Dr. CARLO A. BRAVI Urologist and Andrologist
Understanding Prostate Cancer
Prostate cancer is one of the most common types of cancer affecting men, particularly those over the age of 50. It occurs in the prostate — a small gland in the male reproductive system that produces seminal fluid. Most prostate cancers grow slowly and may not cause significant harm. However, some types can be aggressive and spread rapidly.
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Symptoms and Diagnosis
Common symptoms may include difficulty urinating, blood in the urine or semen, erectile dysfunction, and discomfort in the pelvic area, though the majority of men experience no symptoms in early stages.
The commonest way prostate cancer is discovered is men being referred to a diagnostic clinic for a raised PSA (prostate specific antigen) discovered during a blood test. These tests will have been done usually because of one of the following reasons:
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Some men will have urinary symptoms and go to their GP for advice. A blood test is arranged as part of their assessment.
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Some men have no symptoms but asked to be screened for prostate cancer.
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Some men have a strong family history and are aware of a need to assess their personal risk.
Prostate cancer is diagnosed with a prostate biopsy. Recent evidence showed that having a prostate MRI scan before a prostate biopsy is beneficial to select the appropriate candidates for prostate biopsy. It is essential to identify men who are likely to have clinically significant prostate cancer and ensure that life-threatening cases are not missed. At the same time, prostate biopsies should be performed judiciously, as they carry a small but notable risk — particularly the risk of infection.​​
As a result, the diagnostic pathway of prostate cancer follows a 3 steps-sequence:
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Raised PSA test
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Prostate MRI scan
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Prostate biopsy
The art of prostate cancer diagnostics lies in striking the right balance: investigating thoroughly enough to detect cancers that require treatment, while avoiding unnecessary biopsies in men who are unlikely to benefit. This approach minimizes the risk of complications and reduces the emotional burden associated with unnecessary procedures.
Once a diagnosis is confirmed, treatment options are carefully discussed with the patient. The goal is to tailor the treatment plan to the individual — not to fit the patient to a predetermined treatment. This personalized approach ensures the most appropriate and effective care.
Treatments
Treatment options vary based on the cancer’s stage and aggressiveness and may include active surveillance, surgery, radiation therapy, hormone therapy, or chemotherapy.
For men diagnosed with localized or locally advanced prostate cancer, surgery is one of the main treatment options. The most common surgical procedure is a radical prostatectomy, which involves the removal of the entire prostate gland, and in some cases, nearby lymph nodes.
Surgery aims to completely remove the cancer while preserving urinary and sexual function as much as possible. Advances in robotic surgery have improved precision, reduced recovery times, and minimized side effects compared to traditional open surgery.
Surgical treatment is typically considered for men in good overall health with a life expectancy of at least 10 years, and when the cancer is confined to the prostate or has limited local spread. The decision to proceed with surgery is made in close consultation with the patient, taking into account the cancer’s characteristics and the individual’s preferences and lifestyle.
Robotic radical prostatectomy is the main area of expertise of Dr. Bravi. More detailed information on this surgical intervention are available here.
