Prostate Cancer

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What is Prostate Cancer

The prostate is a gland found below the bladder and only in individuals born male. It makes some of the fluid in semen. Prostate cancer begins when gland cells grow out of control. Almost all prostate cancers are adenocarcinomas, meaning they form in the glandular tissue.

Prostate cancer is the most common cancer in men in the US, other than skin cancer. It's also the second-leading cause of cancer death (after lung cancer). About 1 in 8 men get prostate cancer in their lifetime. Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer don’t die from it. If caught early, prostate cancer is highly treatable.

Prostate Cancer Signs and Symptoms

In many cases, prostate cancer grows gradually and doesn't tend to show signs or symptoms in the earliest stages. Prostate cancer symptoms begin to appear as the cancer progresses and may include:

Blood in the urine or semen
Consistent pain in the back, pelvis, chest or hips
Difficulty urinating
Feeling very tired
Frequent urination, especially at night
Pain or burning sensation when urinating
Struggle to have an erection
Weak urine flow
Weight loss

These symptoms are also caused by benign prostatic hyperplasia, which is when the prostate gland is enlarged but not cancerous. Consult your doctor if you have any of the above symptoms.

Prostate Cancer Causes and Risk Factors

There’s not a single cause of prostate cancer but factors that can increase your risk include:

Age: Prostate cancer happens at any age, but the chances go up at age 50. Most prostate cancers are found in individuals born male over the age of 65.
Chemical exposures: Research suggests that exposure to some chemicals, such as combustion byproducts, agricultural chemicals and arsenic might increase prostate cancer risk.
Diet: Studies suggest individuals who eat a high-fat diet, especially a diet high in red meat or fatty dairy products, have a greater chance of developing prostate cancer.
Family history: Prostate cancer can run in families—suggesting a genetic factor. Having a father or brother with prostate cancer more than doubles a person’s risk of developing the disease. The risk is much higher for a person with several affected relatives, particularly if their relatives were young when the cancer was found. Still, most prostate cancers occur in individuals without a family history of it.
Obesity: Most studies conclude that obesity doesn't affect the overall risk of prostate cancer. However, obese individuals are more likely to develop aggressive forms of prostate cancer.
Race and ethnicity: Prostate cancer develops more often, and at a younger age, in Black and Caribbean males of African ancestry than in males of other races.
Smoking: Makes it more likely to die of prostate cancer.
Vasectomy: Research is still underway.
Testosterone therapy: Promotes prostate cancer cell growth.

How is Prostate Cancer Diagnosed?

Most prostate cancers are found early through a screening. There’s no way to check for prostate cancer at home. If you’re 50 years old, have a prostate and are at average risk, talk to your doctor about the pros and cons of prostate cancer screening. In some cases, you may need to be screened at an earlier age.

Begin screening at age 45. If you’re Black or have a close relative (father or brother) who had prostate cancer before age 65.
Begin screening at age 40. If more than one close relative had prostate cancer before 65.

Screening Tests for Prostate Cancer

Digital Rectal Examination (DRE): Digital rectal examination is when a health care provider inserts a gloved, lubricated finger into a man’s rectum to feel the prostate for anything abnormal, such as cancer. PSA results are paired with DRE.
Prostate Specific Antigen (PSA): A blood test that measures the level of PSA in your blood, a substance made by the prostate. The normal PSA range is 0-4. PSA levels in the blood are higher in individuals who have prostate cancer. Higher levels of PSA can also be caused by other conditions that affect the prostate. Some prostate glands make more PSA than others. PSA levels are also affected by an enlarged prostate, a prostate infection and certain medical procedures and medications. Because many factors affect PSA levels, your doctor will interpret your PSA test results.
Biopsy: If the PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer. During a prostate biopsy, a needle collects tissue samples from your prostate gland.
PSMA PET scan: Prostate-specific membrane antigen (PSMA) PET scan is an imaging test that shows if prostate cancer has spread outside your prostate gland, such as to the lymph nodes and other organs or bones. PET scans are a type of imaging test that use special dye with radioactive tracers to make cancer cells show up more clearly.

What Are the Stages of Prostate Cancer?

Clinical Stages

Determining the stage (extent) of prostate cancer plays a key role in determining a person’s treatment options. There are four clinical stages of prostate cancer. Each stage is based on the results of the urologist's physical examination of the person's prostate (DRE) and any other tests done prior to treatment.

The following clinical stages are used to describe prostate cancer (the “T” stands for “tumor”):

T1: The tumor can’t be felt during the DRE or seen on imaging (CT scan or ultrasound). It may be found incidentally during surgery.
T2: The tumor is confined to the prostate. Due to the size of the tumor, the doctor can feel it during the DRE. Cancer is seen on imaging.
T3: The tumor has grown outside the prostate. It may have spread to the seminal vesicles.
T4: The tumor has spread to tissues next to the prostate other than the seminal vesicles. For example, cancer is growing in the rectum, bladder, urethral sphincter (muscle that controls urination) and/or pelvic wall.

Prostate Cancer Gleason Score

Following surgery to remove the prostate gland, a pathologist assigns the pathologic stage and Gleason score (grade). The Gleason grade of prostate cancer describes what the actual cancer cells look like under a microscope. The cells have five distinct patterns as they change from normal to tumor cells. They’re graded on a scale from one to five based on what the cancer cells look like compared to normal cells. Grade 1 cells resemble normal prostate tissue. Cells closest to 5 are considered "high-grade" and have mutated so much that they barely resemble normal cells.

The pathologist assigns a Gleason score to the most common cells found in a specimen, and the next most common and then adds them together.

Gleason score of 6 is low-grade prostate cancer.
Gleason score of 7 is intermediate-grade prostate cancer.
Gleason score of 8 to 10 is high-grade prostate cancer.

Prostate Cancer Treatment

Some prostate cancers grow slowly and don’t require immediate treatment. In these cases, you and your doctor may decide on “active surveillance” with regular follow-ups. For those prostate cancers that do need treatment, options depend on the stage of the cancer and other medical conditions. Sometimes treatments are combined.

Chemotherapy drugs destroy cancer cells by stopping them from growing or reproducing. It’s often used in more advanced stages of prostate cancer.
High Dose Rate (HDR) Brachytherapy is a form of radiotherapy where a radioactive source is brought to a tumor and targeted via a catheter.
Hormone therapy alters hormone levels in the body to treat cancer cells. For prostate cancer, the goal is to suppress testosterone.
Immunotherapy enhances the body’s immune system to recognize and attack cancer cells.
Radiopharmaceuticals deliver radiation therapy directly to cancer cells.
Radiation therapy uses high-energy radiation to damage the building blocks of cancer cells and stop them from growing or spreading. It can shrink the tumor, and in some cases, eliminate it. The number of radiation therapy sessions needed depends on the intent of treatment and extent of the disease.
Surgery is used to treat prostate cancer. The goal is to remove all the cancer while lowering the risk of complications and side effects from surgery.
Targeted therapy focuses on specific molecules or pathways involved in the growth and survival of cancer cells, blocking their activity, reducing growth and promoting cell death.

Side Effects of Prostate Cancer Treatment

Side effects of treatment depend on the type of therapy used. The two most common side effects are erectile dysfunction and incontinence. They’re most common with surgery and radiation therapy but can improve over time. Talk to your doctor about potential treatment side effects you may experience.

Prostate Cancer Prevention

Prostate cancer is a serious health concern for men. While there's no guaranteed way to prevent it, certain lifestyle factors and regular screenings can significantly reduce your risk.

Avoid excessive dairy and calcium. While research is ongoing, some studies suggest a link between high dairy consumption and prostate cancer risk.
Eat a healthy diet. Focus on fruits, vegetables, whole grains and lean proteins. Limit red and processed meats, sugar-sweetened beverages and highly processed foods.
Exercise regularly. Aim for at least 30 minutes of physical activity most days of the week.
Get enough sleep. Get 7-9 hours each night to support overall health.
Know your family history. Discuss your family's risk factors for prostate cancer with your doctor.
Maintain a healthy weight. Prioritize a healthy diet and regular exercise.
Manage stress. Find healthy ways to manage stress, such as meditation, yoga or spending time in nature.
Quit smoking. Smoking is a major risk factor for prostate cancer and many other health problems.
Stay up-to-date on screenings. Talk to your doctor about prostate cancer screenings and follow their recommendations.

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