This overview is designed to give you medical information and personal insight that can help you in this difficult time. Below you will find an introduction and prostate cancer FAQ section, a personal video message from a renowned oncologist and a written/video first-person story from a prostate cancer patient and survivor. We hope this resource proves useful as you navigate your illness.
- Prostate Cancer Definition
- Prostate Cancer Symptoms and Causes
- Prostate Cancer Risk Factors
- Prostate Cancer Diagnosis and Treatment
- Prostate Cancer Stages and Survival
What Is Prostate Cancer?
Prostate cancer occurs when cells in the prostate begin to grow and divide abnormally and learn how to spread and invade other tissues. Only found in the male sex, the prostate is a roughly golf-ball-sized organ located below the bladder that produces seminal fluid, a component of semen that helps transport sperm.
While there are several different types of this disease, the vast majority of prostate cancer cases are known as adenocarcinomas, which refers to a type of cancer that begins in the mucus-secreting gland cells.
There are several other extremely rare types of cancer that can start in the prostate, but adenocarcinoma is by and large the most common diagnosis.
What Are the Symptoms of Prostate Cancer?
Most early prostate cancers do not cause symptoms. The most common symptoms reported by men with prostate cancer are problems urinating or a weak urinary stream. However, these symptoms are often caused by many normal conditions, such as benign prostatic hyperplasia, which refers to a growth in the prostate that is not cancerous. That is why we cannot rely solely on symptoms to detect prostate cancer early.
Prostate cancer symptoms include:
- the urge to urinate frequently
- blood in the urine or semen
- erectile dysfunction
- pain in the hips, back or chest
- weakness or numbness in the legs or feet
The symptoms of prostate cancer are similar to those of other medical conditions. If you have questions or concerns about your health, please consult a healthcare professional.
While the exact cause of prostate cancer is not yet fully understood, scientists have discovered a number of connections between both inherited and acquired genetic mutations and increased rates of prostate cancer.
- Inherited mutations refer to genetic changes that are passed down from your parents. These include mutations to tumor suppressor genes that work to maintain normal cell growth and division, such as BRCA1, BRCA2 and RNASEL and DNA repair genes, which correct mistakes in DNA before a cell divides, such as MSH2, MSH6, MLH1 and PMS2. When a male inherits mutations to one of these genes, it results in a condition known as Lynch syndrome.
Additionally, HOXB13 is a gene that is important to the proper development of the prostate. Mutations in this gene (although rare) are linked to early-onset hereditary prostate cancer.
- Acquired mutations are changes to the DNA that occur sometime during your lifetime and are not passed on from generation to generation. The majority of prostate cancer cases come from acquired mutations, rather than inherited ones.
Is Prostate Cancer Hereditary?
Yes, but only to an extent. Several different genetic mutations with links to the disease can be inherited from your parents, but the majority of mutations leading to prostate cancer are acquired.
What Are the Risk Factors for Prostate Cancer?
The known risk factors for prostate cancer cannot be avoided or changed, but it is still important to understand each of them to know if you are at a greater risk for developing the disease.
- Age: An individual’s chances of contracting prostate cancer increase with age. It is rare in men younger than 40. The odds of developing the disease increase greatly after the age of 50.
- Race: For reasons that are currently unclear, prostate cancer occurs more commonly in males of African descent than other races, and it generally affects them at a younger age. Also, the disease is less common among Asian-American men and those of Hispanic descent than it is among Caucasians.
- Family history: Some components of prostate cancer appear to be inherited, although the majority of cases occur in men without a family history of the disease. This being said, if one of your immediate blood relatives (a father or brother) has had prostate cancer, your risk of developing it more than doubles.
How Is Prostate Cancer Diagnosed?
There are several tests used to diagnose prostate cancer. Here is a list of what you might experience.
- Physical exam: Your doctor will likely start with a physical exam, which usually includes questions about your family medical history, pre-existing conditions and overall health. They will then look for any physical signs of prostate cancer, and will most likely rely on a digital rectal exam, also referred to as a DRE. During this test, a doctor will (with gloves and lubrication) insert a finger into your rectum to check for any growths or lumps around your prostate that are indicative of the disease.
- PSA blood test: Shortened from prostate-specific antigen, PSA is a protein that is made by cells within the prostate, and this test measures the level of it present in your blood. While a doctor can’t definitively diagnose prostate cancer by using a PSA blood test, if your PSA is above 10ng/mL, you have a 50% chance of having the disease. PSA measurements above 4 ng/mL typically trigger an evaluation for prostate cancer, although adjustments to this number can be made based on age, race and prostate size. Sometimes, additional PSA-based testing, for example, the Free PSA, can be used to help distinguish between PSA elevation due to prostate enlargement and cancer.
- Prostate MRI: Careful imaging of the prostate using magnetic resonance imaging (MRI) can be used to determine the need for a biopsy and sometimes to direct the biopsy. This test is relatively new and is in widespread use in Europe. In the United States, it is often used before a repeat biopsy, but it may soon be recommended more routinely.
- Prostate biopsy: This is the only truly definitive way to determine if you have the disease. Your doctor will likely order a prostate biopsy if the results of your DRE or PSA blood test suggest the presence of prostate cancer. The procedure itself is an office procedure lasting for 15-20 minutes. A local anesthetic is injected to numb the skin and the prostate and then tissue samples are collected via a core needle biopsy and examined under a microscope for signs of prostate cancer.
Which Laboratory Test is Done to Screen for Prostate Cancer?
Generally, both a DRE and a PSA blood test are the exams that a doctor will perform on you when screening for prostate cancer.
I’ve Been Diagnosed with Prostate Cancer, Now What?
A urologist (a doctor who specializes in the urinary system and male fertility) can help you determine the best immediate course of action. Ask what stage of the disease you have, what treatment your care team recommends and why.
In prostate cancer, the aggressiveness of your cancer is assessed with what is known as a Gleason score, which grades cancers (following a biopsy) between 6 and 10. A Gleason score of 7 indicates prostate cancer that’s medium grade; scores of 8 and above are referred to as high-grade cancers and are more aggressive.
If your cancer is aggressive enough to warrant treatment (as opposed to being monitored), it may be useful to consult with a multi-disciplinary team that includes a urologist, radiation oncologist and medical oncologist to get the most comprehensive set of recommendations.
What Is the Treatment for Prostate Cancer?
First, you’ll want to figure out if your case requires immediate treatment, as many do not. When you do start treatment, several prostate cancer treatment methods are available.
- Surgery: This is the most common treatment option for the disease, especially if it has not spread beyond the prostate. During surgery, your surgeon will likely remove the entire prostate gland in addition to some surrounding tissue.
- Radiation therapy: This is an option you’re likely to see performed both by itself, for cases where the cancer has not spread to other organs, and combined with hormone therapy when the disease has progressed. Radiation can be delivered from outside of the body (external beam) and through implantation of radiation seeds.
- Cryotherapy: Also referred to as cryosurgery, this treatment method uses extremely cold temperatures to freeze and destroy the prostate along with any cancerous cells. This treatment option is not as well studied as surgery and radiation and not routinely recommended.
- Hormone therapy: Often used to treat cases of prostate cancer that have progressed and spread to other body parts, this method aims to reduce levels of male hormones, known as androgens, as they are in large part responsible for prostate growth.
- Chemotherapy: While chemotherapy drugs are often used in combination when used to treat other cancers, in the case of prostate cancer they’re usually administered individually. Examples of drugs used to treat prostate cancer include docetaxel (Taxotere), which is usually the first drug patients are given, cabazitaxel (Jevtana), mitoxantrone (Novantrone) and estramustine (Emcyt).
- Immunotherapy: These types of drugs are used to help your body recognize and defend against cancer cells. Immune checkpoint inhibitors such as pembrolizumab (Keytruda) are used to treat a rare subtype of prostate cancer. Drugs known as cancer vaccines, such as sipuleucel-T (Provenge), may also be used.
- Targeted therapy: These drugs are used to identify and attack cancer cells, which causes less harm to your normal cells. In the case of prostate cancer, PARP inhibitors such as rucaparib (Rubraca) and olaparib (Lynparza) can be utilized in some patients whose cancers harbor sensitivity mutations.
Here are a few questions to ask when discussing treatment options with your doctor:
- What stage is the cancer and what does that mean?
- What is the Gleason score?
- Do I need to start treatment right away?
- Which treatment option(s) do you recommend, and why?
- How long will the treatment last?
- What are the risks and side effects?
- How will we know the treatment is working?
Your treatment plan will depend on your symptoms, overall health and fitness level, results of your blood tests and your own personal preferences. Once treatment begins, your progress will be closely monitored. Talk to your doctor to get the care that’s right for you.
What Is Watch and Wait for Prostate Cancer?
Watch and wait, or watchful waiting, refers to the period after you’ve received a prostate cancer diagnosis but before treatment starts. In many cases, prostate cancer progresses very slowly, and does not require immediate treatment. In these instances, your doctor will recommend an approach where the progression of your disease is monitored, but treatment is not started right away.
- Active surveillance is when the cancer is watched very closely, and usually includes a full regimen of tests to measure disease progression (including DREs and PSA blood tests).
- Observation is a less intensive version of this and is used when treatment with curative intent is not likely to be recommended, but you will still be monitored.
There are a number of factors that lead to the decision to opt for the “watch and wait” approach, primarily including the characteristics of the cancer, but also age, overall health, disease stage and personal preference.
When Will My Doctor Know it’s the Right Time to Treat?
While there’s no golden rule on when it is the right time to begin a course of treatment, your doctor will closely monitor the cancer to watch for any changes and begin treatment when necessary. They will likely order regular tests that will keep them informed on the disease status. If the results of a DRE or PSA blood test indicate that this is the case, your doctor is likely to order a biopsy.
All of these results, in addition to your age and your own preference, will determine when your treatment will begin.
What Are the Stages of Prostate Cancer?
While the Gleason score is used to determine how aggressive the cancer is, staging is a different process that determines if your cancer has spread, and how far.
The staging system that is most commonly used for prostate cancer is the American Joint Committee on Cancer TNM system, which uses five metrics for classification:
- T: Refers to the size and extent of the tumor.
- N: Determines if the cancer has spread to nearby lymph nodes.
- M: Determines if the cancer has spread (metastasized) to other parts of the body.
- PSA levels: This refers to the level of PSA in your blood following a PSA blood test.
- Grade Group: This will be determined using your Gleason score, and is a measure of how aggressive the cancer is.
The system has four stages (I, II, III, IV), and for stages I-III your doctor may also be able to categorize your cancer into a risk group, which determines how likely these earlier-stage cancers are to spread. The five classifications of risks groups are very low, low, intermediate, high and very high.
To learn more about prostate staging and grading, speak with your doctor. They can answer your questions and help you better understand your stage and prognosis.
What Is the Survival Rate of Prostate Cancer?
Many patients with prostate cancer see very high survival rates overall. According to Surveillance, Epidemiology, and End Results (SEER) data published by the National Cancer Institute, the relative five-year survival rate from 2010 to 2016 was 97.8%, meaning that the large majority of individuals diagnosed with prostate cancer were still alive five years after their diagnosis.
When the disease is localized or regional, the 5-year survival rate is nearly 100%. For distant stages of the disease, the 5-year survival rate is 31%, but these types of prostate cancer are less common. Even if you are diagnosed with a more aggressive stage of the disease, it is important to recognize that there is hope — regular medical advancements are making progress.