Diagnosing Prostate Cancer: PSA, Biopsy and Staging

Robotic radical prostatectomy is used for low-risk and intermediate-risk disease, and can be used for high-risk disease too, provided the lymph nodes are not involved, in which case it is combined with an extended lymph node dissection. If the lymph nodes are already positive, radical surgery is not performed.

It is not mandatory as routine screening, but a baseline PSA is checked before starting an anti-androgen such as dutasteride, which is commonly prescribed for BPH.

Alfuzosin is a commonly used drug that relieves the urinary symptoms of BPH. Silodosin is a newer, more potent alternative. Alfuzosin is generally preferred in younger, sexually active men, while silodosin is preferred in older patients because of its sexual side-effect profile.

That is not the case. Between the ages of 80 and 90, up to 80% of men are found to harbour some focus of prostate cancer, but most die of other causes rather than the cancer itself. Because it is often a low-risk, indolent disease in this age group, treatment is sometimes deliberately avoided if the patient is asymptomatic.

Yes - this is generally due to atherosclerosis: as blood vessels narrow with age, blood supply to the penis decreases, and this reduced blood flow is the main driver of declining sexual performance.

Above 4 ng/mL, though it can also rise with infection; a single high reading should be repeated after 2-3 weeks rather than triggering an immediate biopsy.

Local spread is assessed with a multiparametric MRI of the prostate, and distant spread with a PSMA PET scan, the most specific imaging for prostate cancer metastasis.