Prostate Cancer

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What Is Prostate Cancer?

Prostate cancer begins when cells in the prostate grow uncontrollably. The prostate is a small gland located below the bladder that helps produce semen. Most prostate cancers grow slowly, but some develop more quickly and can spread beyond the prostate.

Early prostate cancer often causes no symptoms. Some cancers may never become harmful, while others require prompt treatment. Understanding the cancer’s stage, grade and growth pattern helps the healthcare team recommend an appropriate approach.

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What Causes Prostate Cancer?

Prostate cancer develops when genetic changes cause prostate cells to grow and survive abnormally. The exact reason these changes occur in a particular person is usually unknown. Age, inherited genes and other biological and environmental factors may contribute.

Prostate cancer is not caused by sexual activity or a person’s behavior. Benign prostatic hyperplasia, or BPH, and prostatitis can cause similar urinary symptoms, but they are not prostate cancer and are not considered risk factors for it.

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Types and Stages of Prostate Cancer

Most prostate cancers are adenocarcinomas, which begin in the gland cells that produce prostate fluid. Less common types include neuroendocrine and small-cell prostate cancers, which may behave differently and require different treatment.

Localized prostate cancer remains within the prostate. Locally advanced cancer has grown into nearby tissues or lymph nodes. Metastatic prostate cancer has spread to distant areas, most commonly the bones. Cancer that returns after treatment is called recurrent prostate cancer.

Understanding PSA, Grade and Stage

PSA provides information about prostate activity but cannot describe the cancer on its own. Changes in PSA over time may be more informative than a single result.

The Gleason score and Grade Group describe how abnormal the cancer cells look. Grade Groups range from 1 to 5. Grade Group 1 usually represents slower-growing cancer, while higher Grade Groups are more likely to grow and spread quickly.

The stage describes where the cancer is located and whether it has spread. PSA, Grade Group, stage, imaging results and overall health are considered together when discussing risk and treatment.

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How Is Prostate Cancer Treated?

Treatment depends on the cancer’s stage, Grade Group, PSA level, symptoms, genetic features, previous treatment and the person’s general health and priorities.

Options may include active surveillance, surgery to remove the prostate, external or internal radiation therapy and hormone therapy that reduces or blocks testosterone. More advanced cancers may also be treated with chemotherapy, targeted medicines, immunotherapy or radioactive medicines that deliver radiation to cancer in the bones. Clinical trials may provide access to treatments still being studied.

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Advanced and Metastatic Prostate Cancer

When prostate cancer spreads, it most commonly affects the bones and lymph nodes. Possible symptoms include persistent bone pain, fractures, fatigue, weakness, weight loss or anemia. Some people have metastatic cancer without obvious symptoms.

Treatment may not remove all advanced cancer, but it can slow its growth, relieve symptoms and help people live longer. The cancer may initially respond to hormone therapy and later begin growing despite low testosterone levels. This is called castration-resistant prostate cancer, and additional treatments may then be considered.

Risks

The likelihood of prostate cancer increases with age. Having a father, brother or son with prostate cancer can also increase risk, particularly when several relatives were affected or cancer developed at a younger age.

Inherited changes in genes such as BRCA1, BRCA2 and genes associated with Lynch syndrome can increase risk. People of African ancestry also experience higher rates of prostate cancer and are more likely to develop aggressive disease, although biological, healthcare and social factors may all contribute to this difference.

Having one or more risk factors does not mean that someone will definitely develop prostate cancer. Many people diagnosed with it have no known family history.

Symptoms

Early prostate cancer usually causes no noticeable symptoms. When symptoms occur, they may include difficulty starting urination, a weak or interrupted urine flow, needing to urinate more often, difficulty emptying the bladder or pain during urination.

Other possible symptoms include blood in the urine or semen, painful ejaculation and persistent pain in the back, hips or pelvis. These symptoms are often caused by noncancerous conditions, but they should still be assessed by a healthcare professional.

Diagnosis

Assessment may include a PSA test, a physical examination and a digital rectal examination. If cancer is suspected, an MRI can help identify unusual areas and guide decisions about whether a biopsy is needed.

A prostate biopsy removes small tissue samples for examination under a microscope. A biopsy is normally required to confirm whether cancer is present and determine how abnormal the cells appear. Additional imaging may be used to check whether the cancer has spread.