What is prostate cancer?
Prostate cancer develops in the prostate, a small walnut-shaped gland that’s part of a man’s reproductive system. Prostate cancer is very common, affecting one out of every nine men.
What is the prostate gland?
The prostate gland is part of the male reproductive system. The gland makes fluid that mixes with semen during ejaculation. This fluid helps protect sperm and keeps it healthy for conception and pregnancy.
Where is the prostate gland?
The prostate gland sits below a man’s bladder in front of the rectum. The urethra runs through the center of the prostate gland. This tube carries urine and semen through the penis and out of the body. The seminal vesicles that make semen sit behind the prostate gland.
How common is prostate cancer?
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments — and some men don’t need treatment at all. Still, approximately 33,000 men die from the disease every year.
Who might have prostate cancer?
Men over the age of 55 are more prone to the disease. Your chances of developing prostate cancer increase as you age. In fact, 60% of prostate cancers occur in men over the age of 65. Other risk factors include:
- Ethnicity (black men have the highest risk).
- Family history of prostate cancer.
What are the types of prostate cancer?
Almost all prostate cancers are adenocarcinomas (malignant tumors). This type of cancer starts in the cells of glands that make secretions. Rarely, other types of cancer develop in the prostate. These include:
- Small cell carcinomas.
- Transitional cell carcinomas.
- Neuroendocrine tumors.
SYMPTOMS AND CAUSES
What causes prostate cancer?
Experts aren’t sure why some cells in the prostate gland become cancerous (malignant). Genetics appear to play a role. For example:
- You’re two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated (changed) breast cancer genes (BRCA1 and BRCA2) and other gene mutations contribute to a small number of prostate cancers.
What are the symptoms of prostate cancer?
Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:
- Frequent, sometimes urgent, need to urinate, especially at night.
- Weak urine flow or flow that starts and stops.
- Painful urination (dysuria).
- Fecal (bowel) incontinence.
- Painful ejaculation and erectile dysfunction (ED).
- Blood in semen (hematospermia) or urine.
- Lower back pain, hip pain and chest pain.
- Leg or feet numbness.
Are prostate problems always a sign of prostate cancer?
Not all growths in the prostate are cancerous, and not all prostate problems indicate cancer. Other conditions that cause similar prostate cancer symptoms include:
- Benign prostatic hyperplasia (BPH): At some point, almost every man will develop benign prostatic hyperplasia (BPH). This condition enlarges the prostate gland but doesn’t increase cancer risk. The swollen gland squeezes the urethra and blocks the flow of semen and urine. Medications, and sometimes surgery, can help.
- Prostatitis: Men younger than 50 are more prone to prostatitis, inflammation and swelling of the prostate gland. Bacterial infections are often the cause. Treatments include antibiotics or other medications.
DIAGNOSIS AND TESTS
How is prostate cancer diagnosed?
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, you’ll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen (PSA) blood test: The prostate gland makes a protein called protein-specific antigen (PSA). Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging (MRI) technology provides detailed images of the prostate.
What are the stages of prostate cancer?
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three (slow-growing) to five (aggressive). Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score (ranging from six to 10).
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 (slow-growing cancer that might not require treatment). A score of nine or higher puts you in Grade Group five (aggressive, faster-growing cancer that requires immediate treatment). Samples with a higher portion of more aggressive cells receive a higher Grade Group.
MANAGEMENT AND TREATMENT
What are the complications of prostate cancer?
Some aggressive cancers quickly spread (metastasize) outside of the prostate. Prostate cancer most commonly spreads to the bones and lymph nodes. It can also develop in the liver, brain, lungs and other organs.
How is prostate cancer managed or treated?
Some people never need treatment because the cancer grows slowly and doesn’t spread. With treatment, most prostate cancer is highly curable. Treatment options include:
- Active surveillance: With this approach, you get screenings, scans and biopsies every one to three years to monitor cancer growth. Active surveillance works best if the cancer is only in the prostate, slow-growing and not causing symptoms.
- Watchful Waiting: Watchful waiting sounds similar to active surveillance, but is often used in older or frailer patients. Similar to active surveillance, this approach does not involve definitive treatment at diagnosis. However, the testing is much less frequent, and focuses on symptom management.
- Brachytherapy: A form of internal radiation therapy, brachytherapy involves placing radioactive seeds within the prostate. This approach helps preserve surrounding healthy tissue.
- External beam radiation therapy: With external beam radiation therapy, a machine delivers strong X-ray beams directly to the tumor. Intensity-modulated radiation therapy is a form of external radiation therapy that delivers powerful doses of radiation to the disease site.
- Systemic therapies: Your provider may recommend systemic therapies if cancer has spread outside of the prostate gland. These therapies include chemotherapy, androgen deprivation hormone therapy and immunotherapy.
- Focal therapy: Focal therapy is a newer form of treatment focusing on treating only the area of the prostate affected by cancer. You may be able to try this treatment if cancer hasn’t spread. Focal therapy options include high-intensity focused ultrasound (HIFU), cryotherapy, laser ablation and photodynamic therapy.
- Prostatectomy: This surgical procedure removes the diseased prostate gland. Surgeons can perform laparoscopic prostatectomy and robotic radical prostatectomy through small abdominal incisions. These procedures are less invasive than an open radical prostatectomy, which requires a larger abdominal incision, although both are effective in cancer removal.
What are prostate cancer treatment side effects?
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isn’t full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction (ED): Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two (sometimes sooner). In the meantime, medications like sildenafil (Viagra®) or tadalafil (Cialis) can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a woman’s uterus.
How can I prevent prostate cancer?
Most men develop prostate cancer as they get older for no known reason. Prevention isn’t possible. But, if you have certain prostate cancer risk factors, taking these steps may help minimize your risk and catch disease early:
- Get regular prostate screenings.
- Maintain a healthy weight.
- Exercise regularly.
- Eat a nutritious diet.
- Quit smoking.
OUTLOOK / PROGNOSIS
What is the prognosis (outlook) for people who have prostate cancer?
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men — 97% to 98% — diagnosed with localized cancer that hasn’t spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
When should I call my healthcare provider?
You should call your healthcare provider if you experience:
- Difficulty urinating.
- Frequent urination (incontinence).
- Pain during urination or intercourse.
- Blood in urine or semen.
What questions should I ask my healthcare provider?
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?