Prostate cancer has a high survival rate overall — in fact, most people who get prostate cancer will survive it — but it's still the second-leading cause of cancer death in people with prostates in the U.S., according to the American Cancer Society.
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That gives you an idea of how common this type of cancer is. Couple that with the reality that some of the symptoms of prostate cancer can mirror benign prostate issues, especially those associated with normal aging, and it becomes even more important to know the signs of this condition.
Read on for more on the basics of prostate cancer, including risk factors, screening recommendations, how it's diagnosed and what treatments are available.
What Is Prostate Cancer?
Prostate cancer is cancer that originates in the prostate gland, which is only found in people assigned male at birth, according to the Centers for Disease Control and Prevention (CDC). The prostate is part of the male reproductive system, located below the bladder, and it produces fluid that's found in semen.
Cancer of the prostate, like any other type of cancer, occurs when cells begin growing out of control. How aggressively the cells grow — and to what extent they spread — determines what stage of cancer occurs.
There are four stages of prostate cancer:
- Stage 1: The cancer is very small and localized to just the prostate. The cancer is so small, in fact, that it can't even be felt with a physical exam.
- Stage 2: The cancer is still confined to the prostate, but it is larger and can be felt by a doctor as a firm nodule.
- Stage 3: The cancer is still located primarily in the prostate but is beginning to expand to around the prostate, into the seminal vesicle.
- Stage 4: In the most severe stage, the cancer escapes the prostate area and gets into other places in the body, such as the lymph nodes, bones and other organs.
The prognosis for prostate cancer worsens as it progresses through each stage. Treatment for the cancer will vary based on what stage is diagnosed.
Prostate Cancer Causes
Unlike some other types of cancer, prostate cancer doesn't have any clear environmental links, Przemyslaw Twardowski, MD, medical oncologist and Director of Clinical Research in the Department of Urology and Urologic Oncology at the John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, California, tells LIVESTRONG.com.
For instance, lung cancer is clearly associated with smoking, and colon cancer is linked to diet, but prostate cancer doesn't have one single, discernible environmental cause. However, there are certain factors that are associated with an increased risk of prostate cancer.
1. Family History
There is a strong genetic link with prostate cancer.
"If you have a first-degree relative [with prostate cancer] — a father or brother — your risk of developing prostate cancer is double or triple that of someone who does not," Dr. Twardowski says.
Prostate cancer occurs almost exclusively in older adults. Dr. Twardowski notes that the condition is usually diagnosed between the ages of 65 and 80.
"The older you get, the more likely it is that you will get prostate cancer," he says.
There's a clear increased incidence of prostate cancer in Black people, according to the CDC. Black individuals have the highest occurrence of prostate cancer, are twice as likely to die from the cancer once it is diagnosed and also have more aggressive forms of prostate cancer, even at younger ages.
There does appear to be some association between diet and prostate cancer, but overall, the link is "relatively weak," Dr. Twardowski says. In general, though, according to John Hopkins Medicine, any diet high in saturated fat and low in fruits and vegetables is associated with an increased risk of cancer.
Does Bike Riding Up Your Risk for Prostate Cancer?
Dr. Twardowski says this is a myth. So is the belief that smartphones, laptops or other devices cause prostate cancer.
Prostate Cancer Symptoms
According to the Prostate Cancer Foundation, symptoms of prostate cancer can include:
- Slowing down of urine stream — this can look like urine "dribbles," a weak or narrow stream or urine or having to urinate in a seated position because the stream is not strong enough to reach from a standing position.
- Having to get up to empty the bladder at night, even multiple times
- Irritation and discomfort when urinating
- Difficulty starting or stopping the urine stream
- Pain while urinating
- Trouble having an erection and/or pain while ejaculating
- In advanced cases of prostate cancer, blood may be seen in the urine or semen, and if the cancer has spread, symptoms may also occur elsewhere in the body, such as having unexplained bone pain
It is important to note that some of the symptoms of prostate cancer can mirror noncancerous causes. For instance, an infection could cause pain while urinating. And because the prostate enlarges normally with aging, many of the same symptoms also occur without cancer as well.
That doesn't mean you should ignore any prostate-related symptoms, though. If you notice any of the above signs, you should schedule an appointment with your doctor, Dr. Twardowski says.
Should I Get Screened for Prostate Cancer?
The U.S. Preventive Services Task Force updated its recommendations about prostate cancer screening in 2018 for people who don't have symptoms and have never been diagnosed with the disease:
- Ages 55-69: Screening should be an individual decision based on conversations with your doctor about the potential benefits and harms of testing
- Ages 70 and older: Routine screening is not recommended
How Prostate Cancer Is Diagnosed
A prostate cancer diagnosis generally follows a progressive series of tests:
1. Blood Test
The first step in diagnosis is a blood test for the Prostate-Specific Antigen, also known as a PSA test. Many people are familiar with this test as it's commonly done for anyone who has symptoms affecting the prostate. PSA levels can also be elevated by other things, such as a benign enlarged prostate. Thus, Dr. Twardowski explains that if the PSA level is elevated, it's not necessarily proof of cancer, but it is a sign that further testing should be done.
2. Physical Exam
If PSA levels are high, or other symptoms warrant it, a health care provider will often do a physical rectal exam to look for evidence of a nodule in the prostate.
Increasingly, MRI is used to look at the prostate cancer for signs of cancer, Dr. Twardowski says.
While the blood test, physical exam and imaging are helpful as first steps for a prostate cancer diagnosis, the only definitive way to diagnosis the cancer is through a biopsy. A biopsy is a surgical procedure to remove tissue from the suspected area to determine if cancer cells are present. It is a minor, low-risk procedure that can be done in a same-day surgical center.
Treatment for Prostate Cancer
How prostate cancer is treated will depend on what stage the cancer is in. For stage 1, treatment may not even be needed for many years and will only require monitoring, Dr. Twardowski says.
For more aggressive types of cancer, the following treatments may be used:
Surgery can be performed to remove the affected areas, or the entire prostate gland.
2. Radiation Therapy and Chemotherapy
These therapies can be used alone or in conjunction with surgery to kill the cancer without removing the prostate.
3. Investigational Treatment
Some emerging treatments include high-intensity focus ultrasound (HIFU) to target the cancer and cryosurgery, which uses a low-temperature probe to freeze that part of the prostate in an attempt to kill the cancer. Dr. Twardowski cautions that these interventions are not yet proven on a large scale.
4. Hormone Therapy
For prostate cancer that has spread, medications that lower the production of testosterone in the body can help control the growth of the cancer. This type of treatment is primarily used in advanced cases and can be effective for many years, even though a full cure is not possible.
- John Hopkins Medicine: "Prostate Cancer Risk Factors"
- American Cancer Society: "Key Statistics for Prostate Cancer"
- CDC: "What is Prostate Cancer?
- CDC: "Who Is at Risk for Prostate Cancer?"
- Prostate Cancer Foundation: "What are Prostate Cancer Symptoms?"
- Prostate Cancer Foundation: "Should I Be Screened?"
- U.S. Preventive Services Task Force: "Recommendation: Prostate Cancer: Screening"