# Care pathway for prostate cancer On this page you will find information about the different stages of examinations and treatment of prostate cancer at HUS. ## [ From symptoms to diagnosis ](#from-symptoms-to-diagnosis) ## [ Getting a diagnosis ](#getting-a-diagnosis) ## [ Treatments ](#treatments) ## [ After treatments ](#after-treatments) ## [ Support and information ](#support-and-information) ## From symptoms to diagnosis Primary health care ### A symptom appears or an abnormal finding is made --- Prostate cancer occurs when prostate cells start to become malignant. It has not been scientifically proven that any single factor would cause prostate cancer. Approximately 5–10% of patients are estimated to have a hereditary predisposition to prostate cancer. Prostate cancer is the most common cancer among men in Finland. Prostate cancer occurs on average at the age of 70, and age is the single most important risk factor. The majority of patients can be cured completely, and even in patients with a metastatic disease, the disease can be kept under control with treatments for long periods of time. Prostate cancer is usually asymptomatic for a long time. Local symptoms may be similar to those of benign prostatic hyperplasia: poor urine flow, feeling of incomplete emptying of the bladder, frequent need to urinate, and frequent urination during the night. Prostate cancer and benign prostatic hyperplasia can also occur at the same time. ### Required additional examinations in primary health care and a physician’s assessment --- If you are suspected of having prostate cancer, your general practitioner will make an initial assessment of your situation. The initial assessment includes finding out the symptoms and background information through an interview, a physical examination and the necessary laboratory tests. ### A physician writes a referral --- If examinations carried out in primary health care, occupational health care, or at a private clinic have given reason to suspect prostate cancer or you have already been diagnosed with prostate cancer, the physician will refer you to HUS Meilahti Tower Hospital or Peijas Hospital Urology Outpatient Clinic for further examinations. ## Getting a diagnosis Comprehensive Cancer Center and other specialized medical care ### The referral arrives at specialized medical care and an invitation is sent to the patient --- Based on your referral, you will be invited directly to the appointment for an evaluation, or additional scans, such as magnetic resonance imaging of the prostate, will be performed. You will usually receive an invitation by letter. In general, we will also inform you of the result of the scan by letter. Based on the result of the MRI scan, you will be invited for a prostate biopsy at the urology outpatient clinic of Meilahti Tower Hospital or Peijas Hospital. If you have already been diagnosed with prostate cancer and you are coming for a surgical assessment or your prostate cancer is suspected to have recurred, we will send you information on the booked examinations and physician’s appointments prescribed by a urologist. [ See the average treatment wait times for prostate cancer here ](/en/patient/treatments-and-examinations/cancer/access-cancer-treatment) ### If necessary, additional examinations can be carried out --- At the appointment, the urologist will interview you and perform a palpation of the prostate. During the examination, the physician will assess whether any lumps or nodules can be felt in the prostate. We will take various laboratory tests from you. The most important blood test is PSA, or prostate-specific antigen. The function of PSA is to bring semen into a fluid form. Part of the PSA enters the bloodstream. In prostate cancer, the level of PSA in the plasma increases, but PSA levels can also be elevated by benign prostatic hyperplasia, urinary retention and infections. Hence, a PSA level above reference values does not automatically indicate prostate cancer. The diagnosis of prostate cancer is confirmed by taking biopsies of the prostate under ultrasound guidance. Biopsies are taken through the rectum under local anesthesia from an abnormal area in the prostate observed in an MRI scan. The whole procedure takes about 20 minutes, and biopsies take about 5–10 minutes. If necessary, various X-ray examinations are performed to determine the extent of the disease. ### Appointment with a physician and a nurse --- At the appointment, you will receive information on the cancer biopsy classification as well as the extent and risk category of the disease. During the treatment consultation, together with the urologist you will decide on the right form of treatment for you. After the treatment consultation, you will meet with a nurse or prostate cancer nurse. [ Read more about diagnosing prostate cancer ](/en/patient/treatments-and-examinations/cancer/care-pathway-prostate-cancer/appointments-physician-and) ## Treatments Specialized medical care ### Treatment begins --- Prostate cancer can be treated with different forms of treatment and they can also be combined. The choice of treatment for prostate cancer depends on whether the disease is local, locally advanced or metastasized. [ For more information on the treatment of local prostate cancer, visit the Healt… ](/en/patient/treatments-and-examinations/cancer/care-pathway-prostate-cancer/treatment-and-follow-local) ### Healing and follow-up --- Prostate cancer can recur regardless of treatment and treatment form, and it is monitored in different ways after different types of treatment. Prostate cancer usually progresses slowly and therefore recurrence may not occur until many years later. This is why we monitor prostate cancer for a long time. Follow-up mainly consists of PSA monitoring and, if necessary, imaging examinations or taking new prostate biopsies. ### If the disease recurs or treatments do not help --- Metastatic prostate cancer refers to cancer that has metastasized to other parts of the body, typically bones and lymph nodes. Today, we can treat and manage even metastatic prostate cancer for longer than before, even though the disease cannot be completely cured. There are a number of treatment options available to use with different mechanisms of action. [At the Clinical Trial Unit](/en/patient/hospitals-and-other-units/comprehensive-cancer-center/clinical-pharmaceutical-research-unit "Clinical Trial Unit, Comprehensive Cancer Center") we offer an increasing number of patients the opportunity to be among the first to receive new research treatments. [ Read more on the treatment of metastatic prostate cancer ](/en/patient/treatments-and-examinations/cancer/care-pathway-prostate-cancer/treatment-metastatic) ### Palliative care and psychosocial support --- Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the illness or cancer treatments. We help treat difficult symptoms and offer conversational support. A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or hospital-at-home in your area. [ Read more about the Palliative Care Center ](/en/patient/hospitals-and-other-units/comprehensive-cancer-center/palliative-center-comprehensive) ## After treatments ### Follow-up in specialized medical care ends --- When the situation regarding prostate cancer is stable, in most cases follow-up after treatment continues at HUS as mobile monitoring of PSA values. PSA mobile monitoring is automated remote PSA monitoring. You will receive a long-term PSA referral to the HUS laboratory, which is valid for several years. A unique PSA limit value will be set for you in the permanent referral. You will receive a reminder of the test and your test result by text message. Follow-up may also be undertaken by primary health care services. In this case, we will define your follow-up program during your last visit. ## Support and information Getting cancer is a big life change. Here you will find information and support for living with the disease. ### [ Support during cancer treatment ](/en/patient/treatments-and-examinations/support-during-cancer-treatment) Here you can find discussion help and support for rehabilitation for cancer patients.  ### [ Instructions and additional information for cancer patients ](/en/patient/treatments-and-examinations/cancer/instructions-and-additional-information-cancer-patients) Here you will find our patient guide and more information about cancer treatments.  Updated: 10.10.2024