Prostate cancer

The prostate is a small gland, about the size of a walnut, that sits below the bladder and surrounds the upper part of the urethra in men and people assigned male at birth. It produces fluid that forms part of semen. Prostate cancer develops when cells in the prostate begin to grow and divide in an uncontrolled way.

Prostate cancer varies widely in how it behaves. Some tumours grow slowly and may never cause symptoms or shorten life, while others can be more aggressive and spread beyond the gland. How quickly a cancer is likely to grow is reflected in its grade, described later. This wide range of behaviour is why diagnosis and treatment are carefully individualised, and why monitoring rather than immediate treatment is sometimes the most appropriate choice.

Prostate cancer is common. It is one of the most frequently diagnosed cancers in men, and the median age at diagnosis is around 68 years. Most men are diagnosed when the cancer is still confined to the prostate or nearby tissue. Understanding what kind of prostate cancer you have, rather than simply that you have it, is the foundation of every good treatment decision.

The great majority of prostate cancers are adenocarcinomas, which arise from the gland cells that produce prostate fluid. When people say prostate cancer, they almost always mean this type. Within adenocarcinoma, the most common form is described as acinar, and a less common variant is ductal adenocarcinoma, which can behave more aggressively.

A small number of prostate cancers are rarer types that are treated differently from typical adenocarcinoma. These include:

• Small cell (neuroendocrine) carcinoma, an uncommon and usually fast-growing form.
• Transitional cell (urothelial) carcinoma, which usually begins in the urethra or bladder and grows into the prostate.
• Squamous cell carcinoma and sarcomas, which are very rare.

Cancer behaviour is described not only by cell type but by grade, which measures how abnormal the cells look and how likely they are to grow quickly. For prostate cancer this is captured by the Gleason score and Grade Groups, explained later, and it is one of the most important pieces of information your team will use.

The exact cause of prostate cancer is not fully understood, and most men who develop it have no clear single reason. Research has, however, identified factors that raise the likelihood. Having one or more does not mean you will develop the disease, and many men with prostate cancer have none of the strong risk factors.

• Age. Risk rises with age, particularly after 50. The disease is uncommon in younger men.
• Family history. Having a father, brother or son diagnosed with prostate cancer increases a man's risk, and the risk is higher when several relatives are affected or when a relative was diagnosed young.
• Inherited genetic changes. Inherited variants in genes such as BRCA1 and BRCA2, and in genes linked to Lynch syndrome, can increase risk and may be associated with more aggressive disease. A family history of breast, ovarian or pancreatic cancer can be relevant here.
• Ethnicity. Population data show that men of Black African or Caribbean heritage have a higher risk and higher mortality than other groups, while the disease is less common in men of Asian heritage. The reasons are not fully understood.
• Other factors. Obesity has been linked to a higher risk of aggressive disease, and diet and other lifestyle factors are under continued study.

If you have a strong family history or a known inherited gene change, it is worth discussing earlier and more personalised PSA testing, and possibly genetic counselling, with a qualified doctor.

Early prostate cancer often causes no symptoms at all, because the tumour is too small to press on anything. This is an important point: the absence of symptoms does not mean the absence of disease, which is part of why testing is discussed even in men who feel well.

When symptoms do occur, they may include:

• Needing to urinate more often, especially at night.
• Difficulty starting or stopping urination, or a weak or interrupted stream.
• A feeling that the bladder has not emptied fully.
• Blood in the urine or semen.
• Pain or discomfort when urinating or ejaculating.

Importantly, these urinary symptoms are far more often caused by benign prostate enlargement, a non-cancerous swelling of the prostate that is common with age, than by cancer. Advanced disease that has spread to bone can cause new, persistent bone pain, unexplained weight loss or fatigue.

See a doctor if you notice new or worsening urinary symptoms, blood in the urine or semen, or persistent unexplained pain. Getting checked does not mean you have cancer, but it allows the cause to be identified and treated appropriately.

There is no universal national screening programme for prostate cancer in most countries, and major bodies do not recommend routinely screening every man. The consensus from organisations such as the US Preventive Services Task Force is shared, informed decision-making: men should discuss the potential benefits and harms of testing with a clinician and decide based on their own values and risk.

The main screening tool is the PSA (prostate-specific antigen) blood test, sometimes combined with a digital rectal examination. PSA is a protein made by the prostate; higher levels can indicate cancer but also rise with benign enlargement, infection or recent activity, so an elevated PSA is not a diagnosis.

The benefits and harms are genuinely balanced, which is why the decision is personal:

• Potential benefit. PSA testing can detect some cancers earlier and may modestly reduce deaths from prostate cancer in screened populations.
• Potential harms. These include false alarms, anxiety, complications from biopsy, and overdiagnosis, meaning finding slow-growing cancers that would never have caused harm, which can lead to treatment with its own side effects.

The US Preventive Services Task Force frames individual, shared decision-making for men aged 55 to 69, and recommends against routine PSA screening for men aged 70 and older. Earlier discussion may be appropriate for those at higher risk, such as men with a strong family history, an inherited gene change, or of Black heritage. Talk to a qualified doctor about whether and when PSA testing is right for you.

Diagnosis usually begins with a PSA test and a digital rectal examination. If results raise concern, the next step is increasingly a multiparametric MRI scan of the prostate, which helps locate suspicious areas and can sometimes avoid an unnecessary biopsy.

A definitive diagnosis requires a biopsy, in which small tissue samples are taken from the prostate, often guided by MRI and ultrasound, and examined under a microscope. The pathologist assesses how abnormal the cells look and assigns a Gleason score.

The Gleason system grades the two most common cell patterns and adds them, giving scores from 6 to 10. These map onto five Grade Groups, which are easier to interpret:

• Grade Group 1: Gleason 6 or less, least aggressive.
• Grade Group 2: Gleason 3+4=7.
• Grade Group 3: Gleason 4+3=7.
• Grade Group 4: Gleason 8.
• Grade Group 5: Gleason 9 to 10, most aggressive.

If the cancer may have spread, further imaging such as CT, a bone scan, or a PSMA PET scan may be used. Findings are combined into a TNM stage, describing the tumour (T), lymph node involvement (N) and distant spread (M). Stage, Grade Group and PSA together determine the risk group, from very low to very high risk, which guides treatment.

Treatment depends on the risk group, stage, your age and general health, and your own preferences about side effects. For localised disease, more than one option is often reasonable, and decisions are best made through a multidisciplinary tumour board bringing together urologists, radiation and medical oncologists, radiologists and pathologists.

Active surveillance is a planned strategy of close monitoring with PSA tests, examinations, imaging and repeat biopsies, with treatment started only if the cancer shows signs of progressing. It is a recognised option for many low-risk and some favourable intermediate-risk cancers, because it can avoid or delay treatment side effects. Watchful waiting is a less intensive approach used mainly for older men or those with other serious health conditions.

Surgery (radical prostatectomy) removes the whole prostate and seminal vesicles. It can be performed by open surgery or by minimally invasive laparoscopic or robot-assisted techniques. Possible side effects include urinary leakage and erectile difficulties, which may improve over time.

Radiotherapy uses targeted radiation. External beam radiotherapy delivers shaped radiation over several sessions. Brachytherapy places radioactive seeds directly into the prostate. Radiotherapy is sometimes combined with hormone therapy in higher-risk disease.

Hormone therapy (androgen-deprivation therapy, or ADT) lowers or blocks male hormones (androgens) that fuel prostate cancer growth, using injectable LHRH agonists or antagonists, anti-androgen tablets, or surgical removal of the testicles. It is used for higher-risk, recurrent or advanced disease, often alongside other treatments. Chemotherapy, targeted therapy such as PARP inhibitors for men with certain inherited mutations, immunotherapy in selected cases, and bone-protecting drugs are options for advanced or metastatic disease. The right combination should always be set by a qualified oncology team.

Many prostate cancers are found early, and outcomes for early-stage disease are generally favourable. The statistics below come from population data (the US SEER programme, reported by the American Cancer Society) and describe groups of men, not any one person.

For men in the United States diagnosed between 2015 and 2021, the American Cancer Society reports 5-year relative survival rates by extent of disease at diagnosis as follows:

• Localised (confined to the prostate): greater than 99 percent.
• Regional (spread to nearby structures or lymph nodes): greater than 99 percent.
• Distant (spread to distant parts of the body): about 38 percent.
• All stages combined: about 98 percent.

These figures carry essential caveats. They are population-level and stage-dependent, and they are not a prediction for any individual. They reflect men diagnosed years ago and may not capture more recent improvements in treatment. Your own situation depends on many factors, including your Grade Group, PSA, age, overall health and how the cancer responds to treatment. The reliable way to understand what these numbers mean for you is to discuss them with a qualified oncologist who knows your case.

Care does not end when active treatment finishes. Follow-up typically involves regular PSA tests, which are a sensitive way to detect any return of cancer, together with periodic examinations and, when needed, imaging. The schedule depends on your original risk group and the treatment you had.

Supportive (palliative) care focuses on quality of life and can run alongside treatment at any stage, not only at the end of life. It addresses common concerns such as:

• Urinary changes and pelvic floor rehabilitation after surgery or radiotherapy.
• Sexual function, with medical and psychological support available.
• Side effects of hormone therapy, including hot flushes, fatigue, mood changes and bone thinning, which can be monitored and managed.
• Bone health and pain control in advanced disease.

Emotional and psychological support matters too. Anxiety and low mood are common after a cancer diagnosis, and counselling, peer support and involving family can make a real difference. Ask your team what support services are available, both during treatment abroad and after you return home.

Some men consider receiving treatment in another country, with Turkiye being one option among several. If you are weighing this, plan carefully and centre every decision on clinical quality and continuity of care. We do not publish prices here, because the right plan and its cost depend entirely on your individual situation; you can request a personalised estimate through a consultation.

The main factors that influence the overall cost and complexity of treatment include:

• Your risk group and stage, and whether treatment is single-modality (for example surgery alone) or combined (for example radiotherapy plus hormone therapy).
• The specific treatment chosen, such as robot-assisted prostatectomy, external beam radiotherapy or brachytherapy.
• Diagnostic work-up needed on arrival, such as MRI, repeat biopsy review or PSMA PET imaging.
• Length of hospital stay and accommodation, follow-up visits, and any rehabilitation.
• Translation, transfers and the duration of your stay abroad.

To prepare your records, gather your PSA history with dates, your biopsy and pathology reports including the Gleason score and Grade Group, all imaging on disc where possible, a list of current medications, and a summary from your treating doctor. Well-organised records allow an overseas team to give accurate advice, may reduce repeated tests, and support a smooth second opinion.

Turkiye has become a destination for medical care, with internationally accredited hospitals and experienced surgical and oncology teams, including in robot-assisted prostate surgery and modern radiotherapy. Whether it is the right choice is an individual decision that should rest on verifiable quality rather than reputation alone.

Wherever you consider treatment, in Turkiye or elsewhere, it is sensible to verify the following:

• Accreditation. Look for recognised international accreditation such as Joint Commission International (JCI), which assesses patient safety and quality standards.
• Multidisciplinary tumour board. Confirm that your case will be reviewed by a team of specialists, not decided by a single doctor, as this is a marker of good cancer care.
• Specialist experience. Ask about the team's experience with your specific treatment and risk group, and how outcomes and side effects are discussed.
• Continuity of care. Clarify how follow-up, complications and communication with your doctors at home will be handled after you return.
• Clear, written information. A responsible provider gives you a clear plan and honest discussion of benefits, risks and alternatives, in a language you understand.

As a medical-tourism concierge, BergemHealth can help coordinate consultations, records and logistics, but the clinical plan must always be set by qualified specialists. Avoid any provider that promises a cure or guarantees an outcome; responsible teams discuss probabilities, not certainties.

A second opinion is a normal and reasonable step, not a sign of distrust. Because more than one treatment is often appropriate for localised prostate cancer, and because the trade-offs in side effects matter, hearing from another qualified specialist can help you feel confident in your choice. Most cancer teams support this, and your records make it straightforward to arrange.

Clinical trials study new or refined treatments and may offer access to additional options under careful oversight. They are not right for everyone, and participation is always voluntary, but it is worth asking your oncologist whether any well-conducted trials are relevant to your situation. Reliable information on trials is available through national cancer institutes and major cancer centres.

Above all, take the time you reasonably have. With the exception of rare aggressive subtypes, prostate cancer often does not require a decision within days, which can leave room to gather information, prepare your records, seek a second opinion and choose a path that fits both your medical situation and your values, in partnership with a qualified multidisciplinary team.