Prostate cancer develops in the prostate, a small walnut-shaped gland located below the bladder and in front of the rectum in men and people assigned male at birth (AMAB). This tiny gland secretes fluid that mixes with semen, keeping sperm healthy for conception and pregnancy.
Prostate cancer is a serious disease. Fortunately, most people with prostate cancer get diagnosed before it spreads beyond their prostate gland. Treatment at this stage often eliminates the cancer.
What are the types of prostate cancer?
If you are diagnosed with prostate cancer, it is most likely an adenocarcinoma. Adenocarcinomas start in the cells of glands — like your prostate — that secrete fluid. Rarely, prostate cancer forms from other types of cells.
Less common types of prostate cancers include:
- Small cell carcinomas.
- Transitional cell carcinomas.
- Neuroendocrine tumors.
- Sarcomas.
How common is prostate cancer?
Prostate cancer is common, second only to skin cancer as the most common cancer affecting men and people AMAB. According to the U.S. Centers for Disease Control and Prevention (CDC), for every 100 people with prostates, 13 will develop prostate cancer at some point in their lives. Most will live normal lives and eventually die from causes unrelated to prostate cancer. Some will not need treatment.
Still, approximately 34,000 people in the United States die from prostate cancer each year.
What are the symptoms of prostate cancer?
Early-stage prostate cancer rarely causes symptoms. These issues may occur as the disease progresses:
- Frequent, sometimes urgent, need to pee, especially at night.
- Weak urine flow or flow that starts and stops.
- Pain or burning when you pee (dysuria).
- Loss of bladder control (urinary incontinence).
- Loss of bowel control (fecal incontinence).
- Painful ejaculation and erectile dysfunction (ED).
- Blood in semen (hematospermia) or pee.
- Pain in your low back, hip or chest.
Are prostate problems always a sign of prostate cancer?
Not all growths in your prostate are cancer. Other conditions that cause symptoms similar to prostate cancer include:
Benign prostatic hyperplasia (BPH): At some point, almost everyone with a prostate will develop benign prostatic hyperplasia (BPH). This condition enlarges your prostate gland but does not increase your cancer risk.
Prostatitis: If you are younger than 50, an enlarged prostate gland is most likely prostatitis. Prostatitis is a benign condition that causes inflammation and swelling in your prostate gland. Bacterial infections are often the cause.
What causes prostate cancer?
Experts are not sure what causes cells in your prostate to become cancer cells. As with cancer in general, prostate cancer forms when cells divide faster than usual. While normal cells eventually die, cancer cells do not. Instead, they multiply and grow into a lump called a tumor. As the cells continue to multiply, parts of the tumor can break off and spread to other parts of your body (metastasize).
Luckily, prostate cancer usually grows slowly. Most tumors are diagnosed before the cancer has spread beyond your prostate. Prostate cancer is highly treatable at this stage.
What are the risk factors for prostate cancer?
The most common risk factors include:
- Age. Your risk increases as you get older. You are more likely to get diagnosed if you are over 50. About 60% of prostate cancers occur in people older than 65.
- Race and ethnicity. You are at greater risk if you are Black or of African ancestry. You are more likely to develop prostate cancers that are more likely to spread. You are also at greater risk of prostate cancer forming before age 50.
- Family history of prostate cancer. You are two to three times more likely to get prostate cancer if a close family member has it.
- Genetics. You are at greater risk if you have Lynch syndrome or if you inherited mutated (changed) genes associated with increased breast cancer risk (BRCA1 and BRCA2).
Some studies have identified other prostate cancer risk factors, but the evidence is mixed. Other potential risk factors include:
- Smoking.
- Prostatitis.
- Having a BMI > 30 (having obesity).
- Sexually transmitted infections (STIs).
- Exposure to Agent Orange (a chemical used during the Vietnam War).
Diagnosis and Tests
How is prostate cancer diagnosed?
Screenings can help catch prostate cancer early. If you are average risk, you will probably have your first screening test at age 55. You may need earlier screenings if you are in a high-risk group. Screenings usually stop after age 70.
You may need additional tests or procedures if screenings show you may have prostate cancer.
Screening tests for prostate cancer
Screening tests can show whether you have signs of prostate cancer that require more testing.
Digital rectal exam: Your provider inserts a gloved, lubricated finger into your rectum and feels your prostate gland. Bumps or hard areas may mean cancer.
Prostate-specific antigen (PSA) blood test: The prostate gland makes a protein called protein-specific antigen (PSA). High PSA levels may indicate cancer. Levels also rise if you have benign conditions, such as BPH or prostatitis.
Diagnostic procedures for prostate cancer
Not everyone who likely has prostate cancer will need a definitive diagnosis. For example, if your provider thinks your tumor is growing slowly, they may delay more testing because it is not serious enough to require treatment. If it is more aggressive (growing fast or spreading), you may need additional tests, including a biopsy.
Not everyone who likely has prostate cancer will need a definitive diagnosis. For example, if your tumor is thought to be slow growing, your provider may delay more testing because it is not serious enough to require treatment. If it is more aggressive (growing fast or spreading), you may need additional tests, including a biopsy.
Imaging: An MRI or a transrectal ultrasound can show images of your prostate gland, including suspicious areas that may be cancer. Imaging results can help your provider decide whether to perform a biopsy.
Biopsy: During a needle biopsy, a healthcare provider removes a tissue sample for testing in a lab for cancer. A biopsy is the only sure way to diagnose prostate cancer or know for certain how aggressive it is. Your provider may perform genetic tests on the biopsied tissue. Some cancer cells have characteristics (like mutations) that make them more likely to respond to specific treatments.
Prevention
How can I prevent prostate cancer?
Preventing prostate cancer is not possible. Still, taking these steps may reduce your risk:
- Get regular prostate screenings. Ask your healthcare provider how often you should get screened based on your risk factors.
- Maintain a healthy weight. Ask your provider what a healthy weight means for you.
- Exercise regularly. The CDC recommends 150 minutes of moderate-intensity exercise each week, or a little more than 20 minutes daily.
- Eat a nutritious diet. There is no one diet to prevent cancer, but good eating habits can improve your overall health. Eat fruits, vegetables and whole grains. Avoid red meats and processed foods.
- Quit smoking. Avoid tobacco products. If you smoke, work with your provider on a smoking cessation program to kick the habit.
Outlook / Prognosis
What is the prognosis (outlook) for people with prostate cancer?
Your outlook is excellent if your healthcare provider detects prostate cancer early. Almost everyone — 99% — diagnosed with cancer that has not spread outside of their prostate live at least five years after diagnosis.
Prostate cancer survival rates are not as good when the cancers metastasized, or spread outside of your prostate. Thirty-two percent of people with metastatic prostate cancer are alive five years later.
Is prostate cancer very curable?
Yes, if it is caught early. In some cases, cancer grows so slowly that you may not need treatment right away. Treatment can often eliminate prostate cancers that have not spread beyond the prostate gland.
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