One of the biggest challenges I see in my daily clinical practice is helping men make sense of the many prostate-related conditions they may face. Prostate health can be complex, and it’s completely normal to feel uncertain or overwhelmed by the information available online.
In this newsletter, I’d like to address three of the most common questions I am asked by patients in clinic and by men who follow our educational content online.
1. If my PSA is high, does that mean I have prostate cancer?
This is one of the most common and understandable concerns.
A PSA (Prostate-Specific Antigen) test is a blood test we use as an initial screening tool for prostate cancer. However, it’s important to understand that PSA is not specific to cancer.
PSA levels can rise for several reasons, including:
Benign (non-cancerous) prostate enlargement
Prostate inflammation or infection
Recent procedures or even ejaculation
Because of this, a raised PSA does not automatically mean prostate cancer.
Here in Australia, if a man has a PSA level above the expected range for his age, the next step is usually a prostate MRI. This is a non-invasive scan that allows us to assess the prostate in much greater detail and estimate the risk of an abnormal or cancerous area being present.
Think of PSA as an entry-level test. It alerts us that further assessment may be needed — not that cancer is definitely present.
2. Does a prostate biopsy spread cancer?
This is a very common worry and an important question.
If an MRI shows an area of concern, the next step is often a prostate biopsy, where a small tissue sample is taken for analysis. The biopsy tells us:
Whether the area is cancerous or benign
If cancer is present, how aggressive it is
The aggressiveness of prostate cancer is measured using the Gleason score, which reflects how the cancer cells look under the microscope.
The key point to understand is this:
➡️ A prostate biopsy does not cause prostate cancer to spread.
Whether cancer spreads depends on the biology and grade of the tumour itself, not on the biopsy.
Low-grade cancers (Gleason 6) do not spread and are commonly managed with active surveillance rather than treatment.
Higher-grade cancers carry a greater risk of spread because of their inherent biological behaviour.
The biopsy simply provides us with essential information to guide safe and appropriate care.
3. Can I have sex after my prostate is removed?
Yes — but there are important changes to be aware of.
The surgical removal of the prostate is called a radical prostatectomy, most commonly performed today using a robotic (keyhole) approach.
Ejaculation
After prostate removal:
Men no longer ejaculate fluid during orgasm
Orgasms still occur, but the sensation may feel different
Some men report orgasms feel shorter or less intense
These changes are permanent and take some time to adjust to, but they are expected and normal.
Erections
Erectile function recovery depends on several factors:
Age and overall health
Conditions such as diabetes or high blood pressure
Whether the nerves responsible for erections can be preserved during surgery
If the cancer is small and away from the erectile nerves, we can often spare them, significantly improving the chance of recovery. If the cancer is more aggressive or close to the nerves, preservation may not be possible.
Recovery varies from person to person, and it’s important to have realistic expectations and open discussions about sexual rehabilitation.
Stay Connected
If you’d like to stay informed about prostate health, treatments, and new developments, we invite you to subscribe to our YouTube channel.
We also regularly host live Q&A events, where I answer patient questions directly in a supportive and educational setting.