Prostate Cancer and PSA Common Questions

No. PSA is made by normal prostate tissue as well as cancer, hence an elevated PSA has many possible causes — an enlarged prostate, infection, a recent catheter, or even vigorous cycling. Many men with an elevated PSA do not have cancer. The result is interpreted alongside your age, prostate size and an MRI scan before discussing a prostate biopsy. See elevated PSA for more details.

There is no single normal value. Thresholds rise with age, because the prostate grows over time. A level that would prompt investigation at 45 may be unremarkable at 75. What often matters more than a single reading is the trend over several tests, and PSA density — the PSA level divided by the size of the prostate measured on MRI.

Not necessarily. Current practice is to do an MRI scan first. If the MRI shows nothing suspicious and your PSA density is low, a biopsy can often be avoided in favour of monitoring. In the PRECISION trial, 28% of men in the MRI-first group avoided a biopsy altogether. If the MRI does show a suspicious area, a targeted biopsy of that area is recommended.

A transperineal biopsy in this practice is usually done under sedation for comfort; a transrectal biopsy is done under local anaesthetic and is generally well tolerated. Expect some mild discomfort for 1–2 days, and blood in the urine or semen for a few weeks afterwards — that is normal and not a cause for alarm.

Both are offered here and both are reasonable. The transperineal route passes through the skin rather than the bowel, so infection risk is very low and no preventive antibiotics are needed; it also reaches the front of the prostate more easily. The transrectal route is done under local anaesthetic with antibiotics guided by a rectal swab and has a higher risk of infection. The right choice depends on where the suspected cancer is located within the prostate and on your own preference.

Often not. For low-risk and some favourable intermediate-risk cancers, the safest course is active surveillance — close monitoring with PSA, MRI and repeat biopsy, treating only if the cancer shows signs of becoming more aggressive. This is a deliberate strategy, not a decision to do nothing, and it avoids the side effects of treatment for cancers that may never cause harm.

For many men with localised prostate cancer they offer broadly similar long-term cancer control, so the decision usually comes down to the different side-effect profiles and what matters most to you. It is entirely reasonable to ask to discuss your case with both a surgeon and a radiation oncologist before deciding. See treatment options for localised prostate cancer.

Usually around 10 days after robotic prostatectomy, depending on the reconstruction and your recovery. It is removed at a short outpatient appointment, and you will be asked to stay until you have passed urine. Leakage immediately after removal is normal and improves over the following weeks.

Almost all men leak to some degree after the catheter comes out. Most see steady improvement over the first three months, with further gains up to a year. Pelvic floor exercises, ideally started before surgery, make a real difference. Persisting leakage beyond a year can be treated, and options are discussed at follow-up.

Erection quality after surgery is generally not as good as before. Recovery depends on your function beforehand, your age, and whether the nerves alongside the prostate can be preserved without compromising cancer control. Nerve recovery is slow — counted in months rather than weeks — and treatments to support it are available and discussed with you.

No. After the prostate is removed, ejaculation no longer occurs, although the sensation of orgasm is usually preserved. This also means permanent infertility, so if having children may matter to you, sperm banking is discussed before surgery; sperm can also be surgically retrieved from the testes later if needed for assisted fertility.

Focal therapy treats only the part of the prostate containing the cancer rather than the whole gland, using energy such as HIFU or irreversible electroporation. It suits carefully selected men with a single, well-defined area of intermediate-risk cancer who accept close follow-up including repeat MRI and biopsy. It is a developing field rather than a settled standard. See focal therapy.