Prostate Cancer

Prostate Cancer: Overview

What is prostate cancer?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

Prostate cancer starts in the cells that make up the prostate. The prostate is a male gland about the size and shape of a walnut. It surrounds the upper part of the urethra. This is the tube that carries urine from the bladder. The prostate makes some of the fluid that’s part of semen. Semen is the fluid that carries sperm. During orgasm, semen leaves the body through the urethra and comes out at the end of the penis. The prostate tends to grow larger with age.

Nearly all types of prostate cancer start in the gland cells. These are the cells that make the prostate fluid. These types of cancer are called adenocarcinoma. They're the most common. Other types of cancer that can start in the prostate are small cell carcinoma, transitional cell carcinoma, and sarcoma. These are very rare.

Who is at risk for prostate cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The risk factors for prostate cancer include:

• Older age
• African ancestry
• Family history of prostate cancer
• Certain inherited gene changes

Talk with your healthcare provider about your risk factors for prostate cancer and what you can do about them.

Can prostate cancer be prevented?

There is no sure way to prevent prostate cancer. Some risk factors for prostate cancer are not in your control. These include your age and family history. It’s not clear how diet and exercise can affect prostate cancer risk. But you can do some things that might help lower your risk of getting prostate cancer, as well as many other kinds of cancer. These include:

• Eating vegetables and fruits every day
• Not eating high-fat meats or high-fat dairy foods
• Getting to and/or staying at a healthy weight
• Being physically active

If you are at high risk for prostate cancer, your healthcare provider may talk to you about medicines that may lower your risk. 

Are there screening tests for prostate cancer? 

Prostate cancer may be found with a screening test. Screening tests are done to check for disease in people who don’t have symptoms. This may find some types of cancer early, when they’re small, haven't spread, and are often easier to treat. The screening tests used for prostate cancer are: 

• Prostate-specific antigen (PSA) blood test
• Digital rectal exam

Talk with your healthcare provider about the pros and cons of prostate cancer screening so you can decide if it's a good choice for you.  

What are the symptoms of prostate cancer?

Early prostate cancer seldom causes symptoms. By the time symptoms start, the cancer may have spread outside the prostate. When that happens, it’s harder to treat.

Here are some of the more common symptoms:

• A need to urinate often, especially at night
• Weak or interrupted urine flow
• Trouble starting to urinate
• Trouble emptying the bladder
• Pain or burning when you urinate
• Blood in your urine or semen
• Pain or stiffness in your lower back, hips, or pelvis
• Can't get an erection

Many of these may be caused by other health problems. Still, it's important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is prostate cancer diagnosed?

If your healthcare provider thinks you might have prostate cancer, certain exams and tests will be needed to be sure. Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done. You will also have a biopsy.

A biopsy is the only way to know for sure that you have cancer. Small pieces of tissue (called samples) are taken out from your prostate and tested for cancer cells.

After a diagnosis of prostate cancer, you’ll need more tests. They're used to find out the stage of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

The grade is used as part of staging. It gives you an idea of how fast the cancer will grow and spread.

Once your cancer is staged, your healthcare provider will talk with you about what this means for your treatment. Ask your healthcare provider to explain the details of your cancer to you in a way you can understand.

How is prostate cancer treated?

Your treatment choices depend on the type of prostate cancer you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, and help ease problems caused by cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. Other things to think about are if the cancer can be removed with surgery, how your body will work after treatment, and your overall health.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy, hormone therapy, and targeted therapy are systemic treatments. You may get just one treatment or a combination of treatments.

Prostate cancer may be treated with:

• Surgery
• Radiation therapy
• Cryotherapy
• Hormone therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Bone-directed therapy

In some cases, your healthcare provider may recommend active surveillance. The goal of active surveillance is to watch a cancer that's growing very slowly and won't likely cause any harm for a long time, if ever. It's done because the treatments for prostate cancer can cause more harm than living with the disease. This may be a plan for you if your cancer is only in the prostate, does not cause symptoms, and is not likely to shorten your life. Active surveillance often includes PSA tests, rectal exams, and biopsies done on a regular schedule. If the cancer starts growing faster or begins to cause symptoms, treatment can be started.

Talk with your healthcare providers about your treatment choices. Make a list of questions. Think about the benefits and possible side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects? 

Cancer treatments, like chemotherapy and radiation, can damage normal cells. This can cause side effects like hair loss, mouth sores, and vomiting. 

Certain life-changing side effects can also happen with some prostate cancer treatments. These include:

• Trouble controlling urination (incontinence). It may take time for some people to regain control of their bladder after surgery. Over time, with healing, incontinence often happens less. But some people may have long-term problems. Radiation can also cause incontinence. It may not happen right away, but the risk goes up for years after treatment.
• Erectile dysfunction (ED). This means having trouble getting or keeping an erection. Surgery can damage nerves that control erection. Having nerve-sparing surgery may prevent long-lasting (permanent) nerve injury. But it may not be a choice in all cases. ED can also happen when the nerves are damaged by radiation. It may not happen right away but can develop slowly over time after treatment ends. Hormone therapy causes hormone changes that can lower libido and cause ED. Treatments can help with ED.

Talk with your healthcare provider about side effects linked with your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

Coping with prostate cancer

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about problems or concerns you may have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are some tips:

• Talk with your family or friends.
• Ask your healthcare team or social worker for help.
• Speak with a counselor.
• Talk with a spiritual advisor, such as a minister or rabbi.
• Ask your healthcare team about medicines for depression or anxiety.
• Keep socially active.
• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.
• Drink plenty of water, fruit juices, and other liquids.
• Keep physically active.
• Rest as much as needed.
• Talk with your healthcare team about ways to manage treatment side effects.
• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if any of the following occur:

• New symptoms or symptoms that get worse
• Signs of an infection, such as a fever
• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.