Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 3 of 11 in Prostate Cancer: Diagnosis and Management
Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
September 6, 2026
Most of the prostate cancers Dr. Amit Goel and his colleagues diagnose are organ-confined and caught early, largely because PSA screening now identifies the disease before it causes any symptoms at all. That makes early detection as much a story about testing as about symptoms, since by the time a patient with more advanced disease actually feels unwell, the cancer has often already progressed.
Locally Advanced Disease
When prostate cancer grows beyond being organ-confined, it can produce obstructive voiding symptoms: hesitancy starting the urinary stream, an intermittent stream, and decreased force of urine. Blood can appear in the urine or semen. If the disease has spread into the pelvic lymph nodes, patients can develop swelling in the lower extremities along with pelvic and perineal discomfort.
Metastatic Disease
Bone is the most common site for prostate cancer to spread to, and metastatic bone disease can cause pathological fractures or spinal cord compression severe enough that the resulting neurological symptoms are what first bring the underlying prostate cancer to light. Less commonly, metastasis reaches the lungs, liver, pleural cavity, peritoneal cavity or central nervous system, a pattern Dr. Goel noted is seen more often after a patient has already been through hormone therapy.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Dr. Yanik
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?
Dr. Amit Goel
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
Frequently Asked Questions
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
Does prostate cancer usually cause symptoms early on?▼
No. Most prostate cancer is organ-confined and asymptomatic at diagnosis, found through PSA screening rather than symptoms.
What symptoms suggest prostate cancer has spread?▼
Obstructive urinary symptoms, blood in the urine or semen, leg swelling, pelvic pain and bone pain from metastasis are all signs of more advanced disease.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer