Prostate cancer is a serious disease that affects thousands of men each year who are middle-aged or older. About 60 percent of the cases occur in men older than age 65. The American Cancer Society (ACS) estimates that 174,650 American men will be newly diagnosed with this condition in 2019.
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 second-leading cause of cancer deaths for men in the United States.
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.
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
- 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.
As mentioned above, age is a primary risk factor for prostate cancer. The disease occurs most often in men older than age 65. It occurs in about 1 in 14 men between the ages of 60 and 69.
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 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)
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 following areas:
If the cancer spreads to the spinal cord, you may lose feeling in your legs and your bladder.
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.
So, while it’s important to keep tabs on any symptoms you may have, 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.
Screening for prostate cancer often depends upon your own personal preferences. This is largely because most prostate cancers grow slowly and don’t cause any health problems, according to the Centers for Disease Control and Prevention (CDC).
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.
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.
The U.S. Preventive Services Task Force (USPSTF) now recommends that men aged 55 to 69 decide for themselves whether to undergo a prostate-specific antigen (PSA) test, after talking it over with their doctor.
The USPSTF concludes that the potential benefits of PSA-based screening for men aged 70 and above does not outweigh the expected harms.
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 the following section for more information on the PSA test.
- 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 an MRI scan, CT scan, or bone 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.
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 USPSTF now recommends that men aged 55 to 69 decide for themselves whether to undergo a PSA test, after talking it over with their doctor.
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.
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.
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 to 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.
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.
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.
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.
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. 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.
There are certain risk factors for prostate cancer, such as age, that you can’t control. However, there are others you can control.
For example, 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.
Certain foods may help reduce your risk of prostate cancer, including:
- cruciferous vegetables such as broccoli, Brussels sprouts, and kale
- 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 can likely help reduce your risk of developing advanced prostate cancer, and of dying of prostate cancer.
Exercise can also help you lose weight. This 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.
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.