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Prostate cancer is the abnormal growth of cells in a man's prostate gland. The prostate sits just below the bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. As men age, the prostate usually grows larger.
Prostate cancer is common in men older than 65. It usually grows slowly and can take years to grow large enough to cause any problems. As with other cancers, treatment for prostate cancer works best when the cancer is found early. Often, prostate cancer that has spread responds to treatment. Older men who have prostate cancer usually die from other causes.
Experts don't know what causes prostate cancer, but they believe that your age, family history (genetics), and race affect your chances of getting it.
Prostate cancer usually doesn't cause symptoms in its early stages. Most men don't know they have it until it is found during a regular medical exam.
When problems are noticed, they are most often problems with urinating. But these same symptoms can also be caused by an enlarged prostate (benign prostatic hyperplasia). An enlarged prostate is common in older men.
See your doctor for a checkup if:
The most common way to check for prostate cancer is to have a prostate-specific antigen (PSA) blood test. A higher level of PSA may mean that you have prostate cancer. But it could also mean that you have an enlargement or infection of the prostate.
If your PSA is high, you may need a prostate biopsy to figure out the cause. A biopsy means that your doctor takes tissue samples from your prostate gland and sends them to a lab for testing.
Your treatment will depend on what kind of cancer cells you have, how far they have spread, your age and general health, and your preferences.
You and your doctor may decide to manage your cancer with active surveillance or to treat it with surgery or radiation.
If you are over age 80 or have other serious health problems, like heart disease, you may choose not to have treatments to cure your cancer. Instead, you can just have treatments to manage your symptoms. This is called watchful waiting.
Choosing treatment for prostate cancer can be confusing. Talk with your doctor to choose the treatment that's best for you.
Your age and overall health will make a difference in how treatment may affect your quality of life.
Both surgery and radiation can cause side effects. Radiation is more likely to cause bowel problems. Surgery is more likely to cause leaking urine or erection problems.
Medicines and mechanical aids may help men who have erection problems after surgery. And there are ways to target the radiation and protect the rectum during radiation.
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The exact cause of prostate cancer isn't known. But experts believe that your age and family history (genetics) may have something to do with your chances of getting the disease.
The prostate usually gets larger as you age. Having an enlarged prostate (benign prostatic hyperplasia, or BPH) is very common among older men and doesn't increase your chances of getting prostate cancer. But an enlarged prostate is sometimes caused by prostate cancer instead of BPH.
Prostate cancer usually doesn't cause symptoms in its early stages. When there are symptoms, they may include:
Symptoms that may show that the cancer has spread, or metastasized, to other parts of the body include:
For more information about prostate cancer that has come back or spread, see the topic Prostate Cancer, Advanced or Metastatic.
Prostate cancer is a common cancer affecting older men. It usually takes years to become large enough to cause any problems. Sometimes, though, it grows quickly.
Many prostate cancers are found early, when the cancer cells are only in the prostate. When prostate cancer spreads beyond the prostate, it goes first to the lymph nodes in the pelvis, and then on to the bones, lungs, or other organs. For more information, see the topic Prostate Cancer, Advanced or Metastatic.
About 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime during their lifetime.footnote 1 But most men who are diagnosed with prostate cancer don't die from prostate cancer.
Some things can increase your chances of getting prostate cancer. These things are called risk factors. But many people who get prostate cancer don't have any of these risk factors. And some people who have risk factors don't get this cancer.
Being older than 50 is the main risk factor for prostate cancer. About 6 out of 10 new prostate cancers are found in men who are 65 or older.footnote 2
Your chances of getting the disease are higher if other men in your family have had it.
Call your doctor right away if:
Watch closely for changes in your health, and be sure to contact your doctor if:
The following health professionals can evaluate urinary symptoms:
The following doctors treat prostate cancer:
You may want to get a second opinion from a different specialist before making your treatment decision. For example, if your doctor is a family medicine physician, you may want to talk to a radiation oncologist, a urologist, or a urologic or medical oncologist.
If you have low-risk localized prostate cancer and decide on active surveillance, you will have regular checkups and tests, including PSA tests and prostate biopsies. You may also have other tests, such as an mpMRI. If there is no change in your condition, you may continue active surveillance. If tests show that your cancer is growing, you will need to consider having other treatment. Of course, you can also decide at any time to have treatment even if your cancer isn't growing.
If your cancer appears to be a faster-growing type, more tests will be done to see if the cancer has spread. Tests may include:
After treatment for prostate cancer, you have regular checkups to check for any signs that the cancer has come back or spread. Tests include:
Screening for prostate cancer involves checking for signs of the disease when there are no symptoms. It may be done with the PSA test. And while it's important to have regular health checkups, experts disagree on whether PSA testing should be used to routinely screen men for prostate cancer. Testing could lead you to have cancer treatments that you don't need.
So talk with your doctor. Ask about your risk for prostate cancer, and discuss the pros and cons of PSA testing.
Your treatment decision will depend on:
Treatment may be more successful if prostate cancer is found and treated early. But not all prostate cancers may need to be treated, at least not right away. Treating low-risk prostate cancer may be unnecessary, as some of these cancers grow so slowly that they will never cause problems during a man's lifetime. Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.
The main treatments for prostate cancer include:
Cancer that hasn't spread outside the prostate is called localized prostate cancer. Men with localized prostate cancer have options for their care. Tests show if a localized prostate cancer is likely to grow.
Men who have prostate cancer that has come back or has already spread throughout the body may have other treatments, including hormone therapy.
A diagnosis of prostate cancer usually means that you will be seeing your doctor regularly for years to come. So it's a good idea to build a relationship that is based on full and honest information. Ask your doctor questions about your cancer so that you can make the best decision about treatment. Your doctor also may give you some advice on changes to make in your life to help your treatment succeed.
Additional information about prostate cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/prostate.
Treatments such as surgery or radiation can cause serious side effects. Some are short-term problems. But a side effect can become a long-term problem.
For men with high-risk prostate cancer, radiation treatment is given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.footnote 3
A cancer diagnosis can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit the website at www.cancer.org.
After surgery or radiation
If you choose surgery or radiation to treat your prostate cancer, it will be important to have regular checkups. If your cancer comes back, this will help your doctor find it early.
To make the decision that is best for you, take the time to understand your options and the medical facts about your cancer. Sometimes the medical facts will guide your decision. But a good decision also reflects what matters most to you. This includes how you feel about radiation or surgery and the likely side effects. It also includes deciding if you want any treatment if you are an older man or have other health problems.
One thing you can do that may lower the risk for prostate cancer is to eat some of these foods:
Being physically active and staying at a healthy body weight also can help reduce the risk of prostate cancer.footnote 5
During any stage of prostate cancer, there are things you can do at home to help manage the symptoms of cancer or the side effects of treatment or both. If your doctor has given you instructions or medicines to treat symptoms or side effects, be sure to use them. Healthy habits such as eating right and getting enough sleep and exercise can help control your symptoms and side effects.
Try the following tips to manage:
For more information, see the topic Getting Support When You Have Cancer.
Hormones are medicines that can affect the growth of prostate cancer cells. Hormone therapy is sometimes used with radiation treatment or surgery to help make sure that all cancer cells are destroyed.
Hormone therapy can't cure prostate cancer. But it will usually shrink the tumor and slow the rate of cancer growth, sometimes for years. Taking a hormone-therapy medicine lowers your level of testosterone and other male hormones. Another way to lower male hormones is by having surgery to remove the testicles, called an orchiectomy.
Surgery for prostate cancer may be done to:
Radical prostatectomy is an operation to remove the entire prostate and any nearby tissue that may contain cancer. It can be done as open surgery through an incision (cut) in the belly, or as laparoscopic surgery through several very small incisions in the belly. Laparoscopic surgery to remove the prostate is done with a tiny camera and special tools. Sometimes lymph nodes in the area also are removed so that they can be checked for signs of cancer. This is called a lymph node biopsy.
Surgery may completely remove your prostate cancer. But it isn't possible to know for sure before surgery whether the cancer has spread beyond the prostate. When cancer has spread, it can't always be cured with surgery alone.
Active surveillance means that you will be watched closely by your doctor. If the cancer starts to grow more quickly, you will need to have other treatment, such as surgery. Your regular checkups may include digital rectal exams, PSA tests, and biopsies.
Watchful waiting also means that you will be closely watched by your doctor. But the goal of watchful waiting is to treat symptoms that cause problems rather than to cure the cancer. Men who are older and men who have other serious health problems, like heart disease, and aren't well enough to have surgery or radiation often choose watchful waiting.
Radiation therapy may be used alone or combined with hormone treatment when the cancer has high-risk features (based on Gleason score and stage). Radiation may also be used when the cancer has spread after surgery.
Radiation treatment for prostate cancer includes:
Some less common or newer treatments still being studied for prostate cancer include:
Your doctor may talk to you about joining a research study called a clinical trial if one is available in your area. Clinical trials are research studies to look for ways to improve treatments for prostate cancer.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like those mentioned above may help you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies aren't meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
National Cancer Institute (2017). SEER cancer stat facts: Prostate cancer. National Cancer Institute. www.seer.cancer.gov/statfacts/html/prost.html. Accessed July 10, 2017.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
Resnick MJ, et al. (2013). Long-term functional outcomes after treatment for localized prostate cancer. The New England Journal of Medicine, 368(5): 436–445.
Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.
Kushi LH, et al. (2012). American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 62: 30–67.
Other Works Consulted
Keating NL, et al. (2010). Diabetes and cardiovascular disease during androgen deprivation therapy: Observational study of veterans with prostate cancer. Journal of the National Cancer Institute, 102(1): 39–46.
Malcolm JB, et al. (2010). Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. Journal of Urology, 183(5): 1822–1828.
National Cancer Institute (2011). Prostate Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient.
National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Schaeffer EM, et al. (2012). Radical retropubic and perineal prostatectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2801–2829. Philadelphia: Saunders.
Scher HI, et al. (2015). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 932–980. Philadelphia: Walters Kluwer.
Su L, Smith JA (2012). Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2830–2849. Philadelphia: Saunders.
Current as of: December 19, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson MD - Internal MedicineKathleen Romito MD - Family MedicineAdam Husney MD - Family MedicineChristopher G. Wood MD, FACS - Urology, OncologyRichard M. Hoffman MD, MPH - Internal Medicine
Current as of:
December 19, 2018
Medical Review:E. Gregory Thompson MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & Christopher G. Wood MD, FACS - Urology, Oncology & Richard M. Hoffman MD, MPH - Internal Medicine
To learn more about Healthwise, visit Healthwise.org.
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