Diagnosis How Is Prostate Cancer Diagnosed? Your doctor may perform a number of tests to diagnose prostate cancer, including: Digital Rectal Exam A doctor uses a gloved finger to feel for abnormalities in the prostate. This is useful in men who have symptoms as well as those who don’t. It can also help a doctor decide if further tests are necessary after a cancer diagnosis or check how prostate cancer is responding to treatment. Prostate-Specific Androgen (PSA) Blood Test This measures the amount of PSA circulating in the body. PSA is a protein that both cancerous and noncancerous tissue in the prostate produces. Generally, PSA levels are higher for more advanced prostate cancers . Biopsy A doctor specializing in cancer treatment, known as an oncologist, extracts cancerous tissue, examines it under a microscope, and compares it with normal prostate tissue. They will use the Gleason score to estimate how likely it is to spread. Imaging Tests Various tests are available, such as computerized tomography (CT), magnetic resonance imaging (MRI) scans, and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scanning. PSMA PET scans check if the prostate cancer has spread. Bone Scans These can determine if cancer has spread to the bones. Not everyone needs a PSA blood test for prostate cancer screening, and different organizations have different recommendations. The American Cancer Society guidelines suggest that men with an average prostate cancer risk should discuss with their doctors whether they’d benefit from screening after age 50. According to the American Urological Association and Society of Urologic Oncology guidelines, this shared decision-making for people at average risk may begin as early as age 45.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cc578f68-8fae-45e7-8c62-9b41bd39271be60dc2a1-f33c-4a05-9b50-8e3e8e597629a26c0f37-875d-43f4-82bf-560480e71412 Men in high-risk groups, such as Black men and those with a family history, should have these discussions from ages 40 to 45 and onward. PSA Levels PSA levels can spike due to reasons other than prostate cancer, including inflammation, infection, certain medications, or even strenuous exercise like cycling, running, or heavy lifting. For this reason, there is no specific level of PSA that’s considered normal or abnormal.e60dc2a1-f33c-4a05-9b50-8e3e8e59762955c3d758-a779-407a-ad90-0dea0f159545 However, higher PSA levels mean a higher likelihood of cancer, and PSA levels over 4 nanograms per milliliter might be cause for concern. At that level, your doctor might order another PSA test to confirm the finding. If your high PSA level is confirmed, additional testing, such as a biopsy, may be needed. A PSA level between 4 and 10 is associated with a 1-in-4 chance of having prostate cancer, and a PSA level greater than 10 is associated with a more than 50 percent chance of having prostate cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cbd57c93-d9dd-4d1d-859f-f8693f0a5a48 Stages of Prostate Cancer A cancer care team will assign prostate cancer one of four stages based on how advanced the cancer is, how much it has grown in the prostate, and how far it has spread. The PSA level and Gleason score also help a doctor determine the stage of prostate cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e456d315-864e-47ee-a93f-4d4acfa23f76 Stage 1 In this stage, a doctor can’t feel the cancer, and typical screening tools aren’t likely to pick it up. Stage 2 The tumor has grown but is still small and hasn’t spread beyond the prostate. PSA screening may not detect cancer at this stage because PSA levels will be low to medium. Stage 3 PSA levels are high, and the Gleason score may be higher. The cancer may have spread to nearby tissues, the seminal vesicles, or the bladder or rectum. Stage 4 Also called advanced prostate cancer or metastatic prostate cancer, stage four means that the cancer has spread beyond the prostate to other parts of the body, including the distant lymph nodes, liver, bladder, or bones. These stages also have different grade groups and relate to different Gleason scores, depending on a combination of where the cancer has spread and the PSA level. Prostate cancer staging is complex and affects both your treatment and outlook, so ask your doctor to explain what this means for you. If prostate cancer hasn’t spread, a doctor might also assign a risk group to it. This can help them decide if prostate cancer needs immediate treatment and which treatments might be suitable.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e456d315-864e-47ee-a93f-4d4acfa23f76
Treatment Treatment and Medication Options for Prostate Cancer Different types of treatment are available for men with prostate cancer. Some treatments are standard, while other treatments may be available to you through clinical trials to expand or improve the standard treatments that are currently available. The choice of treatment often depends on the cancer’s stage, type, and location, the individual’s age and overall health, and the expected side effects.e60dc2a1-f33c-4a05-9b50-8e3e8e59762904dd8706-c417-49db-b72a-30efbc9452fa Medication Options A cancer care team prescribes medications for prostate cancer to block hormones, kill cancer cells, or boost the immune system. Hormone Therapy This treatment, also called androgen deprivation therapy (ADT), removes or blocks the action of male sex hormones called androgens that cause prostate cancer to grow. Medications include: Luteinizing hormone-releasing hormone agonists, such as leuprolide (Lupron, Lupron Depot, Eligard, Prostap, Viadur), goserelin (Zoladex), degarelix (Firmagon), and relugolix (Orgovix), to stop the testicles from making testosteronee60dc2a1-f33c-4a05-9b50-8e3e8e5976297752f6cf-4f42-49a6-bf9d-2e92920a1679e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a25dbac-c496-49d1-a9fa-670ed6ce0adce60dc2a1-f33c-4a05-9b50-8e3e8e597629f6178e16-8fab-43a4-af8a-b485f0c1a810e60dc2a1-f33c-4a05-9b50-8e3e8e597629b7775a49-37cc-4c01-8d2b-fc4159d303ff Antiandrogens, such as apalutamide (Erleada), darolutamide (Nubeqa), flutamide (Euflex, Euflexin), and enzalutamide, to block the action of androgense60dc2a1-f33c-4a05-9b50-8e3e8e5976294b637b9a-b103-4d60-8f19-0e345162c54ee60dc2a1-f33c-4a05-9b50-8e3e8e597629000958ce-964e-494f-8c82-7698d3940a07e60dc2a1-f33c-4a05-9b50-8e3e8e597629c8eac030-3978-4fa3-aef7-a42f8c054a59 Abiraterone acetate (Zytiga) to prevent all tissues and cancer cells from making androgense60dc2a1-f33c-4a05-9b50-8e3e8e597629a533dedc-d5a1-42c4-b238-711b4e9a82ed Chemotherapy This treatment uses drugs to stop the growth of cancer cells, either by killing them or by stopping them from dividing. A person typically receives these drugs by infusion. For people with prostate cancer, the most common chemotherapy drug is docetaxel (Taxotere). A doctor often gives this along with steroids. They may prescribe cabazitaxel (Jevtana) if this isn’t effective.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f3dded4-0325-45ff-80f7-b0f345d18203 Targeted Therapy These drugs identify and attack specific targets on cancer cells. PARP inhibitors, such as olaparib (Lynparza), block an enzyme involved in DNA repair with links to prostate cancer. Doctors recommend them for some men with mutations in genes like BRCA1 or BRCA2.e60dc2a1-f33c-4a05-9b50-8e3e8e597629335cd609-7cde-4f34-9e68-cd2649ff8620 Immunotherapy This therapy uses an individual’s own immune system to fight cancer. Sipuleucel-T (Provenge) is a type of immunotherapy that oncologists use to treat prostate cancer that has stopped responding to hormone treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b6fb2af5-ded3-45f8-9055-e9c162b509a9 Bone Health Therapy Doctors prescribe drugs like zoledronate (Reclast, Zometa).e60dc2a1-f33c-4a05-9b50-8e3e8e5976291ef59f9b-40c0-4bf8-83f8-2b996e61f76a Surgery Your doctor may recommend surgery to treat prostate cancer in men with otherwise good health whose tumor hasn’t spread from the prostate gland. Surgical methods might include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e59762904dd8706-c417-49db-b72a-30efbc9452fa Radical Prostatectomy A surgeon removes the prostate, surrounding tissue, and seminal vesicles. They can perform this procedure through a cut in the abdomen or perineum or by using keyhole (laparoscopic) or robot-assisted surgery. Pelvic Lymphadenectomy This procedure involves removing lymph nodes in the pelvis to check their tissue for cancer cells. Transurethral Resection of the Prostate (TURP) A surgeon removes tissue from the prostate using a tool they insert through the urethra. They may perform this to relieve symptoms like a blocked urine flow before trying other treatments. Cryosurgery or Cryotherapy This treatment is currently only available in clinical trials and uses an instrument to freeze and destroy prostate cancer cells. Radiation Therapy Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. External Radiation Therapy A machine outside the body sends radiation toward the cancer. Approaches include conformal radiation (shaping beams to the tumor) and hypofractionated radiation (larger doses over fewer days). Proton therapy is a form of external radiation therapy that is more precise than other formats and may reduce the side effects of radiation.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295dbcc8ce-3400-409d-9e2f-4e65a650dffb Internal Radiation Therapy Also known as brachytherapy, this uses radioactive seeds, needles, or wires placed directly into or near the cancer. Radiopharmaceutical Therapy A radioactive substance is used to treat cancer. For example, radium-223 (an alpha emitter) is injected into the bloodstream to treat prostate cancer that has spread to the bone. Watchful Waiting and Active Surveillance These approaches both involve deferring immediate treatment but differ in their intensity of monitoring. For watchful waiting, there’s no testing. Instead, it involves closely monitoring the condition without giving treatment until signs or symptoms develop. Doctors usually use it for men with limited life expectancy due to age or other health problems, usually for advanced prostate cancer. This may be helpful for older men without symptoms or those with other medical conditions.e60dc2a1-f33c-4a05-9b50-8e3e8e59762904dd8706-c417-49db-b72a-30efbc9452fa During active surveillance, testing is performed regularly. When the cancer grows, regardless of symptoms, treatment starts. A cancer care team may follow early-stage cancer in healthy men who’d prefer to avoid the side effects of treatment but are still looking to cure the disease. Erectile Dysfunction Management Nearly every man who has prostate cancer treatment will have some issues with getting or maintaining an erection, known as erectile dysfunction. After two years, between 3 and 6 in 10 men will have returned to their pretreatment sexual function, although this can vary with the type of treatment a man receives.e60dc2a1-f33c-4a05-9b50-8e3e8e59762950f9e64d-6c91-4fae-9a5d-5df8d3447411 These options for achieving an erection are available: Oral medications, including sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra)e60dc2a1-f33c-4a05-9b50-8e3e8e5976295a31b13a-a747-480e-ad5c-d0d9c9185618 Locally applied therapies, like prostaglandin A device known as a penis pump that pulls blood into the penis using a vacuum seal Implants under general anesthesia that allow a man to press a release button and achieve an erection Which measure you use may depend on your preferences, other health conditions, and your doctor’s advice. Many people who’ve had prostate cancer treatment have active and fulfilling sex lives afterward.
Types Types of Prostate Cancer Most prostate cancers are carcinomas, meaning they start in tissue that lines the prostate gland, known as epithelial tissue. Knowing your type of prostate cancer influences your outlook and how a cancer care team may recommend treating it.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a126b6e6-1bcd-497e-8462-236398bc5080 Adenocarcinomas Adenocarcinoma is the most common type of prostate cancer, accounting for more than 95 percent of cases. It starts in the cells of the gland.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a126b6e6-1bcd-497e-8462-236398bc5080 Acinar Adenocarcinoma This is the most common subtype, starting in the parts of the gland that make the fluid in semen, known as the acini. Variations of this type include pleomorphic giant cell adenocarcinoma, signet ring cell-like carcinoma, and sarcomatoid carcinoma. Ductal Adenocarcinoma This rare, aggressive type starts in the tubes that carry secretion to the urethra. Some prostate cancers have both types of acinar and ductal cells. Neuroendocrine or Small Cell Carcinomas These rare cancers start in neuroendocrine cells, which share traits with both nerve and hormone-producing cells. Neuroendocrine carcinomas of the prostate are sometimes called small cell carcinoma. This is a highly uncommon type of prostate cancer. It can occur at first diagnosis, or it can occur later in the course of treatment, as the cancer changes from adenocarcinoma to neuroendocrine carcinoma.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a126b6e6-1bcd-497e-8462-236398bc5080 Small Cell Carcinoma The most common type of neuroendocrine prostate cancer, this aggressive type consists of cells that appear small under a microscope. Treatment-Related Neuroendocrine Carcinoma This type also has the same aggressive variant of prostate cancer and can develop from adenocarcinoma after hormone therapy. Other Rare Types Several other forms of cancer rarely develop in the prostate, including the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a126b6e6-1bcd-497e-8462-236398bc5080 Squamous cell carcinoma Adenoid cystic carcinoma, or basal cell carcinoma Lymphoma Urothelial carcinoma Sarcoma
Complications Prostate Cancer Complications Prostate cancer has several possible complications that can lead to further health problems and affect quality of life. These can include: Spreading Cancer Prostate cancer can move into other areas, such as other organs or the bones, and lead to pain or fractures in areas like the hips or spine. This is known as metastatic prostate cancer. Erectile Dysfunction Both prostate cancer and the surgeries, radiation therapy, and medications that treat prostate cancer can cause problems getting or maintaining an erection. Leaking Urine The cancer and treatment can also cause issues with how your bladder works, leading to leaking urine or urinary incontinence.
Resources We Trust Mayo Clinic: Prostate Cancer: Screening and Treatment Options Cleveland Clinic: Prostate Cancer Prostate Cancer Research Institute: Prostate Cancer Staging Guide American Cancer Society: Prostate Cancer Prostate Cancer Foundation: Black Men: Know Your Risk
Symptoms Signs and Symptoms of Prostate Cancer Early-stage prostate cancer usually causes no symptoms. Advanced prostate cancer can cause the following symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e59762976139434-cc1c-44e9-815c-51f9eccab418 Problems with peeing, including weak or interrupted flow, peeing more often than usual, or feeling like you can’t completely empty your bladder Pain or burning while peeing Blood in your pee or semen Pain in the hips, spine, or ribs because some types of prostate cancer can spread to the bones These may be signs of prostate cancer. Or, more likely, they are caused by something else, such as benign prostate hyperplasia (BPH), a noncancerous growth of the prostate. However, you should see your doctor if you experience these symptoms.
Prostate cancer is the fourth most commonly diagnosed cancer in the world and the second most common cancer (after skin cancer) in men, according to the American Cancer Society. In the United States, about 1 in 8 men will get a prostate cancer diagnosis in his lifetime.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b3cf1d7e-ba6e-477c-bed4-edca65569298 However, most men with prostate cancer in the United States do not die from it. Prostate cancer is treatable and survivable, depending on the stage at which a person is diagnosed and their age, general health, and the effectiveness of treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b3cf1d7e-ba6e-477c-bed4-edca65569298 Overall, prostate cancer has one of the highest survival rates among all types of cancer. At least 3.5 million men who’ve had a prostate cancer diagnosis at some point remain alive to this day because of advances in detection and treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b3cf1d7e-ba6e-477c-bed4-edca65569298
Support Support for People With Prostate Cancer Prostate Cancer Foundation The Prostate Cancer Foundation (PCF) provides simple handbooks and videos that explain your diagnosis without the medical jargon. They connect men who have prostate cancer with an online community of people who truly understand the journey, while providing down-to-earth advice on diet and exercise and finding available doctors and clinical trials. They also offer guidance and support on paying for treatment and other costs of care. Zero Prostate Cancer Zero Prostate Cancer helps people with prostate cancer find support. They have a dedicated helpline, ZERO360, which you can call for support in navigating insurance and payment challenges. They also have a mentorship program called MENtor that pairs you with someone who’s already had prostate cancer and can guide you through the journey. Zero Prostate Cancer also connects people with financial grants and assistance and has a massive network of local and online support groups for caregivers and partners as well as patients.
Inequities Disparities and Inequities in Prostate Cancer Black men have specific gene changes that might have links to more aggressive cancers, higher levels of certain hormones linked to prostate cancer growth, and more inflammation in the area around the prostate.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5423e09-8d2c-4091-86ad-655f852ad925 More research could help cancer care teams understand and manage the differences in risk and close the life-expectancy gap in broader society. In the United States, Black men are nearly twice as likely to be diagnosed with prostate cancer and more than twice as likely to die from it compared with white men.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5423e09-8d2c-4091-86ad-655f852ad925 A review suggests that some social factors, including unequal access to medical facilities, financial and insurance factors, and changing guidelines, may have led to some, but not all, differences in survival rates. Genes, hormones, and inflammation could play a key role in the differences in cancer development between races, even in situations in which Black men have comprehensive insurance and access to good medical care.
Prognosis Prostate Cancer Prognosis Prostate cancer often progresses slowly, and most men with a prostate cancer diagnosis are over 65 years of age. For these reasons, it’s often said that men with a prostate cancer diagnosis are more likely to die with prostate cancer but from other causes.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915228b14-c4fc-475f-8422-60328b38c919 A doctor will only treat prostate cancer if they believe it will have a real impact on quality of life and life expectancy — but these treatments are available, and they can help. The American Cancer Society’s five-year relative survival rates compare the percentage of men who are alive five years after a diagnosis of prostate cancer with the general population. They estimate five-year relative survival based on whether the cancer is localized, regional, or distant, known as their Surveillance, Epidemiology, and End Results (SEER) stages.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952fdebb4-a14f-45f8-ad6f-ceaad9fb6654 If the cancer is localized, meaning there is no sign that the cancer has spread beyond the prostate, or if it is regional, meaning it has spread only to nearby structures or lymph nodes, the five-year survival rate is greater than 99 percent. So, on average, men with cancer at these stages are only 1 percent less likely than those without to still be alive five years later.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952fdebb4-a14f-45f8-ad6f-ceaad9fb6654 If the cancer is distant, meaning it has spread to farther parts of the body — including the lungs, liver, or bones — the five-year survival rate drops to 38 percent. Accounting for all SEER stages, the average estimated survival rate is around 98 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952fdebb4-a14f-45f8-ad6f-ceaad9fb6654 No matter how advanced the cancer is, these estimates apply only to the stage of cancer at the point of diagnosis. They don’t suggest how long you will survive with prostate cancer. Every case of prostate cancer is unique, and your age, your overall health, and your body’s response to treatment can all affect your outlook.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952fdebb4-a14f-45f8-ad6f-ceaad9fb6654
Causes Causes and Risk Factors for Prostate Cancer There are some factors that may increase the risk of developing prostate cancer, including: Age Nearly 60 percent of all prostate cancers are diagnosed in men who are over 65 years of age, according to the American Medical Association.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f161f86e-c7c9-4d50-80e5-1bb0f1300bee However, around 1 in 10 new prostate cancer diagnoses occur in men under 55 years of age, and the outlook is often worse for men who have a prostate cancer diagnosis at a younger age.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295078d0d4-9011-462d-b04a-c418c513917e Race It is not clear why, but Black men in the United States are far more likely to develop prostate cancer than white men, and often at a younger age.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fe6f7f15-65b2-4643-a88c-2f0544734750 Black men are also more than twice as likely as white men to die of prostate cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629407c193f-4852-46e2-9142-3ef108641aab Family History Having a father or brother with prostate cancer can more than double a person’s prostate cancer risk. The risk increases if you have multiple relatives with prostate cancer, especially if they were younger than average at diagnosis. And you’re at a higher risk of prostate cancer if you have a brother with it than if you’ve got a father with the disease.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fe6f7f15-65b2-4643-a88c-2f0544734750 Obesity This has links to more dangerous, higher-grade tumors. One study concluded that every five-point increase in body mass index (BMI) raises the risk of death from prostate cancer by 10 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b040c797-77cf-4d7d-a81f-6e8a32fd161a
Lifestyle Lifestyle Changes and Prevention of Prostate Cancer Because the development of prostate cancer is largely determined by factors beyond your control, including age, race, and family history, no surefire method exists that can prevent it. However, some recommendations might lower your risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fbbfb647-b1e6-422d-8cab-721c6440e431 For example, quitting or avoiding smoking and limiting alcohol intake to no more than two drinks daily for men or one for women if you do drink can help you reduce the risk of getting other cancers.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c47e9815-9bd0-4a2a-a98c-b35fb49653a2 Manage Your Body Weight Through Diet and Exercise Excess body weight may have links to increased risk of advanced prostate cancer. Managing your body weight can help you reduce your risk of advanced or fatal prostate cancers. You might be able to support this with the following steps:e60dc2a1-f33c-4a05-9b50-8e3e8e597629fbbfb647-b1e6-422d-8cab-721c6440e431 Moving more and engaging in physical activity Eating a healthy diet full of fruits, vegetables, and whole grains Avoiding or limiting red and processed meats and highly processed foods Some studies have linked high dietary calcium intake through food groups like dairy to an increased risk for prostate cancer. However, not all studies agree, and others have suggested it can help reduce your risk. More research is necessary.e60dc2a1-f33c-4a05-9b50-8e3e8e597629efcc0132-8dc6-44f8-8aaa-9b9b7190eae8 Get Emotional Support for Side Effects Prostate cancer treatment can affect sexual function, and it can also lead to long-term bladder or bowel problems in some men. This can contribute to anxiety, worry, and depression for many people with this cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a60c5b9b-d13e-4ab1-91cd-5f763ab3db7a Hormone therapy can also lead to mood changes. If you feel this way and are comfortable doing so, speak to your partner, friends, family, support groups, religious leaders, or a professional counselor.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a60c5b9b-d13e-4ab1-91cd-5f763ab3db7a
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