Prostate Cancer

Prostate cancer is cancer that develops in the prostate, a small, walnut-shaped gland located below the bladder and in front of the rectum in males. This tiny gland secretes fluid that mixes with semen, keeping sperm healthy for conception and pregnancy.

Prostate cancer is a serious disease. And it’s common. For every 100 males, 13 will develop prostate cancer at some point in their lives. Fortunately, most people get diagnosed before it spreads beyond their prostate glands. Treatment at this stage often eliminates the cancer. Still, approximately 35,770 people in the United States die from prostate cancer each year.

Types of prostate cancer

If you’re diagnosed with prostate cancer, it’s most likely an adenocarcinoma. Adenocarcinomas start in the cells of glands that secrete fluid, like your prostate. Rarely, prostate cancer forms from other types of cells.

Less common types of prostate cancers include:

• Small cell carcinomas
• Transitional cell carcinomas
• Neuroendocrine tumors
• Sarcomas

Symptoms of prostate cancer

Early-stage prostate cancer rarely causes symptoms. But as prostate cancer progresses, you may start to notice changes. Contact your healthcare provider if you have any of these symptoms of prostate cancer:

• Frequent, sometimes urgent, need to pee, especially at night
• Weak urine flow or flow that starts and stops
• Pain or burning when you pee (dysuria)
• Loss of bladder control (urinary incontinence)
• Loss of bowel control (fecal incontinence)
• Painful ejaculation and erectile dysfunction (ED)
• Blood in semen or pee
• Pain in your low back, hip or chest

Prostate cancer causes

Experts aren’t sure what causes cells in your prostate to become cancer cells. As with cancer in general, prostate cancer forms when cells divide faster than usual. While normal cells eventually die, cancer cells don’t. Instead, they multiply and grow into a lump called a tumor. As the cells continue to multiply, parts of the tumor can break off and spread to other parts of your body (metastasize).

Luckily, prostate cancer usually grows slowly. Most tumors are diagnosed before the cancer has spread beyond your prostate. Prostate cancer is highly treatable at this stage.

Risk factors

The most common risk factors for prostate cancer include:

• Age. Your risk increases as you get older. You’re more likely to get diagnosed if you’re over 50. About 60% of prostate cancers occur in people older than 65.
• Race and ethnicity. Your risk is higher if you’re Black or of African ancestry, especially for aggressive cancers and those diagnosed before age 50.
• Family history of prostate cancer. You’re two to three times more likely to get prostate cancer if a close family member has it.
• Genetics. You’re at a greater risk if you have Lynch syndrome or if you inherited mutated (changed) genes associated with increased breast cancer risk (BRCA1 and BRCA2).

Some studies have identified other prostate cancer risk factors, but the evidence is mixed. Other potential risk factors include:

• Smoking
• Prostatitis
• Having a BMI greater than 30 (having obesity)
• Sexually transmitted infections (STIs)
• Exposure to Agent Orange (a chemical used during the Vietnam War)

How doctors diagnose this condition

Doctors use screening tests, physical exams, scans and, sometimes, a biopsy to diagnose prostate cancer. Most people start screening at age 55, or earlier if they’re at a higher risk. Screening usually stops after age 70. If the results show something unusual, you may need more tests. But if your doctor thinks the tumor is slow-growing and not likely to cause problems, they may wait before doing more tests. Faster-growing cancers or those that have spread outside the prostate usually need a biopsy to confirm the diagnosis.

Tests that are used

Screening tests can show whether you have signs of prostate cancer that require more testing:

• Digital rectal exam. Your provider inserts a gloved, lubricated finger into your rectum and feels your prostate gland. Bumps or hard areas may mean cancer.
• Prostate-specific antigen (PSA) blood test. The prostate gland makes a protein called prostate-specific antigen (PSA). High PSA levels may indicate cancer. Levels also rise if you have benign conditions, such as benign prostate hyperplasia or prostatitis.
• Imaging. An MRI or a transrectal ultrasound can show images of your prostate gland, including suspicious areas that may be cancer. Imaging results can help your provider decide whether to perform a biopsy.
• Biopsy. During a needle biopsy, a healthcare provider removes a tissue sample to check for cancer. This is the only way to confirm prostate cancer and know how aggressive it is. Genetic testing of the sample may help guide treatment.

What are the grades and stages of prostate cancer?

Healthcare providers use the Gleason score and cancer staging to determine how serious the cancer is and the types of treatments you need.

Gleason score

The Gleason score allows your provider to rate how abnormal your cancer cells are. The more abnormal cells you have, the higher your Gleason score. The Gleason score allows your provider to determine the grade of your cancer, or its potential to be aggressive.

Staging prostate cancer

Cancer staging allows your provider to determine how advanced your cancer is, or how much it’s spread. Cancer may be in your prostate gland only (local), invading nearby structures (regional) or spreading to other organs (metastasized). Prostate cancer most commonly spreads to your bones and lymph nodes. It can also develop in your liver, brain, lungs and other organs.

How is prostate cancer treated?

Your treatment depends on multiple factors, including your overall condition, if the cancer’s spread and how fast it’s spreading. Depending on your treatments, you may work with various healthcare providers, including urologists, radiation oncologists and medical oncologists. Most prostate cancers diagnosed in the early stages can be cured with treatment.

Specific medications and procedures

Surveillance

If your cancer is slow-growing and hasn’t spread, your doctor may monitor it instead of treating it right away.

• Active surveillance. You’ll get regular screenings, scans and biopsies — every one to three years — to track cancer growth. It’s best for early, low-risk cancer with no symptoms. Treatment starts if the cancer gets worse.
• Watchful waiting. This method is used for people who are older or have other health issues. Testing is less frequent. Care focuses on easing symptoms rather than removing the cancer.

Surgery

A radical prostatectomy removes a diseased prostate gland. It can often successfully eliminate prostate cancers that haven’t spread. Your provider can recommend the best removal method if they believe you’d benefit from this surgery.

• Open radical prostatectomy. Your provider makes a single cut (incision) into your abdomen and removes your prostate gland. This technique isn’t as common as less-invasive methods.
• Robotic radical prostatectomy. Robotic radical prostatectomy allows your provider to perform surgery through several tiny incisions. They operate a robot system via a console.

Radiation therapy

You may receive radiation therapy as a standalone treatment for prostate cancer or in combination with other treatments. Radiation can also provide symptom relief.

• Brachytherapy. This involves placing radioactive seeds inside your prostate. It kills cancer cells while preserving surrounding healthy tissue.
• External beam radiation therapy (EBRT). A machine delivers strong X-rays at the tumor. Advanced types — like IMRT — can target the cancer while sparing healthy tissue.

Systemic therapies

If cancer spreads outside your prostate, your oncologist may recommend systemic treatments. These therapies travel through your body to destroy cancer cells or stop them from growing.

• Hormone therapy. Testosterone helps prostate cancer grow. In hormone therapy, medication blocks or lowers testosterone. Some people may have their testicles removed (orchiectomy) to stop its production.
• Chemotherapy. This treatment uses drugs to kill cancer cells. It may be used alone or with hormone therapy for advanced cancer. You may receive chemotherapy alone or with hormone therapy if the cancer has spread beyond your prostate.
• Immunotherapy. This boosts your immune system so it can better find and fight cancer cells. It’s often used for advanced or recurring cancer (cancer that goes away but then returns).
• Targeted therapy. These therapies focus on the genetic mutations that cause cancer. They work best for tumors with BRCA mutations.

Focal therapy

Focal therapy is a newer form of treatment that destroys tumors inside your prostate. Your healthcare provider may recommend this treatment if the cancer is low risk and hasn’t spread. Many of these treatments are still considered experimental.

• High-intensity focused ultrasound (HIFU). High-intensity sound waves generate powerful heat to kill cancer cells within your prostate.
• Cryotherapy. Cold gases freeze cancer cells in your prostate, eliminating the tumor.
• Laser ablation. Intense heat directed at the tumor kills cancer cells within your prostate, destroying the tumor.
• Photodynamic therapy. Medications make cancer cells more sensitive to certain wavelengths of light. A healthcare provider exposes cancer cells to these light wavelengths, killing the cancer cells.

What are the side effects of prostate cancer treatment?

Potential side effects include:

• Incontinence. You may leak urine when coughing or laughing. Or you may feel an urgent need to pee even when your bladder isn’t full. This usually improves within six to 12 months without treatment.
• Erectile dysfunction (ED). Surgery and other treatments can affect erections. Sex might be different for a year or two. Medications like sildenafil (Viagra®) or tadalafil (Cialis®) can help by increasing blood flow to your penis.
• Infertility. Treatments can affect your sperm production or ejaculation. If you want children, consider banking sperm before treatment. Afterward, sperm can be extracted and implanted into your partner’s uterus.

Let your cancer care team know if you have side effects. Often, they can recommend medicines and procedures that can help.

What questions should I ask my healthcare provider?

If you have prostate cancer, you may want to ask your healthcare provider:

• Has the cancer spread outside of my prostate gland?
• What’s the best treatment for the stage of prostate cancer I have?
• What are the treatment risks and side effects?
• Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
• What kind of follow-up care do I need after treatment?
• Should I look out for signs of complications?

What can I expect if I have prostate cancer?

You have an excellent outlook when prostate cancer is found early. Almost everyone — 99% — diagnosed before it spreads lives at least five years after diagnosis. In many cases, treatment can eliminate cancers that stay in the prostate. Survival rates aren’t as good if the cancer spreads — 32% of people with metastatic prostate cancer are alive five years after diagnosis.