET/CT, CT, MRI, or bone scan reports and images, if performed.
- Dates of hormone injections, medicines, chemotherapy, surgery, or radiotherapy already received.
- Genetic or tumour profiling reports, if available, and any family history of prostate, breast, ovarian, or pancreatic cancer.
Frequently asked questions
Does a high PSA always mean prostate cancer?
A high PSA can also occur with benign enlargement or inflammation. The next step depends on the level, how it has changed, and what the examination and MRI show. [1]
Is active surveillance a safe option?
For appropriately selected men with low-risk disease, active surveillance is a standard approach. Its safety depends on keeping scheduled follow-up and reassessing if the findings change. [1]
Is robotic surgery better than radiotherapy?
The choice depends on the stage and risk group, baseline urinary and sexual function, other health conditions, and what each option would involve. For example, radiation may include ADT, while some patients who start with surgery may need radiation afterward. Ask both teams to explain the likely full course of treatment. [1]
Can metastatic prostate cancer be cured?
Treatment usually aims to control the cancer, relieve symptoms, and help patients live longer. How long the disease responds varies, and the team may use several treatments over time. [1, 3]
Before deciding, ask your team to write down your Grade Group, stage, and risk group, and to explain whether the immediate goal is monitoring, cure, or long-term control. If more than one approach is reasonable, compare the full treatment course and likely effects on your day-to-day life.
This page is for general education. Individual treatment decisions require review of your pathology, scans, PSA results, and overall health by your treating team.
Clinical references
- European Association of Urology and partner societies. EAU Guidelines on Prostate Cancer. 2026 edition. Sections on diagnostic evaluation, classification and staging, treatment, and follow-up.
- American Society of Clinical Oncology. Germline and Somatic Genomic Testing for Metastatic Prostate Cancer: ASCO Guideline. 2025.
- American Society of Clinical Oncology. Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Living Guideline. 2026.