Low risk or localised prostate cancers are typically small, have not grown beyond the prostate and often grow very slowly or not at all.

To provide an overall picture of a prostate cancer diagnosis, your doctor will undertake a series of tests and investigations including a physical examination, blood test, biopsy and sometimes a MRI or CT scan.

Low-Risk Prostate Cancer often grows very slowly or not at all, yet men faced with this diagnosis report more difficulty making a treatment decision than any other cancer clinical group. This is largely due to the variety of management options including Active Surveillance (close monitoring) versus active treatment such as radiotherapy or surgery. The decision will depend on a number of factors including age and general health, treatment side effects and personal preferences.

Active Surveillance is a management plan which may be suggested by your doctor if the cancer is small or slow growing, and is unlikely to spread. Over time, you are carefully monitored for signs of progression. Other treatment options (e.g. surgery or radiotherapy) are not started unless there are signs that the cancer has changed or grown. Active Surveillance may be a preferred option if the possible risks and side effects of other treatments may have a greater impact on your quality of life than the cancer itself.

Active Surveillance may be considered as a management option, as guided by the following tests and investigations:

Blood Test: Prostate Specific Antigen (PSA) (20 or less)
Prostate Biopsy: Gleason Score (7 or less)
Imaging (MRI/CT) / Digital Rectal Examination: Cancer Stage (T1 or T2a)

PSA (Prostate-Specific Antigen) is a protein made by both normal and cancerous cells in the prostate gland, and is measured using a blood test. Whilst a high PSA level may indicate the presence of prostate cancer, it can also be a sign of other non-cancerous conditions such as inflammation or an enlargement of the prostate. Equally, a low PSA level does not necessarily mean cancer is not present. Since PSA levels can be difficult to interpret on their own, your doctor may recommend you have a prostate biopsy as well.

A prostate biopsy helps to identify if cancer cells are in your prostate. This involves taking small samples of tissue from your prostate gland using an ultrasound-guided needle. A biopsy is usually done as an outpatient procedure (you will be sent home on the same day). The tissue samples are then sent to a pathologist to see if cancer cells are present. The pathologist will assign a grade (Gleason Score) to the cancer cells based on how they compare to normal cells within the prostate.

The Gleason Score is a way to grade prostate cancer. This information gives your doctor an idea of how the cancer might behave and what treatment you might need. The pathologist will look at the cancer cells (taken from your biopsy) and grade the cells based on how they compare to normal cells. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less healthy receive a higher score. Some Australian doctors use the following guide to work out the grade and risk of a particular prostate cancer.

Cancer staging provides an estimate of how big a tumour is, and if it has spread beyond the prostate. This is investigated in a number of different ways including a Digital Rectal Examination (DRE) and imaging scan results. The most common method to describe cancer staging is the Tumour Node Metastasis (TNM) system. A summary of the staging is provided below:

A tumour is any abnormal growth of tissue. In the context of cancer, the word usually refers to malignant (cancerous) lumps of tissue.

A Digital Rectal Examination (DRE) is an examination of the prostate through the wall of the rectum. The doctor inserts a finger into the rectum (back passage / anus) and feels the shape of the prostate. Irregularities may be caused by cancer.

Lymph nodes are small rounded or bean-shaped pieces of lymphatic tissue found all over the body but easier to feel in the neck, armpits and groin. Lymph nodes are part of the immune system, acting as filters for foreign substances and commonly become inflamed if there is an infection nearby. They can also harbour cancer cells that have spread from elsewhere in the body (for example, cancer cells in the prostate can spread to the lymph nodes).

Metastasis describes the spread of cancer cells away from the place where it began. For example, prostate cancer can metastasize or spread to the bones.