Cancer / OncologyMen's HealthProstate / Prostate CancerUrology / Nephrology

Prostate cancer: What to know

Prostate cancer is a common form of cancer in males but in the early stages it is highly treatable. This starts in the prostate gland, which lies between the bladder and the penis.

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The prostate has various functions, including:

  • producing the fluid that nourishes and transports sperm
  • secreting prostate specific antigen (PSA), a protein that helps semen retain its liquid state
  • helping aid urine control

In the United States, prostate cancer is the most common cancer that affects males.

In addition, the American Cancer Society ( ACS) expects about 174,650 new prostate cancer diagnoses and around 31,620 deaths from this form of cancer in 2019.

At some point in their lives, about 1 in 9 males will get a diagnosis of prostate cancer. But as a result only 1 in 41 of these will die.

This is because, particularly in the early stages, treatment is successful. Routine screening helps doctors to identify several cases of prostate cancer before it spreads.

Symptoms

A man with tatoo
Treatment for prostate is very effective in the early stages.

In the early stages of prostate cancer, there are often no signs but screening can detect changes that can suggest cancer.

Screening involves a blood test which measures PSA levels. High levels suggest you may have cancer.

Males suffering from symptoms may notice:

  • difficulty starting and maintaining urination
  • a frequent urge to urinate, especially at night
  • blood in the urine or semen
  • painful urination
  • in some cases, pain on ejaculation
  • difficulty getting or maintaining an erection
  • pain or discomfort when sitting, if the prostate is enlarged

Advanced symptoms

Advanced prostate cancer can involve the following symptoms:

  • bone fracture or bone pain, especially in the hips, thighs, or shoulders
  • edema, or swelling in the legs or feet
  • weight loss
  • tiredness
  • changes in bowel habits
  • back pain

Treatment

Treatment may depend, among other factors, upon the cancer stage.

In the following pages, we list some treatment options for each stage of prostate cancer, as well as some new strategies and what fertility treatment means:

Early stage prostate cancer

Doctors in surgery room
A prostatectomy is one possible treatment for early stage prostate cancer.

A doctor can prescribe if the cancer is small and localized:

Watchful waiting or monitoring

The doctor can routinely test blood PSA levels but do not take immediate action.

Prostate cancer is developing slowly, and the risk of side effects that outweigh the need to be treated immediately.

Surgery

A surgeon may carry out a prostatectomy. They can take either laparoscopic or open surgery to remove the prostate gland.

Radiation therapy

Options include:

Brachytherapy: A doctor will insert radioactive seeds to provide targeted radiation treatment in the prostate.

Conformal radiation therapy: It addresses a specific region reducing the risk to healthy tissue. One form, called intensity modulated radiation therapy, uses variable intensity beams.

Treatment depends on different factors. A doctor will discuss the individual’s best choice.

Advanced prostate cancer

When cancer grows it will spread all over the body. When it spreads, or returns after remission, then the care options must change.

Options include:

Chemotherapy: Cancer cells can be destroyed around the body, but this can cause adverse effects.

Hormonal therapy: Androgens are male hormones. Testosterone and dihydrotestosterone are the primary Androgens. Blocking or reducing these hormones would appear to stop or delay cancer cell growth. One choice is surgery to remove the testicles, which contain much of the hormones in the body. A variety of drugs can help too.

Lupron is a kind of hormone therapy which is used by physicians to treat prostate cancer.

In later stages, most physicians do not prescribe surgery, because it does not treat cancer that has spread to other areas of the body. Some experts have indicated, however, that in some situations this can help.

New treatments

Some newer approaches are aimed at treating prostate cancer without the side effects other treatment options could have.

These include:

After surgery, a doctor will continue to monitor PSA levels.

Effects on fertility

The prostate gland plays a role in sexual reproduction. Prostate cancer and many of its therapies have a cumulative effect on fertility.

For example, if a male has surgery to remove either the prostate gland or the testicles, semen production and fertility may be affected by this.

Radiation therapy can also affect prostate tissue, destroy sperm and decrease the amount of semen required to transport it.

Hormonal therapy can affect fertility too.

Some ways to maintain these functions, however, do include:

  • banking sperm before surgery
  • extracting sperm directly from the testicles for artificial insemination

Nevertheless, after treatment for prostate cancer there is no guarantee that fertility will remain intact. Anyone who wishes to have children after diagnosis will explore reproductive options with their physician while establishing their treatment plan.

Causes

Prostate cancer usually occurs in glandular cells when particular changes occur.

Cancerous or pre-cancerous cells in the prostate gland are called intraepithelial prostatic neoplasia (PIN).

Almost 50 percent of all males over 50 years of age have PIN.

The changes will be gradual at first, and the cells won’t be cancerous. With time, though, they can get cancerous. Cancer cells can be degrees high or low.

High-grade cells are more likely to develop and spread, whereas low-grade cells are unlikely to expand, and are not a concern.

Risk factors

Doctors do not know exactly why prostate cancer occurs, but can raise the probability of the following risk factors:

Age: Risk increases after age 50, but is rare before age 45.

Race or ethnicity: black males are more common than white males. Asian and Hispanic males are at a lower risk than white males or black males.

Personal history: If a male has a close relative with a history of prostate cancer, they ‘re more likely to develop it on their own.

Genetic factors: Inherited characteristics, including changes to the genes BRCA1 and BRCA2, can increase the risk. Mutations in these genes also increase breast cancer chances in females.

Other possible factors

There is some evidence to indicate that other factors can play a role, but to confirm their involvement scientists need more proof:

What about trans people?

People who are assigned males at birth will develop prostate cancer, whether or not they remain male.

Trans women using hormone therapy such as estrogen may have a lower risk but the risk remains.

Anyone who is assigned a male at birth will speak to their doctor about prostate cancer screening.

Stages

Knowing the stage of prostate cancer will help a person understand what to expect, and that will guide treatment decisions. We list the following stages:

Stage 0: There are precancerous cells, but they only affect a small area, and develop gradually.

Localized (stage 1): Cancer is found only in the prostate gland. This is the stage where successful treatment is possible.

Regional (stages 2–3): Cancer has spread to tissues nearby.

Distant (stage 4): Cancer has spread to other parts of the body , including the lungs or bones.

Diagnosis

If a male has symptoms that may indicate prostate cancer, the doctor will likely:

  • ask about symptoms
  • ask about personal and medical history
  • conduct a blood test to assess PSA levels
  • carry out a urine test to look for other biomarkers
  • carry out a physical examination, which may include a digital rectal exam (DRE)

In a DRE the doctor must manually test with his finger for any prostate abnormalities.

Further tests

A female doctor discussing with her patient
A number of tests can help a doctor diagnose prostate cancer.

When a doctor suspects cancer, more testing may be suggested, such as:

A PCA3 test: It is searching in urine for the PCA3 gene.

A transrectal ultrasound: It involves inserting a probe into the rectum with a mirror.

A biopsy: A doctor will take a sample of the tissue under a microscope for analysis.

The existence and form of cancer can be confirmed only by biopsy.

An individual requiring care instead of treatment may need a regular MRI or CT scan.

Outlook

Males with an early stage prostate cancer have a fair chance of being diagnosed and surviving successfully.

Based on previous estimates, the ACS expects the following percentages of people to live on average for at least another 5 years following diagnosis:

Localized or regional cancer: At least another 5 years will survive nearly 100 percent.

Distant: If the cancer has affected other parts of the body, around 30 per cent will survive for at least 5 more years.

The overall 5-year survival rate for prostate cancer is 98 per cent with treatment. However, lots of people live longer than this.

In the early stages the best way to detect prostate cancer is to attend regular screening. Anyone who has not yet completed the screening should inquire the options from their doctor.

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