The Facts About Prostate Cancer

The prostate gland is unique to the male reproductive system and has an important role in sexual intercourse and reproduction. This gland produces fluid that combines with sperm to create semen, enabling ejaculated sperm to swim to a woman's fallopian tubes for conception.

The prostate is composed of glands and stroma (muscle) and has three main functions in the male body: maintaining urinary continence, reproduction and preventing bladder infections.

The internal structure of the prostate resembles a tree. Each of the lobes in the prostate has a main trunk, which drains secretions into a network of ducts that look like tree limbs. At the end of each of these ducts are structures called acini, similar to leaves attached to tree limbs. The acini are the conduit for moving secretions through the urethra.

Of all the cancers men get, prostate cancer and melanoma (skin cancer) are the two most common. About 13 percent of American males will develop prostate cancer at some point in their lives, and about 1 in 41 will die from the disease.

However, prostate cancer is not a death sentence, although early detection and rapid treatment are both key to survival. The relative five-year survival rate for all stages of prostate cancer is about 98 percent.

Overview of prostate cancer

The prostate is a walnut-sized gland located just below the bladder. The prostate is composed of three lobes and wraps around the urethra, whose job is to take semen and urine out of the body.

As men age, the prostate usually enlarges slightly. However, if the prostate grows too much, other health issues such as prostate cancer can occur. The American Cancer Society estimates in 2022 almost 269,000 men will be diagnosed with prostate cancer and about 35,000 men will die from prostate cancer.

Adenocarcinomas—cancers that begin in glandular cells involved in secretion—make up most of the prostate cancer cases. However, there are rarer kinds of cancer that start in the prostate, such as:

• Sarcomas. Soft tissue cancers.
• Small cell carcinomas. Highly malignant cancers with shorter doubling times, faster growth rates and earlier metastases.
• Transitional cell carcinomas. Urinary system cancers that begin in the transitional epithelium.
• Neuroendocrine tumors. Cancers that begin in cells with characteristics of nerve cells and hormone-producing cells.

If you are diagnosed with one of the rarer types of prostate cancer, your urologist will also order a full-body CT scan or MRI because the probability of these types of cancers metastasizing in other parts of the body is extremely high. Additionally, your urologist will likely recommend immediate aggressive treatment.

Most adenocarcinoma prostate cancers develop slowly. In some cases, the growth is so slow men who have it die from other causes without being aware they even had prostate cancer. More than half of American males have cancerous prostate glands by the time they reach 80 years old.

Changes in prostate cells can begin as much as 30 years before tumors grow large enough for symptoms to develop. However, by the time symptoms of prostate cancer manifest, the likelihood of an advanced stage of cancer and/or metastases in other parts of the body is greater.

Prostate cancer risks

Every male carries the risk of developing prostate cancer, but some demographic groups are more likely to have a positive diagnosis.

One such demographic group is men over 50 years old. When you turn 50, the probability you will develop prostate cancer increases and continues to rise until age 80. The highest number of prostate cancer cases occur in men between the ages of 65 and 74.

Race is another factor in determining risk, although oncologists are unsure which factors make up the demographic disparities in race.

From 2014-2018, Black males in the U.S. developed prostate cancer at a rate of 172.6 per 100,000. In comparison, white males in the U.S. developed prostate cancer at a rate of 99.9 per 100,000. According to the nonprofit group Zero – The End of Prostate Cancer, Black men are 1.8 times more likely to be diagnosed with and 2.2 times more likely to die from prostate cancer than white men. It is also true to say that if you are a Black or white male, you are more likely to have prostate cancer than males of any other race or ethnicity. Asian-American and Hispanic/Latino males have the lowest risk of developing prostate cancer.

Geography is another determinant. North American, Caribbean, Australian and Northwest European men have the highest probability of a prostate cancer diagnosis, while prostate cancer is more uncommon among South American, African, Central American and Asian men.

There is also a genetic component associated with this disease. If you have immediate male relatives (father or brother) who have or had prostate cancer, your own risk is doubled. If there are several males in your family who have experienced prostate cancer, the risk could be even greater.

The mutated genes you could inherit include:

• Mutated BRCA1 or BRCA2 genes can increase sexual reproductive system cancer risks in both men and women.
• The gene behind Lynch syndrome can increase the risk for colorectal cancer and other forms of cancer, including sexual reproductive system cancers in both females and males.

What you eat and drink also plays a role, and there is research indicating diets with a lot of dairy products, red meat and animal fats can increase the likelihood of prostate cancer.

While most research has not discovered a concrete correlation between smoking tobacco and prostate cancer, some studies link smoking tobacco to a slightly higher chance of dying from prostate cancer if you already have it.

Finally, exposure to toxic chemicals is another risk factor for prostate cancer. Agent Orange, a chemical used for defoliation in Vietnam during the Vietnam War, has been linked to an increased risk of prostate cancer in veterans who served in the country. Firefighters, who are routinely exposed to toxic chemicals, may also have an elevated risk of developing prostate cancer.

Prostate cancer symptoms

It's possible to have prostate cancer that presents few or even no symptoms. However, common symptoms you should be looking out for include:

• Persistent pain in your pelvis, back or hips
• Bloody urine or semen
• Difficulty urinating
• Urinating frequently, especially during the night
• Inability to empty your bladder
• Urine flow changes
• Pain when you ejaculate
• Inability to get an erection
• Rectal pain or pressure

Schedule an appointment with your primary care doctor immediately if you experience one or more of these symptoms.

Prostate cancer diagnosis

Men over age 50 might want to include prostate cancer screenings as part of their annual wellness checkups. If you have risk factors that make it more likely you will develop prostate cancer, then alert your primary care doctor.

There are two tests to screen for prostate cancer. The first is a digital rectal exam (DRE), which looks at the physical structure of your prostate and determines if the size, shape or texture is abnormal.

The second is a blood analysis test called a prostate-specific antigen (PSA) test. A small amount of PSA in your blood is normal. However, if the analysis finds high amounts, you may have prostate enlargement, inflammation, infection or cancer.

Further testing from a urologist for a diagnosis include:

• A transrectal ultrasound
• An MRI
• A biopsy of prostate cells

If the biopsy confirms you have prostate cancer, your urologist will next determine how aggressive the cancer is and whether it has spread beyond the prostate. The cancer is graded based on how much cancer cells look like healthy cells. Cancer cells similar to healthy cells indicate a less aggressive cancer, whereas highly mutated cancer cells indicate a more aggressive cancer.

Your urologist may use a variety of techniques to identify how aggressive your prostate cancer is. One common technique is the Gleason Score that grades prostate biopsy cells on a scale of 1 (normal cells) to 5 (highly abnormal cells).

The two most predominant kinds of cells in your prostate are then graded using the Gleason scale. Adding the two numbers together results in your Gleason Score, with 10 (5+5) being the highest. Your score is then assigned to a Grade Group:

• Grade Group 1 has a Gleason score of 6 or less and indicates low-risk prostate cancer.
• Grade Groups 2 (3+4) and 3 (4+3) have a Gleason score of 7 and indicate intermediate-risk prostate cancer.
• Grade Group 4 has a Gleason score of 8 and indicates high-risk prostate cancer.
• Grade Group 5 has a Gleason score of 9 or 10 and indicates very-high-risk prostate cancer.

Prostate cancer stages

Once your prostate cancer has been diagnosed, your urologist will use five factors to determine the stage of cancer:

• The result of your PSA test.
• The Grade Group of your prostate cancer.
• How large and contained your tumor is.
• Whether your cancer has spread outside your prostate.
• How far your cancer has spread beyond your prostate.

Once these factors have been assessed, your current stage of prostate cancer can be calculated:

• Stage I. Small number of cancerous cells in only the prostate.
• Stage II. Larger number of cancerous cells in only the prostate.
• Stage III. Cancerous cells have spread outside the prostate to seminal vessels or adjacent lymph nodes.
• Stage IV. Cancerous cells have spread to distant parts of the body (lungs, liver, bone, brain, etc.).

Prostate cancer treatment options

Treatment for your prostate cancer is determined by the stage of the cancer and includes:

• Surgery
• Targeted radiation therapy
• High-intensity focused ultrasound (HIFU) therapy
• Hormone therapy
• Chemotherapy (Stage IV)
• Immunotherapy
• Vaccines
• Immune checkpoint inhibitors
• Chimeric antigen receptor (CAR) T-cell therapy
• Poly-adenosine diphosphate ribose polymerase (PARP) inhibitors
• Monoclonal antibodies
• Radiofrequency ablation (Stage IV with bone metastasis)

Prostate cancer prognosis

The treatments for stages I, II and III prostate cancers usually have successful outcomes. If your prostate cancer is localized (only in your prostate) or regional (in your prostate and spread to nearby lymph nodes and/or seminal vesicles), there is a high likelihood your cancer will be cured and your prostate cancer will not return within five years.

If you have stage IV prostate cancer, treatment will likely be more difficult because the cancer has spread distantly. The five-year survival rate with stage IV prostate cancer is 28 percent.

Prostate cancer recurrence

Up to 4 in 10 men who are successfully treated for prostate cancer experience a recurrence. After treatment is complete, it is important your primary care physician includes prostate screenings in all future wellness exams.

Prostate cancer can recur at any time, and the first indication of recurrence will be an elevated PSA level.

Prostate cancer prevention

While there is no hard science that indicates prostate cancer can be prevented, there is research that suggests you can lower your risk of developing prostate cancer.

One way to reduce your likelihood of prostate cancer is by eating healthy foods and eliminating excess fat from your diet. Dairy products seem to be connected to a greater risk of developing prostate cancer.

Another way to lower your chance of developing prostate cancer is to exercise and maintain a healthy weight. Also, if you know you have high-risk factors for prostate cancer, talk with your doctor about additional options such as medications.

Prostate cancer resources

Although prostate cancer can be cured if it's discovered early, you may still experience emotional and physical side effects from your diagnosis and treatment. Your urologist will engage a palliative doctor as part of your cancer team who will manage any side effects you experience during treatment.

You may also experience depression or have worries and fears about how your sexual performance could be affected by treatment. Ask your urologist or palliative doctor about any counseling resources available as an honest and open discussion is often the best way to better understand your circumstances and relieve stress.

If you have a local hospital that specializes in cancer, it will likely have programs, including group and individual counseling, free for cancer patients. Reach out online, too: A quick search will uncover all kinds of web-based information as well as people who have been through everything you're going through now.