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Prostate Cancer

Overview

Prostate cancer develops in the prostate gland, a part of the reproductive system in men and people assigned male at birth. Many people choose active surveillance (no treatment) because prostate cancer tends to grow slowly and stay in the gland. For cancers that grow fast and spread, common treatments include radiation and surgery.

What is prostate cancer?

Prostate cancer develops in the prostate, a small walnut-shaped gland located below the bladder and in front of the rectum in men and people assigned male at birth (AMAB). This tiny gland secretes fluid that mixes with semen, keeping sperm healthy for conception and pregnancy.

 

Prostate cancer is a serious disease. Fortunately, most people with prostate cancer get diagnosed before it spreads beyond their prostate gland. Treatment at this stage often eliminates the cancer.

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

 

Less common types of prostate cancers include:

 

  • Small cell carcinomas.
  • Transitional cell carcinomas.
  • Neuroendocrine tumers.

Early-stage prostate cancer rarely causes symptoms. These issues may occur as the disease progresses:

 

  • 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 (tospermia) or pee.
  • Pain in your low back, hip or chest.

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.

The most common risk factors include:

 

  • 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.You’re at greater risk if you’re Black or of African ancestry. You’re more likely to develop prostate cancers that are more likely to spread. You’re also at greater risk of prostate cancer forming 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.
  • You’re at 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 > 30 (having obesity).
  • Sexually transmitted infections (STIs).

Screenings can help catch prostate cancer early. If you’re average risk, you’ll probably have your first screening test at age 55. You may need earlier screenings if you’re in a high-risk group. Screenings usually stop after age 70.

You may need additional tests or procedures if screenings show you may have prostate cancer.

 

Screening tests for prostate cancer

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 protein-specific antigen (PSA). High PSA levels may indicate cancer. Levels also rise if you have benign conditions, such as BPH or prostatitis.

Diagnostic procedures for prostate cancer

Not everyone who likely has prostate cancer will need a definitive diagnosis. For example, if your provider thinks your tumor is growing slowly, they may delay more testing because it’s not serious enough to require treatment. If it’s more aggressive (growing fast or spreading), you may need additional tests, including a biopsy.

  • 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 for testing in a lab for cancer. A biopsy is the only sure way to diagnose prostate cancer or know for certain how aggressive it is. Your provider may perform genetic tests on the biopsied tissue. Some cancer cells have characteristics (like mutations) that make them more likely to respond to specific treatments.

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 spread 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.

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 cancer diagnosed in the early stages can be cured with treatment.

Specific procedures used

 

Surveillance

Your healthcare provider may monitor your condition instead of providing treatment if your cancer grows slowly and doesn’t spread.

 

  • Active surveillance:You get screenings, scans and biopsies every one to three years to monitor cancer growth. Active surveillance works best if the cancer grows slowly, is only in your prostate and isn’t causing symptoms. If your condition worsens, your provider can start treatments.
  • Watchful waiting:Watchful waiting is similar to active surveillance, but it’s more commonly used for people who are frailer with cancer that likely won’t go away with treatment. Also, testing is much less frequent. Instead of eliminating the tumor, treatments usually focus on managing symptoms.


Surgery

 

A radical prostactomy 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 — from your belly button to your pubic bone — and removes your prostate gland. This technique isn’t as common as less-invasive methods like robotic prostatectomy.
  • Robotic radical prostatectomy:Robotic radical prostatectomy allows your provider to perform surgery through several tiny incisions. Instead of operating directly, 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:A form of internal radiation therapy, brachytherapy involves placing radioactive seeds inside your prostate. This approach kills cancer cells while preserving surrounding healthy tissue.
  • External beam radiation therapy:With external beam radiation therapy (EBRT), a machine delivers strong X-ray beams directly to the tumor. Specialized forms of EBRT, like IMRT, can direct high doses of radiation toward the tumor while sparing healthy tissue.

Systemic therapies

 

Your provider may recommend systemic therapies if cancer has spread outside your prostate gland. Systemic therapies send substances throughout your body to destroy cancer cells or prevent their growth.

 

  • Hormone therapy:The hormone testosterone boosts cancer cell growth. Hormone therapy uses medications to combat testosterone’s role in fueling cancer cell growth. The medicines work by preventing testosterone from reaching cancer cells or by reducing your testosterone levels. Alternatively, your provider may recommend surgery to remove your testicles (orchiectomy) so they can no longer make testosterone. This surgery is an option for people who don’t want to take medications.
  • Chemotherapy:Chemotherapy uses medicines to destroy cancer cells. You may receive chemotherapy alone or with hormone therapy if your cancer has spread beyond your prostate.
  • Immunotherapy:Immunotherapy strengthens your immune system so it’s better able to identify and fight cancer cells. Your healthcare provider may recommend immunotherapy to treat advanced cancer or recurrent cancer (cancer that goes away but then returns).
  • Targeted therapy:Targeted therapy zeroes in on the genetic changes (mutations) that turn healthy cells into cancer cells to prevent them from growing and multiplying. Targeted therapies that treat prostate cancer destroy cancer cells with BRCA gene 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.

Potential side effects include:

 

  • Incontinence:You may leak urine when you cough or laugh or feel an urgent need to pee even when your bladder isn’t full. This problem usually improves over the first six to 12 months without treatment.
  • Erectile dysfunction (ED):Surgery, radiation and other treatments can damage the erectile nerves in your penis and affect your ability to get or maintain an erection. It’s common to regain erectile function within a year or two (sometimes sooner). In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to your penis.
  • Infertility:Treatments can affect your ability to produce or ejaculate sperm, resulting in infertility. If you want children in the future, you can preserve sperm in a sperm bank before starting treatment. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into your partner’s uterus.

Talk to your healthcare provider if you’re experiencing treatment side effects. Often, they can recommend medicines and procedures that can help.

Your outlook is excellent if your healthcare provider detects prostate cancer early. Almost everyone — 99% — diagnosed with cancer that hasn’t spread outside of their prostate live at least five years after diagnosis.

 

Prostate cancer survival rates aren’t as good when the cancer’s metastasized, or spread outside of your prostate. Thirty-two percent of people with metastatic prostate cancer are alive five years later.