The prostate is a small, walnut-sized gland that sits just below a man’s bladder. Like other types of cancer, prostate cancer begins when cells in the prostate begin growing and dividing more rapidly than normal cells. When other cells complete their lifespan, they die. Cancer cells continue living and reproducing. As these abnormal cells accumulate, they can develop into a tumor. This tumor can eventually spread (metastasize) to nearby tissues, organs, lymph nodes, and eventually bones.
Prostate cancer is the second most common cancer in the United States and the second leading cause of cancer-related deaths among men. In the United States, 1 in 7 men will be diagnosed with prostate cancer in their lifetime. It’s estimated that more than 2.5 million men in the United States are living with prostate cancer. Each year almost 30,000 men die from it, according to the American Cancer Society.
Keep reading to learn who’s at risk, warning signs, latest treatments, discussion topics for you and your doctor, and more.
The most common symptoms of prostate cancer include:
- trouble urinating
- increased frequency of urination
- decreased force when urinating
- blood in the urine and semen
- swelling in the legs
- discomfort in the pelvis or rectal region
- pain with ejaculation
- erectile or other sexual dysfunction
In some men, prostate cancer can develop for months or years before it begins causing symptoms. That’s why regular cancer screenings are important.
Prostate-specific antigen (PSA) screenings detect the amount of PSA in the blood. PSA is a protein produced by the prostate gland. PSA levels can be measured through a simple blood test. When the prostate gland is affected by cancer, infection, inflammation, or enlargement, it releases higher than normal levels of the enzyme.
As part of a regular physical, doctors may begin performing a digital rectal exam (DRE) on men around the age of 50 or earlier in those with risk factors for the cancer. An ultrasound may be needed to check for the presence of a tumor. If these initial tests are concerning, a biopsy may be warranted. This is a procedure using a needle to sample a piece of the prostate for doctors to analyze under a microscope.
A prostate biopsy is graded by the look of the cells under the microscope and assigned a score, called a Gleason score. The higher the Gleason score, the more aggressive the cancer appears to the pathologist. The Gleason score along with the DRE and PSA helps indicate the stage of the cancer and how likely the prostate cancer has spread into nearby tissue, organs, or bones.
How to read a Gleason score
|1||Low-risk for prostate cancer|
|2-5||Early-stage prostate cancer: The cancer probably hasn’t spread past the prostate.|
|6-7||Intermediate-stage prostate cancer: Many prostate cancers are found during this stage.|
|8-10||Advanced-stage prostate cancer: It’s likely the cancer has spread outside the prostate.|
The following factors increase a man’s risk of prostate cancer:
- Age: Prostate cancer is most common in men over 65, but the likelihood of developing prostate cancer increases after age 50.
- Race: African-American men have a higher risk, while Asian-American men have the lowest risk.
- Family history: Men with a family history of prostate cancer have an increased risk of developing the cancer. The closer the relation, the higher your chances.
- Obesity: Overweight and obese men are more likely to have prostate cancer than men of a healthier weight.
Healthcare professionals and doctors differ in their thoughts about who should have regular PSA screenings. That’s because some men may have a falsely elevated test result and choose to have treatment that might not be necessary. It’s important to note that an increased PSA level isn’t always a sign of cancer. It can indicate an infection, inflammation, or prostate enlargement. Before undergoing a PSA test, you should consult with your doctor about your risks and make your decision accordingly.
Men with prostate cancer have several treatment options. These include:
- radical prostatectomy, which is the removal of the prostate gland
- radiation therapy, which uses high-energy radiation that can shrink and kill cancer cells
- chemotherapy, a drug treatment that uses chemicals to kill cancer cells
- hormone therapy, which stops the body from producing testosterone, the hormone prostate tumors use to grow
- brachytherapy, a procedure where radioactive seeds are placed in or near the tumor to shrink and kill it
- cryosurgery, where tissue is frozen to kill cancer cells
- ultrasound therapy, which heats the prostate tissue to kill cancer cells
Advances in treatment
In 2010, the U.S. Food and Drug Administration approved the first-ever cancer treatment immunotherapy vaccine, sipuleucel-T (Provenge). The Provenge vaccine has been found to extend the lives of men with advanced-stage prostate cancer.
Researchers are also developing newer forms of treatment for prostate cancer, such as high-intensity focused ultrasound therapy to destroy cancer cells, and targeted therapy drugs to stop the growth of cancerous cells. Doctors are also looking into the use of radiofrequency ablation to reduce pain in men with prostate cancer.
The earlier prostate cancer is found, the better. Early-stage prostate cancers can often be treated, but advanced stage prostate cancer becomes harder to treat. Plus, the treatments that are usually most effective for advanced prostate cancer tend to have the most negative side effects. These include urinary incontinence and erectile dysfunction.
Based on your individual risk for the disease, your lifestyle, and your age, you and your doctor can decide how often you should be screened and at what age those screenings should start.