Everything You Want to Know About Prostate Cancer

Medically reviewed by Christina Chun, MPH on September 18, 2017Written by Tricia Kinman

What’s prostate cancer?

Prostate cancer is a serious disease that affects thousands of men each year who are middle-aged or older. Most prostate cancers occur in men older than age 65. The American Cancer Society (ACS) estimates that 161,360 American men will be newly diagnosed with this condition in 2017.

The prostate is a small gland found in a man’s lower abdomen. It’s located under the bladder and surrounding the urethra. The prostate is regulated by the hormone testosterone and produces seminal fluid, also known as semen. Semen is the substance containing sperm that exits the urethra during ejaculation.

When an abnormal, malignant growth of cells — which is called a tumor — forms in the prostate, it’s called prostate cancer. This cancer can spread to other areas of the body. In these cases, because the cancer is made of cells from the prostate, it’s still called prostate cancer.

According to the Urology Care Foundation, prostate cancer is the third most common cause of all cancer-related deaths among men in the United States. However, the numbers of American men with prostate cancer are going down. See a chart of prostate cancer incidence and mortality in the United States.

Types of prostate cancer

Most cases of prostate cancer are a type of cancer called an adenocarcinoma. This is a cancer that grows in the tissue of a gland, such as the prostate gland.

Prostate cancer is also categorized by how fast it grows. It has two types of growths:

  • aggressive, or fast growing
  • nonaggressive, or slow growing

With nonaggressive prostate cancer, the tumor either doesn’t grow or grows very little over time. With aggressive prostate cancer, the tumor can grow quickly and may spread to other areas of the body, such as the bones.

Prostate cancer causes and risk factors

There’s no known cause for prostate cancer. Like all cancers, it could be caused by many things, including a family history or exposure to certain chemicals.

Whatever the instigating factor is, it leads to cell mutations and uncontrolled cell growth in the prostate.

Who’s at risk?

While prostate cancer could occur in any man, certain factors raise your risk for the disease. These risk factors include:

  • older age
  • a family history of prostate cancer
  • certain ethnicities or race — for instance, African American males are at greater risk of having prostate cancer
  • obesity
  • genetic changes

Where you live could also play a role in your prostate cancer risk. Find out more about causes and risk factors for prostate cancer.

Prostate cancer age

As mentioned above, age is a primary risk factor for prostate cancer. The disease occurs most often in men older than age 65.

In fact, according to The Prostate Cancer Foundation, only 1 in 10,000 men under the age of 40 will get prostate cancer. However, that number rises to 1 in 14 for men between the ages of 60 and 69. Find out more about age and the incidence of prostate cancer.

Prostate cancer symptoms

Some forms of prostate cancer are nonaggressive, so you may not have any symptoms. However, advanced prostate cancer often causes symptoms.

If you have any of the following signs or symptoms, don’t hesitate to call your doctor. Some symptoms of prostate cancer can be caused by other conditions, so you’ll need an examination. They can make sure you receive the correct diagnosis and treatment.

Symptoms of prostate cancer can include urinary problems, sexual problems, and pain and numbness.

Urinary problems

Urinary problems are a common symptom because the prostate is located beneath the bladder, and it surrounds the urethra. Because of this location, if a tumor grows on the prostate, it could press on the bladder or urethra and cause problems.

Urinary problems can include:

  • frequent need to urinate
  • a stream that’s slower than normal
  • bleeding while urinating (hematuria)

Sexual problems

Erectile dysfunction may be a symptom of prostate cancer. Also called impotence, this condition makes you unable to get and keep an erection. Blood in the semen after ejaculation can also be a symptom of prostate cancer.

Pain and numbness

Metastatic cancer is cancer that has spread to other areas of the body from where it first occurred. When prostate cancer metastasizes, it often spreads to the bones. This can cause pain in the:

  • pelvic area
  • back
  • chest

If the cancer spreads to the spinal cord, you may lose feeling in your legs and your bladder.

Some men can have prostate cancer for years without any symptoms. Learn more about symptoms to watch for.

Early signs of prostate cancer

While any of the above symptoms can be your first indication that you have prostate cancer, urinary symptoms are more likely than other symptoms to appear early.

It’s important to keep in mind that most of these symptoms can also be caused by other conditions that aren’t cancer. These conditions include benign prostatic hyperplasia (BPH) and prostatitis. So, while it’s important to keep tabs on any symptoms you may have, you should remember that there’s a good chance they’re not caused by cancer.

That said, neither of these conditions causes blood to appear in your urine. If you have this symptom, call your doctor right away. Blood in your urine may be caused by something other than cancer, but it’s a good idea to get it diagnosed as soon as possible. Find out more about possible early symptoms of prostate cancer and when to call your doctor.

Prostate cancer screening and diagnosis

Screening for prostate cancer often depends upon your own personal preferences. This is largely because, as stated by the Centers for Disease Control and Prevention (CDC), most prostate cancers grow slowly and don’t cause any health problems.

It’s also because the results from the prostate-specific antigen (PSA) test, which can be part of the screening, may lead to a misdiagnosis of cancer. For both of these reasons, screening could cause unnecessary worry and unneeded treatment.

Screening recommendations

The ACS does have screening recommendations for men as they get older. They recommend that during an annual exam, doctors talk to men of certain ages about the pros and cons of screening for prostate cancer. These conversations are recommended for the following ages:

  • Age 40: For men at very high risk, such as those with more than one first-degree relative — a father, brother, or son — who had prostate cancer at an age younger than 65.
  • Age 45: For men at high risk, such as African American men and men with a first-degree relative diagnosed at an age younger than 65.
  • Age 50: For men at average risk of prostate cancer, and who are expected to live at least 10 more years.

Tools for diagnosis

If you and your doctor decide that screening for prostate cancer is a good choice for you, your doctor will likely do a physical exam and discuss your health history. They’ll also do one or more tests, which may include:

  • Digital rectal exam (DRE): With this exam, your doctor will insert a gloved finger into your rectum to inspect your prostate. They can feel if there are any hard lumps on your prostate gland that could be tumors.
  • Prostate specific antigen (PSA) test: This blood test detects your levels of PSA, a protein produced by the prostate. See below for more information.
  • Prostate biopsy: Your doctor may order a biopsy to help confirm a prostate cancer diagnosis. For a biopsy, a healthcare provider removes a small piece of your prostate gland for examination.
  • Other tests: Your doctor may also do a magnetic resonance imaging (MRI), a bone scan, or a computed tomography (CT) scan.

Your doctor will discuss with you the results of these tests and make recommendations for any next steps that may be needed. Learn more about what to expect during a prostate exam and how to prepare for one.

PSA test

The PSA blood test checks the amount of prostate-specific antigen that’s in your blood. If the levels are high, this could mean you have prostate cancer. However, there are many reasons why you could have a high amount of PSA in your blood, so the test results could lead to a misdiagnosis and unnecessary treatment.

Therefore, the American Urological Association and the U.S. Preventive Services Task Force no longer recommend the PSA blood test for screening for prostate cancer. However, the PSA test is still appropriate in certain cases, such as for men at high risk of prostate cancer. Also, if you already have a confirmed case of prostate cancer, this test is still approved for cancer staging or grading. See below for more on that.

Before you consider having a PSA blood test, talk to your doctor about the risks and benefits. Find out more about the pros and cons of having a PSA test.

Gleason scale

If you’ve had a prostate biopsy, you’ll receive a Gleason score. Pathologists use this score to classify the grade of prostate cancer cells. The grade means how much the abnormal cells look like cancer, and how aggressive their growth seems to be.

A Gleason score lower than six means your cells don’t show signs of cancer, so your risk is low. If your score is seven or higher, your doctor will likely look at your score and your PSA level to assess the cells.

For instance, a Gleason score of 7, with a PSA level between 10-20 ng/mL, means that cancer cells have been identified — but the cancer is likely nonaggressive, with slow-growing cells. A Gleason score of 8 or higher, with PSA levels greater than 20 ng/mL, indicates a more advanced tumor. That means your risk of an aggressive cancer is higher. Learn about how a Gleason score is calculated and what your score means for you.

Prostate cancer stages

Your doctor will likely use both the results from your PSA test and your Gleason score to help determine the stage of your prostate cancer. The stage indicates how advanced your cancer is. This information helps your doctor plan your treatment.

Another tool used in staging prostate cancer is the American Joint Committee on Cancer (AJCC) TMN staging system. Like many other types of cancer, prostate cancer is staged using this system based on:

  • the size or extent of the tumor
  • the number of lymph nodes involved
  • whether or not the cancer has spread (metastasized) to other sites or organs

Prostate cancer stages range from 1 to 4. The disease is most advanced in stage 4. Learn more about prostate cancer staging, and what each stage means.

Prostate cancer treatment

Your doctor will develop an appropriate treatment plan for your cancer based on your age, health status, and the stage of your cancer.

If the cancer is nonaggressive, your doctor may recommend watchful waiting, which is also called active surveillance. This means you’ll delay treatment but have regular checkups with your doctor to monitor the cancer.

More aggressive types of cancer may be treated with other options, such as:

If your cancer is very aggressive and has metastasized, there’s a good chance it has spread to your bones. For bone metastases, the above treatments may be used, in addition to others. Learn more about treatments and outlook for bone metastases.

Prostatectomy

A prostatectomy is a surgical procedure during which part or all of your prostate gland is removed. If you have prostate cancer that hasn’t spread outside of the prostate, your doctor may suggest that you have a radical prostatectomy. With this procedure, the entire prostate gland is removed.

There are different types of radical prostatectomies. Some are open, which means you’ll have a larger incision in your lower abdomen. Others are laparoscopic, which means you’ll have several smaller incisions in your abdomen. Find out more about the types of surgical options and what to expect with a prostatectomy.

Prostate cancer survival rate

If prostate cancer is diagnosed early and hasn’t spread from the original tumor, the outlook is usually good. Early detection and treatment are key to a positive outcome. So, if you think you have symptoms of prostate cancer, you should schedule an appointment with your doctor right away.

However, if the cancer advances and spreads outside of your prostate, that will affect your outlook. Find out more about survival rates for advanced prostate cancer, including cancer that has spread to your bones.

Prostate cancer prevention

There are certain risk factors for prostate cancer, such as age, that you can’t control. However, others you can control.

For instance, quitting smoking could reduce your risk of prostate cancer, as research has shown that smoking increases your risk. Diet and exercise are also important factors that can influence your risk of prostate cancer.

Diet

A 2005 review of studies explored the role of diet in prostate cancer. Evidence from the studies suggest that certain foods may help reduce your risk of prostate cancer, including:

  • tomatoes
  • cruciferous vegetables such as broccoli, Brussels sprouts, and kale
  • fish
  • soy
  • oils that contain omega-3 fatty acids, such as olive oil

The evidence also suggests that certain foods may increase your risk of prostate cancer, such as:

  • milk and dairy products
  • saturated fat, which is found in animal products
  • red meat
  • grilled meat

Exercise

According to a 2006 study of over 29,000 men, exercise can likely help reduce your risk of developing advanced prostate cancer, and of dying of prostate cancer.

Exercise can also help you lose weight, which is key because research has shown obesity to be a risk factor for prostate cancer. With your doctor’s approval, aim for 30 minutes of exercise most days of the week. Learn more about how diet and exercise could help reduce your risk of prostate cancer.

Talk with your doctor

Prostate cancer is a risk for all men as they age, but if it’s caught and treated early, the outlook is generally very good. So as you get older, be sure to have open conversations with your doctor about your risk.

If you have any symptoms you think might be prostate cancer, talk to your doctor right away. And even if you don’t have symptoms, consider adopting a healthy lifestyle to decrease your risk. A diet rich in vegetables and fish and low in full-fat dairy and red meat, paired with an exercise plan approved by your doctor, could help reduce your risk of prostate cancer, as well as boost your health overall.

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