Prostate Cancer
Prostate cancer is the second most common type of cancer among American men, second only to skin cancer. In the United States, more than 3.3 million men are living with or have had prostate cancer, and more than 313,780 men are diagnosed with the disease each year.
The prostate is a walnut-sized organ that helps in the production of semen. It is located just below the bladder, in front of the rectum.
Prostate cancer occurs when cells in the prostate gland grow abnormally, multiplying without control and forming a mass or a tumor in the prostate gland.
In most men diagnosed with prostate cancer, the tumor is only in the prostate and has not spread to other parts of the body. There are different treatments available depending on whether the cancer is only in the prostate or if it has spread to other parts of the body. If you have been diagnosed with prostate cancer, it is important to learn as much as possible about your diagnosis and to talk with your doctor to find the treatment option that is right for you.
Prostate cancer can strike fear in those who receive this diagnosis. Understanding the experiences of living with prostate cancer — ranging from 'scanxiety' to intimacy-related side effects — can enhance person-centered care and improve overall well-being.
Risk Factors
There are several factors that can increase your risk of prostate cancer. Speak with your doctor if you believe you may be at risk of developing prostate cancer. They may recommend earlier screening. Three common risk factors include:
- Age - Most men with prostate cancer are over 65; the disease is rare in men under 45.
- Family history - A person is more likely to get prostate cancer if his father, brother or son had prostate cancer. It is more common among Black men than white or Hispanic/Latino men. It’s least common among Asian American/Pacific Islander and American Indian/Alaska Native men.
- Prostate changes - Men with high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk of prostate cancer. PIN is a condition in which prostate cells appear abnormal under a microscope but are not yet cancerous.
Signs and Symptoms
Men are often diagnosed with prostate cancer following a digital rectal exam (DRE) or a prostate-specific antigen (PSA) test. Early prostate cancer usually causes no symptoms. Advanced prostate cancer can cause symptoms such as:
- Weak urine stream
- Blood in urine or semen
- Back pain
- Discomfort or evidence of swollen lymph nodes in the pelvic area
- Bone pain
- Weight loss
- Tiredness
If you experience any of these symptoms, speak with your doctor right away. If your primary care doctor determines that you have prostate cancer, ask to be referred to a specialist in medical oncology, radiation oncology and/or urology for confirmation of your diagnosis and next steps.
Let's Talk about Prostate Cancer: A Patient's Journey
Watch this 60-minute discussion with a cancer survivor and an oncology expert for tips to navigate a prostate cancer diagnosis, from treatment to coping strategies.
Screening
Screening is a way to look for signs of cancer before symptoms start. It is meant to detect cancer at an early stage. When found early, cancer is usually easier to treat.
The prostate specific antigen (PSA) test is the most widely accepted screening method. During a PSA test, your doctor will collect a small blood sample. The test will measure the amount of PSA in your blood. High PSA levels may be an early sign of prostate cancer. This is not always the case. An enlarged prostate can also secrete more PSA.
Talk with your care team about whether prostate cancer screening is right for you.
If you have had prostate cancer or have a family history of the disease, it is important to talk to your family and friends about screening. It may not always be an easy conversation. Still, talking about screening can help everyone take action to better their health.
Men Open Up About Cancer Support
Hear how some men talk about their cancer experiences and what has been helpful for them.
Diagnosis and Staging
In order to diagnose prostate cancer, your doctor will perform a physical exam, and may order additional tests including one or more of the following:
- Transrectal Ultrasound
- Biopsy
- Digital Rectal Exam
- Prostate-specific Antigen (PSA) Blood Test
- Imaging
A doctor inserts a probe into the rectum. The probe uses sound waves to look for abnormal growth in the prostate.
A doctor uses a needle inserted through the rectum or skin near the rectum to remove small tissue samples, called cores, from several areas of the prostate. A pathologist looks at the samples under a microscope to check for cancer cells.
As part of the digital rectal exam (DRE), the doctor uses a lubricated, gloved finger inserted into the rectum to feel the prostate. This test is often performed to screen for prostate cancer or if a man has symptoms of an enlarged prostate.
The prostate-specific antigen blood test checks levels of PSA (prostate-specific antigen) in the blood. The prostate makes PSA, and a high level in the blood could be caused by cancer. This blood test is often used to screen for prostate cancer and evaluate response to treatment.
Imaging scans such as a bone scan, ultrasound, CT scan or MRI are used to determine how far the cancer has spread. There are also new PET scans that are sometimes used.
Stages of Prostate Cancer
If prostate cancer is diagnosed, the doctor needs to determine the stage, or extent, of the cancer to plan the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body.
- Stage I: The cancer cannot be felt during a digital rectal exam or seen on a sonogram. It is found through a prostate biopsy or during surgery for another reason. The cancer is only in the prostate.
- Stage II: The tumor is more advanced or a higher grade than stage I, but the tumor is only in the prostate. It may be felt during a digital rectal exam or seen on a sonogram.
- Stage III: The tumor extends beyond the prostate wall. The tumor may have invaded the seminal vesicles, which sit on top of the prostate, but cancer cells have not spread to the lymph nodes.
Stage IV: The tumor may have invaded the bladder, rectum or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.
Grades and Scores
As part of the staging process, a pathologist will assign a score to the prostate cancer based on how the cancer cells look under a microscope. Pathologists score prostate cancer according to the Gleason grade. The Gleason score indicates how aggressive the prostate cancer appears to be. A higher number means that the cancer is more aggressive and more likely to spread. The Gleason score is determined by adding the two most common grades seen in a sample by the pathologist. Grades range from 3 (least aggressive) to 5 (most aggressive) and scores range from 6 (least aggressive) to 10 (most aggressive).
- A Gleason score of 6 is often considered low risk prostate cancer
- A Gleason score of 7 is often considered intermediate risk prostate cancer
- A Gleason score of 8-10 is often considered high risk prostate cancer
Grade Group is another way to categorize prostate cancer. It is a score from 1 to 5 that may also be assigned based on your Gleason grade.
- Grade group 1 is Gleason grade 3+3=6
- Grade 2 is Gleason grade 3+4=7
- Grade 3 is Gleason grade 4+3=7
- Grade 4 is Gleason grade 4+4=8
- Grade 5 is any Gleason score of 9-10
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Treatment
Options
After diagnosis, it is important to work with your doctor and discuss treatment options. Treatment for prostate cancer depends on:
- the stage of your cancer
- the grade of your tumor
- your age and medical history
- your overall health and symptoms
Treatment options include:
Active Surveillance - Doctors recommend active surveillance when the risks and side effects of treatment outweigh the potential benefits. During active surveillance, your doctor will perform regular checks to monitor the Gleason score of your cancer. You avoid the side effects of other treatments but risk missing the chance to control the cancer before it spreads. Doctors may suggest active surveillance for a diagnosis of slow-growing, early stage prostate cancer. It may also be recommended for men who are older or have other serious health problems. People who choose active surveillance can try another approach at any time.
Surgery - Surgery is an option for people with early (stage I or II) prostate cancer and is sometimes an option for people with stage III prostate cancer. The surgeon usually removes the entire prostate and sometimes the lymph nodes in the pelvis. If cancer is found in the lymph nodes, the surgeon may suggest other treatments after the surgery, such as radiation or hormone therapy.
There are several types of surgery, including:- Open surgery
- Robotic laparoscopic surgery (small cuts with very small tools
attached to a robotic arm) - Cryosurgery (use of extreme cold to destroy abnormal or diseased
tissue)
Ask your doctor to explain the types of surgery and why one may be better for you. Also ask about any risks you may face based on your age, body type, or overall health.
Possible side effects of surgery include:
- Urinary issues: Loss of bladder control, leaking urine, strong urges to
urinate, and difficulty emptying the bladder are common short-term
effects. How quickly and how much control you get back depends on
many factors. - Erectile dysfunction: The temporary or permanent inability to obtain
an erection may be caused by damage to the nerves around the
prostate. - Loss of fertility (the ability to have children): If the prostate is removed,
men will no longer be able to produce semen. Semen is the fluid that
carries sperm. Men may still be able to get an erection and have an
orgasm. Talk to your doctor about sperm banking before surgery, if you
wish to have children in the future.
Hormone therapy - Hormone therapy uses drugs to stop the body from producing testosterone. Less commonly, it may include surgical removal of the testicles. Without testosterone, prostate cancer cells may die or grow more slowly. Depending on how far the cancer has spread, hormone therapy may be used instead of, before, during, or after radiation or surgery.
Learn more about hormone therapy for prostate cancer
Radiation therapy - Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy to treat the prostate gland can be delivered externally, through a needle, or with a special medicine.
Learn more about radiation therapy for prostate cancer
Chemotherapy - Chemotherapy uses drugs to kill cancer cells. It is most commonly used when prostate cancer has spread to other parts of the body or doesn’t respond to hormone therapy alone. Chemotherapy for prostate cancer is usually given through a vein.
Learn more about chemotherapy for prostate cancer
Immunotherapy - Immunotherapy uses the body’s natural defenses (the immune system) to find, attack and kill cancer cells. Some kinds of immunotherapy use your own immune cells, while others use medicines that are made in a lab.
Learn more about immunotherapy for prostate cancer
Targeted therapy - Targeted therapy aims to more precisely attack cancer cells. These drugs target changes in the genes or proteins of cancer cells that help them grow, divide, and spread. They keep cancer from growing and spreading with less harm to normal cells.
Learn more about targeted therapy for prostate cancer
Did You Know?
In recent years, researchers have found that prostate cancers may respond to immunotherapy. Right now, one immunotherapy treatment is approved by the Food and Drug Administration.
Glen's Prostate Cancer Clinical Trial
Glen lives with prostate and Merkel cell cancer. He joined a clinical trial for prostate cancer when he was first diagnosed to give himself a chance at less side effects than the standard treatment.
Side Effects Management
Ask your doctor about the possible side effects of treatment before you begin so you will know what to expect. When you know more, you can work with your health care team to improve your quality of life during and after treatment.
Everyone reacts differently to treatment and experiences side effects differently. Always tell a member of your health care team about any uncomfortable problems you may be experiencing, such as erectile dysfunction, pain, nausea, fatigue, incontinence and bodily changes that affect your sense of self. These things are common and can be managed.
Follow-up Care
Recovery after prostate cancer depends on the type of treatment, spread of disease and other factors. Follow-up care is important. Don’t be afraid to seek emotional support. Social workers and counselors who specialize in cancer are available to provide confidential help. Many hospitals offer free support groups, information, or connections to other men who’ve had similar experiences. Ask your doctor or nurse about resources in your area.
