Prostate cancer survivor here, AMA. Tips: * I recommend everyone with a prostate get their PSA tested by age 45, or earlier if it runs in the family. It's a s

Prostate cancer survivor here, AMA. Tips: * I recommend everyone with a prostate get their PSA tested by age 45, or earlier if it runs in the family. It's a simple blood test but sometimes you have to ask for it. * Early detection is key. A biopsy can assess how aggressive it is (the Gleason score). They can even genetically profile the tumor to further gauge risk (the Decipher score). * Most cases are slow growing and may never escape the prostate. These are usually treated by simply monitoring them with more PSA testing, imaging and the occasional biopsy. Years ago these cases uses to be over-treated but now they have high quality data showing the safety of monitoring. * If it hasn't left the prostate (stage 1 or 2) and they think you need treatment there are a few options. In lesser cases you can do focal therapy which is like zapping a small tumor. But it tends to be a multi-focal disease, so often you'll end up getting "definitive treatment": removing the prostate surgically or saturating it with radiation. * Surgery typically uses a cool-ass remote-controlled robot called "the DaVinci" that operates through a set of small incisions. * Radiation is done either via external beam -- you just lie there and get zapped -- or by inserting radioactive seeds directly into the prostate (brachytherapy). * The main side effect of surgery is erectile dysfunction, because the nerves that control that run right along the prostate and nerves do not like getting manipulated. Recovery can take up to two years and you don't always get all your function back. I think that stat is something like 1/3rd get back to baseline, 1/3rd get there but with the help of meds (Viagra), and 1/3rd suffer permanent decline / need other interventions. There is also some incontinence but that typically resolves within weeks/months. * Radiation also causes ED, as well as urinary bother and potentially some other issues. But these typically kick in later, possibly years later. There are also some short term side effects while undergoing treatment. It's a good option for older patients for sure but "younger" patients (<60 y.o.) have to consider the effects of radiation on healthy tissue decades out. You may also have to undergo a 6-18 month course of hormone therapy which I'll discuss next. * If it escapes the prostate (stage 3 or 4) then there is an awesome new scan called a PSMA PET that can locate where it is with radiomarkers. They might do focal treatment on hot spots, but the main course of treatment is hormone therapy. * Hormone therapy is essentially chemical castration. It removes all the testosterone from your body, and this weakens prostate cancer cells. By all accounts it is not fun: kills libido, saps energy levels. But it's also not as rough as chemotherapy, so we're "lucky" prostate cells work that way. There has been a lot of development here; often when you hear there's a new prostate cancer drug it's for hormone therapy. * We all die but you don't want to die from prostate cancer. It's typically drawn out and painful. I watched my dad go through it, and it's why I got tested early. Fortunately it is very treatable if caught early.