Few words in a doctor’s clinic carry as much weight as a diagnosis of prostate cancer. In my career of over two decades, having sat with hundreds of men and their families at that moment, I have also seen how much changes, once the diagnosis is better understood.
Prostate cancer is often slow-moving and highly treatable, with advances offering more choices while preserving quality of life. It mostly affects men in their sixties, although younger men are increasingly being diagnosed, with age, family history and obesity among the key risk factors. It is vital to note that early detection remains one of the most important advantages in prostate cancer care. The PSA test, a simple blood test, is a valuable tool, although a raised PSA can also indicate an enlarged prostate or infection rather than cancer. Combined with regular check-ups and a physical examination, screening can help detect the disease early, giving doctors and patients more time and a wider range of treatment choices.
Once a diagnosis is confirmed through imaging and a tissue biopsy, treatment decisions depend on how the cancer looks under the microscope and whether it has remained within the prostate or moved beyond it. Reassuringly, prostate cancer does not always require immediate treatment. For many low-risk, slow-growing cancers, active surveillance through regular tests is recommended, with treatment available if needed. For those who do require treatment, several well-established options are available, with the choice guided by both medical necessity and personal comfort.
Surgery, known as radical prostatectomy, removes the prostate gland and is now usually performed through robot-assisted techniques. In my own practice, robotic surgery has been a genuine turning point. The greater precision around the delicate nerves and structures surrounding the prostate can mean smaller incisions, less blood loss, less pain and a quicker return to normal life. For many stages of prostate cancer, radiation therapy too has been equally effective and does not require surgery. Options include external beam radiation, brachytherapy and proton therapy, which targets the tumour precisely, while sparing the nearby bladder and rectum. Some men, particularly those with more advanced disease, do also benefit from hormone therapy.
Alongside, questions about urinary changes, bowel changes and sexual function understandably come up in nearly every consultation. These concerns are real and deserve to be discussed openly. Most side effects are temporary, while modern techniques, including the greater precision of robotic surgery, have meaningfully reduced how often they occur. Preserving urinary and sexual function, wherever possible, is therefore an important part of the treatment conversation and of protecting quality of life.
There is another reason prostate cancer is a very different conversation today from the one it was a generation ago. Advances in diagnosis and treatment are making care more precise and increasingly personalised, with greater attention to protecting quality of life. This progress has also changed how treatment decisions are made. Rather than resting with one doctor, care increasingly brings together urologists, radiation oncologists and medical oncologists to determine the approach best suited to the cancer and the patient’s overall health.
At leading institutions, this multidisciplinary approach also means that expertise across surgery, radiation and medical oncology can be brought together when evaluating each case. The choice is therefore not simply between different treatments, but about identifying the treatment, or sometimes active surveillance, most appropriate for the individual patient while considering both disease control and quality of life.
The prostate cancer conversation has therefore changed considerably. A diagnosis remains serious, but the focus now extends beyond treating the disease to how early it is detected, whether immediate treatment is necessary, which option is most appropriate and how quality of life can be protected.
Perhaps that is the most reassuring progress of all. Better treatment today also means more considered choices, and a greater focus on the life that continues beyond prostate cancer!
Dr. Deepak Raghavan is a Senior Consultant Urologist and Robotic Surgeon at Apollo Hospitals, Chennai, with over two decades of experience in urology and uro-oncology, laparoscopic and robotic-assisted surgery, renal transplantation and complex urological conditions.