Prostate Cancer

Found just beneath the bladder in front of the rectum, the prostate is a walnut-sized gland that’s part of the male reproductive system. It produces fluid that contributes to semen. Prostate cancer is the most commonly diagnosed cancer in males, with risk factors including advanced age and a family history of the condition. Typically, this cancer spreads slowly, though it can be dangerous if it moves beyond the prostate.

Prostate cancer is categorized into four stages that indicate severity and spread. Stages 1 and 2 are known as localized or early-stage cancer; stage 3 is called locally advanced cancer, and stage 4, or advanced cancer, is the most severe. If identified and treated promptly, most cases of prostate cancer can be effectively managed.

This article will help you understand the causes of this condition, its signs, treatments, and prognosis.

Prostate Cancer Symptoms: What Are the Signs?

Prostate cancer can be challenging to diagnose in its early stages since it may not cause many symptoms. There can also be considerable variation in how it presents from person to person. Primarily, the symptoms occur when cancerous tumor growth obstructs the urethra (the tube for urine and semen).  

Early Signs of Prostate Cancer

Any sign of prostate cancer warrants medical evaluation. Early signs of prostate cancer include:

• Difficulty initiating urination
• Interruption or weakness of the flow of urine
• Frequent urination, especially at night
• Pain or a burning sensation during urination
• Blood in the urine or semen
• Persistent pain in the hips, lower back, or pelvis
• Pain during ejaculation

Advanced Symptoms

Advanced prostate cancer spreads outside the prostate and affects surrounding organs, bone marrow, or blood. The following are common signs of more progressed cases:

• Fatigue
• Difficulty urinating or interrupted urine flow
• Frequent urination
• Pain during urination
• Erectile dysfunction (difficulty maintaining an erection) or painful ejaculation
• Pain felt in the bones
• Insomnia (interrupted sleep)
• Weakness or numbness in the hands or feet
• Depression and/or anxiety
• Loss of appetite or difficulty eating
• Weight loss
• Nausea and/or vomiting
• Diarrhea

What Causes Prostate Cancer?

Prostate cancer arises when there are changes in the genes of prostate cells. These mutations cause genes that code for cell division (oncogenes) to be more active while hampering others that regulate growth and repair DNA (tumor suppressor genes). As a result, affected cells (malignant, or cancerous, cells) grow uncontrollably and can spread to other body parts. Researchers aren’t exactly sure what triggers this process.   

Prostate Cancer Risk Factors

Though all males are susceptible, specific populations are at increased risk for developing prostate cancer. These include:

• Adults over age 55, with risk increasing as you get older
• Those with a first-degree relative (father, son, or brother) who has a history of prostate cancer
• Those with a history of a prostate cancer diagnosis before the age of 55
• A family history of other cancers, such as breast, ovarian, or pancreatic cancer  

Prostate Cancer Screening and Early Detection

Most prostate cancer cases are detected through screening, often before symptoms arise. However, there’s no single test for this condition. Healthcare providers use two tests to screen for prostate cancer: the prostate-specific antigen (PSA) test and the digital rectal exam (DRE), as follows:

• PSA test: This blood test measures prostate-specific antigen levels, a substance manufactured in the prostate gland. Elevated levels can indicate prostate cancer or an enlarged prostate, medication side effects, and prostate infection, among others.
• DRE: In the DRE, a healthcare provider physically assesses the prostate for signs of growths or cancer using a gloved, lubricated finger inserted into the rectum. Anything that feels unusual warrants additional testing to confirm the diagnosis.

How Is Prostate Cancer Diagnosed?

If a healthcare provider suspects prostate cancer after the screening, they may use various tests to confirm a diagnosis.

Biopsy

The primary method of prostate cancer diagnosis is a prostate biopsy, which involves harvesting a small sample of prostate tissue. The tissue is sent to a specialist, a pathologist, to evaluate it under a microscope and identify cancer cells.

The sample is collected using a specialized probe inserted into the rectum or using a syringe to pierce the perineum, the tissue between the scrotum and rectum. The pathologist will then assess the severity (grade) of the tumor.

Imaging

Sometimes, imaging techniques are used to help the provider target the right area and collect the sample. Such techniques include ultrasound, which relies on sound waves, and magnetic resonance imaging (MRI) which employs magnets and radio waves, to produce images of the prostate.

Prostate Cancer Stages

Prostate cancer ranges in severity and is categorized by stages based on cancer growth and spread. Here’s a quick breakdown:

• Stages 1 and 2 (localized): Its least severe form, stage 1 and stage 2 of prostate cancer, is when cancer cells are only found in the prostate and have not spread to other body parts.
• Stage 3 (locally advanced): Stage 3 prostate cancer occurs when the cancer cells spread to areas near the prostate gland, such as the seminal vesicles.  
• Stage 4 (advanced): The most advanced and dangerous form, in stage 4 prostate cancer the cancer cells spread throughout the body (metastasize) and may be present locally, in the rectum or bladder, and the bones or lymph nodes.  

Gleason Score

Pathologists use Gleason score scaling to evaluate the severity of the case. Cancer cells appear significantly different from healthy cells, so pathologists evaluate samples based on how much their structure has changed. They’re rated on a scale of 1 (they look healthy) to 5 (cells are cancerous).

Sometimes, pathologists rate the Gleason score out of 10, using the sum of the dominant and secondary patterns seen in the cells. So, for instance, if you primarily score 3, though some areas look like a 4, the two are put together to make 7. You’re considered not to have cancer with scores of 2 to 5, but 6 to 10 indicate an increasing seriousness of cancer risk.

Prostate Cancer Treatment

The specific course of treatment for prostate cancer depends on the severity of the case and can vary from person to person. Approaches taken in early-stage prostate cancer can look different than therapies for when the disease has advanced. Much depends on how the body reacts to the treatment and whether methods yield success.  

Treatment for Early Stage Prostate Cancer

Several therapies may be used for prostate cancer stages 1 and 2, when the cancer is localized in the prostate gland, and stage 3, in which it starts spreading in the surrounding area. Early-stage treatments include:

• Active surveillance: If the cancer risk is low or very low, a provider may consider a course of close medical monitoring instead of treatment. Healthcare providers track progress using blood tests, biopsies, and other means, delaying therapy until there are signs the condition is worsening.
• Radical prostatectomy: Radical prostatectomy is a surgery that removes the prostate. After the gland is removed, the urethra and bladder are reconnected.  
• External beam radiation therapy: Radiation therapy (RT) involves exposing affected areas to radioactive waves, which work to kill cancerous cells. This treatment requires multiple daily sessions over several weeks.
• Brachytherapy: Another form of RT, brachytherapy, involves directly exposing the prostate to radiation. One type, low-dose-rate brachytherapy, is an outpatient procedure that involves placing a small radioactive pellet directly on the affected gland. Another alternative is high-dose brachytherapy, in which a stronger radioactive pellet is implanted in the body and then removed two days later.
• Androgen deprivation therapy (ADT): Testosterone (androgen) can promote tumor growth. ADT involves taking medications (e.g., leuprolide acetate subcutaneous injections) that interfere with androgen production or surgery to remove the testicles, where this hormone is manufactured. ADT is often indicated alongside other therapies.

Treatment for Advanced Prostate Cancer

When prostate cancer metastasizes, further treatments are necessary. ADT is typically recommended as a first-line approach to slow the progression of cancer. Other treatments may occur alongside ADT, including:

• Abiraterone (Zytiga) inhibits androgen production in the testes and adrenal glands, as well as in prostate cancer itself. Prednisone, a corticosteroid, is often indicated alongside abiraterone to prevent complications.
• Androgen receptor inhibitors include enzalutamide, apalutamide, and darolutamide. Enzalutamide is recommended when other therapies, such as chemotherapy, aren’t yielding results. All three may be used to slow the progression of cancer when ADT alone is not working.
• Chemotherapy aims to slow or stop cancer progression and is considered when prostate cancer has spread to the bones, lymph nodes, or other organs. Chemotherapy drugs, most often docetaxel, are administered via intravenous (IV) drip.
• Immunotherapy, such as checkpoint inhibitors, may be used for some types of advanced prostate cancer that are resistant to treatment. These drugs stimulate the T cells of the immune system, getting them to identify and attack cancer cells.

Complications of Prostate Cancer

If prostate cancer cells access the blood or the lymph nodes (glands associated with immune response), they can spread throughout the body and lead to complications. Severe prostate cancer can cause cancer in the bones, which inhibits red blood cell production. Cancer metastasizing in this way can cause severe bone pain, bone fracture, and bone marrow cancer.

Other complications can arise with prostate cancer. Erectile dysfunction (ED), an inability to achieve or maintain an erection, can be a side effect of surgery, chemotherapy, or radiation treatment. Furthermore, prostate cancer can lead to a loss of bladder control (incontinence).

How to Prevent Prostate Cancer

Specific lifestyle changes and habits can work to prevent prostate cancer from forming. Recommended preventive measures include:

• Maintaining a healthy weight: Excess weight raises the risk of developing many health problems, including cancer.
• Stopping smoking: Cigarette smoking dramatically increases the chances of developing cancer, among other adverse health effects.
• Exercise: Ensuring you are getting enough exercise can be another means of improving your health and possibly deter cancer; aim for one to three hours of light to moderate activity a week.
• Diet: Eating a healthy diet that emphasizes fresh fruits and vegetables and fiber and limiting sugars and processed foods has been shown to help prevent cancer.

Prostate Cancer Prognosis

The prognosis for prostate cancer depends on many factors, including how much it has spread and your health status. Screening and early treatment have improved the outlook for prostate cancer.

According to the National Cancer Institute, the overall survival rate for this condition five years after diagnosis is 96.8%, which rises to 100% if the condition is detected in its localized stage. However, this number drops considerably for advanced prostate cancer, for which this rate is 32.3%.

Every case of prostate cancer is different, but most people can live well following diagnosis. However, living with this condition can impact your quality of life and your emotional and mental health. Several strategies may help you cope, including:

• Talking to and seeking the support of family and friends
• Seeking mental health treatment from an individual therapist or in a group setting
• Seeking out support groups for cancer survivors in-person or online
• Finding peers, information, and opportunities for advocacy by joining an advocacy organization, such as the Prostate Cancer Foundation and the American Cancer Society