Prostate Can­cer

All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.

The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.

Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.

African-American Men

• Are more likely to get prostate cancer than other men.
• Are more than twice as likely to die from prostate cancer than other men.
• Get prostate cancer at a younger age, tend to have more advanced disease when it is found, and tend to have a more severe type of prostate cancer than other men.

Family History (Genetic Risk Factors)

For some men, genetic factors may put them at higher risk of prostate cancer. You may have an increased risk of getting a type of prostate cancer caused by genetic changes that are inherited if—

• You have more than one first-degree relative (father, son, or brother) who had prostate cancer, including relatives in three generations on your mother’s or father’s side of the family.
• You were diagnosed with prostate cancer when you were 55 years old or younger.
• You were diagnosed with prostate cancer, and other members of your family have been diagnosed with breast, ovarian, or pancreatic cancer.

Talk to your doctor about your family’s health history. For more information, visit the National Cancer Institute’s Genetics of Prostate Cancer (PDQ^®)–Health Professional Version.

Different people have different symptoms for prostate cancer. Some men do not have symptoms at all.

If you have any of the following symptoms, be sure to see your doctor right away—

• Difficulty starting urination.
• Weak or interrupted flow of urine.
• Frequent urination, especially at night.
• Difficulty emptying the bladder completely.
• Pain or burning during urination.
• Blood in the urine or semen.
• Pain in the back, hips, or pelvis that doesn’t go away.
• Painful ejaculation.

Keep in mind that these symptoms may be caused by conditions other than prostate cancer.

Cancer screening means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.

If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.

There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.

Prostate Specific Antigen (PSA) Test

A blood test called a prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by—

• Certain medical procedures.
• Certain medications.
• An enlarged prostate.
• A prostate infection.

Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results. If the PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer.

Digital Rectal Examination (DRE)

Digital rectal examination (DRE) is when a health care provider inserts a gloved, lubricated finger into a man’s rectum to feel the prostate for anything abnormal, such as cancer. The U.S. Preventive Services Task Force does not recommend DRE as a screening test because of lack evidence on the benefits.

In 2018, the U.S. Preventive Services Task Force (USPSTF) made the following recommendations about prostate cancer screening—

• Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.
• Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
• Men who are 70 years old and older should not be screened for prostate cancer routinely.

This video helps men understand their prostate cancer screening options.

This recommendation applies to men who—

• Are at average risk for prostate cancer.
• Are at increased risk for prostate cancer.
• Do not have symptoms of prostate cancer.
• Have never been diagnosed with prostate cancer.

Other organizations, like the American Urological Association and the American Cancer Society, may have other recommendations.

Talk to Your Doctor

If you are thinking about being screened, you and your doctor should consider—

• If you have a family history of prostate cancer.
• If you are African-American.
• If you have other medical conditions that may make it difficult for you to be treated for prostate cancer if it is found, or that may make you less likely to benefit from screening.
• How you value the potential benefits and harms of screening, diagnosis, and treatment.

The U.S. Preventive Services Task Force (Task Force) is an organization made up of doctors and disease experts who look at research on the best way to prevent diseases and make recommendations on how doctors can help patients avoid diseases or find them early.

Dr. Alex Krist, vice chair of the U.S. Preventive Services Task Force, provides an overview of the Task Force’s prostate cancer screening recommendation in this video.

The Task Force made the following recommendations about prostate cancer screening—

• Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.
• Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
• Men who are 70 years old and older should not be screened for prostate cancer routinely.

The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread. However, most prostate cancers grow slowly or not at all.

Facts About Prostate Cancer Screening

• For every 1,000 men between the ages of 55 and 69 years old who are screened, about 1 death will be prevented, and 3 men will be prevented from getting prostate cancer that spreads to other places in the body.
• Many men with prostate cancer never experience symptoms and, without screening, would never know they had the disease.

Possible Benefits of Screening

The benefits of screening for prostate cancer may include—

• Finding prostate cancers that may be at high risk of spreading, so that they can be treated before they spread. This may lower the chance of death from prostate cancer in some men.
• Some men prefer to know if they have prostate cancer.

Possible Harms

The possible harms of screening for prostate cancer include harms from screening, diagnosis, and treatment.

Possible Harm from Screening

False positive test results: This occurs when a man has an abnormal PSA test but does not have prostate cancer. False positive test results often lead to unnecessary tests, like a biopsy of the prostate. They may cause men to worry about their health. Older men are more likely to have false positive test results.

Possible Harms from Diagnosis

Screening finds prostate cancer in some men who would never have had symptoms from their cancer in their lifetime. Treatment of men who would not have had symptoms or died from prostate cancer can cause them to have complications from treatment, but not benefit from treatment. This is called overdiagnosis.

Prostate cancer is diagnosed with a prostate biopsy. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells. Older men are more likely to have a complication after a prostate biopsy.

A prostate biopsy can cause—

• Pain.
• Blood in the semen or ejaculate.
• Infection.

Possible Harms from Treatment

The most common treatments for prostate cancer are surgery to remove the prostate and radiation therapy.

The most common harms from prostate cancer treatment are—

• Urinary incontinence (accidental leakage of urine). About 1 out of every 5 men who have surgery to remove the prostate loses bladder control.
• Erectile dysfunction (impotence). About 2 out of every 3 men who have surgery to remove the prostate become impotent, and about half of men who receive radiation therapy become impotent.
• Bowel problems, including fecal incontinence (accidental leakage of bowel movements) and urgency (sudden and uncontrollable urge to have a bowel movement). About 1 out of every 6 men who has radiation therapy has bowel problems.

A biopsy is a procedure that can be used to diagnose prostate cancer. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.

A Gleason score is determined when the biopsy tissue is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2 to 10. The lower the score, the less likely it is that the cancer will spread.

A biopsy is the main tool for diagnosing prostate cancer, but a doctor can use other tools to help make sure the biopsy is made in the right place. For example, doctors may use transrectal ultrasound or magnetic resonance imaging (MRI) to help guide the biopsy. With transrectal ultrasound, a probe the size of a finger is inserted into the rectum and high-energy sound waves (ultrasound) are bounced off the prostate to create a picture of the prostate called a sonogram. MRI uses magnets and radio waves to produce images on a computer. MRI does not use any radiation.

Staging

If prostate cancer is diagnosed, other tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. This process is called staging. Whether the cancer is only in the prostate, or has spread outside the prostate, determines your stage of prostate cancer. The stage of prostate cancer tells doctors what kind of treatment you need.

More Information

• Gleason Score and Grade Group (Prostate Cancer Foundation)
• Understanding Your Pathology Report: Prostate Cancer (American Cancer Society)

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are—

• Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you don’t treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
  • Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
  • Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
• Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
• Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer. There are two types of radiation therapy—
  • External radiation therapy. A machine outside the body directs radiation at the cancer cells.
  • Internal radiation therapy (brachytherapy). Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.

Other therapies used in the treatment of prostate cancer that are still under investigation include—

• Cryotherapy. Placing a special probe inside or near the prostate cancer to freeze and kill the cancer cells.
• Chemotherapy. Using special drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through your veins, or, sometimes, both.
• Biological therapy. Works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.
• High-intensity focused ultrasound. This therapy directs high-energy sound waves (ultrasound) at the cancer to kill cancer cells.
• Hormone therapy. Blocks cancer cells from getting the hormones they need to grow.

For more information, visit the National Cancer Institute’s Prostate Cancer Treatment Option Overview. This site can also help you find a doctor or treatment facility that works in cancer care. Visit Facing Forward: Life After Cancer Treatment for more information about treatment and links that can help with treatment choices.

Clinical Trials

Clinical trials use new treatment options to see if they are safe and effective. If you have cancer, you may want to take part. Visit the sites listed below for more information.

• NIH Clinical Research Trials and You (National Institutes of Health)
• Learn About Clinical Trials (National Cancer Institute)
• Search for Clinical Trials (National Cancer Institute)
• ClinicalTrials.gov (National Institutes of Health)

Complementary and Alternative Medicine

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.

Which Treatment Is Right for Me?

Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects. Side effects are how your body reacts to drugs or other treatments.

Sometimes people get an opinion from more than one cancer doctor. This is called a “second opinion.” Getting a second opinion may help you choose the treatment that is right for you.