Prostate Cancer: Causes, Symptoms, & Care

Each year, over 300,000 new cases of prostate cancer are diagnosed in the United States, and more than 35,000 die from the disease. Please continue reading to learn more about what can increase prostate cancer risk, symptoms, and treatment options.

What is Prostate Cancer?  

Prostate cancer is cancer that starts in the prostate gland. The prostate gland is a part of the male reproductive system. It is located just below the urinary bladder and helps to make semen.

Prostate Cancer Symptoms

Many men with early-stage prostate cancer do not experience symptoms until advanced stages. However, if symptoms are present, they can include: 

• Blood in the urine 

• Blood in the semen

• Frequent urination

• Nocturia (getting up frequently at night to urinate)

• Trouble starting a urine stream

People with advanced prostate cancer may develop symptoms such as: 

• Urinary incontinence (leakage)

• Back pain

• Bone pain

• Weakness

• Fatigue

• Unexplained weight loss

• Erectile dysfunction (difficulty getting an erection)

Note: Benign prostatic hyperplasia (BPH) is a benign (non-cancerous) enlargement of the prostate gland. It can also put pressure on the urinary bladder and cause urinary symptoms.

What Causes Prostate Cancer?  

Genetics and Gene Mutations  

While the exact cause of prostate cancer is unknown, scientists have found that cancer cells develop due to a change in the DNA (genetic material) of healthy cells or normal cells. These genetic mutations cause uncontrolled cell growth, leading to tumor formation. The tumor can invade surrounding tissues, and cancer cells can break away and spread to other parts of the body—this is called metastatic prostate cancer.

Lifestyle and Environmental Influences 

Researchers have found that certain lifestyle factors can increase the risk of prostate cancer, such as:

• Obesity: According to the American Cancer Society, obesity (body mass index or BMI of 30 or higher) increases the risk of aggressive prostate cancer by approximately 20%. Obese people are also more likely to have faster-growing prostate cancer and recurrence of the cancer after treatment.

• Smoking: Studies show mixed results, but smoking may increase the risk of developing prostate cancer, metastatic prostate cancer, and recurrent cancer after treatment.

• Chemical exposures: There are potential links between prostate cancer and exposure to certain chemicals such as arsenic, Agent Orange, and chemicals used in firefighting. 

Other possible risk factors for developing prostate cancer that are still being studied include eating a dairy and calcium-rich diet, prostatitis (inflammation of the prostate gland), sexually transmitted infections like gonorrhea and chlamydia, and vasectomy surgery.

Who Is At Risk of Developing Prostate Cancer?

In addition to the different risk factors listed above, there are certain non-modifiable risks for prostate cancer:

• Older age: The risk of prostate cancer is higher in older men. Most people who are diagnosed with prostate cancer are over the age of 50.

• Race and ethnicity: African American men have the highest incidence of prostate cancer and are more likely to be diagnosed at advanced stages. The reason for this is not known.

• Family history: Having a first-degree relative with prostate cancer is linked to an increased risk of prostate cancer.

• Inherited genes: Having certain gene changes such as BRCA1 and BRCA2 is linked to an increased prostate cancer risk (in women, these genes increase the risk of breast cancer and ovarian cancer). 

• Inherited disorders: An inherited condition called Lynch syndrome can increase the risk of different cancers, including a man’s risk of prostate cancer and other cancers such as colon cancer.

How is Prostate Cancer Diagnosed?  

Healthcare providers can diagnose prostate cancer based on your medical history, symptoms, physical exam, and test results. Diagnostic tests for prostate cancer may include:

• Prostate-specific antigen (PSA).

• Imaging tests such as prostate ultrasound and prostate MRI.

• Prostate biopsy to obtain a small sample of prostate tissue for examination in the laboratory, looking for abnormal cells.

Search For Savings On Your Prostate Cancer Treatments

Treatment Options

According to the American Cancer Society, treatment depends on the stage of the cancer (how quickly the cancer grows and how far it has spread), PSA level, and Gleason score (a grading system based on how abnormal the cancer cells look under the microscope). Low-grade cancers have a smaller chance of growing and spreading than high-grade ones.

Active Monitoring

Very low-grade prostate cancers are sometimes not treated since they are slow-growing and have a low overall risk of spreading. On the other hand, cancer treatments in such people can cause severe side effects. Doctors may recommend active surveillance for low-grade prostate cancers to avoid unnecessary treatment side effects. For patients who aren’t comfortable with monitoring alone, radiation or surgery may be offered. 

Less invasive options include cryotherapy or high-intensity focused ultrasound (HIFU), which uses extreme cold or high-intensity sound waves to kill cancer cells. However, whether these treatments are as effective as surgery and radiation therapy is unclear.

Surgical Options  

Surgery to completely remove the prostate gland is called radical prostatectomy. Doctors may recommend this for intermediate or high-risk prostate cancers. Nearby lymph nodes may also be removed during the procedure.

Radiation Therapy

Radiation therapy for prostate cancer consists of external beam radiation and brachytherapy (placing a radiation source inside the body). This treatment uses high-energy radiation to kill cancer cells.

Learn what to expect after radiation treatment for prostate cancer.

Hormone Therapy

Treatment with hormones may be recommended in men with high-grade prostate cancer. Androgens (testosterone and dihydrotestosterone or DHT) support the growth of prostate cancer cells. Hormone therapy for prostate cancer consists of blocking the effects of androgens. Androgen blockade can be achieved with surgical castration (orchiectomy or surgical removal of the testicles) or medical castration with drugs such as;

• LHRH analogs or GnRH agonists, for example, leuprolide (Lupron), leuprolide mesylate (Camcevi), triptorelin (Trelstar), and goserelin (Zoladex)

• LHRH antagonists such as degarelix (Firmagon) and relugolix (Orgovyx)

Other Treatments

Chemotherapy may be used to kill cancer cells. Additionally, immunotherapy and targeted therapy are sometimes used to treat prostate cancer patients. Immunotherapy helps the body’s immune system identify and destroy cancer cells. Targeted drugs target specific proteins in cancerous cells.

Emerging Treatments

Emerging treatments such as prostate-specific membrane antigen (PSMA)-targeted therapy and next-generation androgen receptor inhibitors offer promising options for advanced prostate cancer.

Managing Side Effects

Common side effects of prostate cancer treatment include:

• Urinary incontinence

• Erectile dysfunction

• Decreased sexual desire

• Painful ejaculation

• Altered bowel function

Pelvic floor therapy can help improve urinary incontinence following prostate cancer treatment. It’s important to communicate with your oncology care team about the side effects you are experiencing during treatment. Early management of side effects can improve quality of life and life expectancy in prostate cancer patients.

Survival Rates and Prognosis   

Most prostate cancers grow slowly and, when detected early, have a high survival rate. However, various factors can influence survival rates in people with prostate cancer, including:

• The stage and grade of the cancer at the time of diagnosis.

• PSA level.

• Overall health status.

• Treatment success.

• Lifestyle factors like obesity and smoking.

• Ethnicity (Black people tend to have more aggressive prostate cancers).

What Is The 5-year Relative Survival Rate? 

The relative 5-year survival rate is the percentage of people with prostate cancer who are likely to be alive after 5 years compared to people who don’t have prostate cancer. For example, suppose the 5-year relative survival rate for stage 1 prostate cancer is 99%. In that case, it means that about 99 out of 100 men with stage 1 prostate cancer are, on average, likely to be alive 5 years after the diagnosis compared to healthy men who don’t have cancer.

Life Expectancy with Prostate Cancer 

The relative 5-year-survival rate for various stages of prostate cancer is as follows:

• Localized prostate cancer that is limited to the prostate gland: More than 99%

• Regional prostate cancer that has spread to nearby lymph nodes: More than 99%

• Prostate cancer that has spread to distant organs in the body: 37%

• All stages combined: 97%

At What Stage Is Prostate Cancer Not Curable?

Stage IVB prostate cancer that has spread to distant organs such as bones is generally not curable. However, stage 4 prostate cancer can be treated to improve quality of life and prolong survival.

Can a Man Live a Normal Life After Prostate Cancer?

Men who have their prostate gland surgically removed can live a normal life. However, because sperm cannot leave the body with the prostate absent, the surgery leads to infertility. The inability to father a child is a permanent side effect of radical prostatectomy (prostate removal surgery). Other common side effects, such as incontinence and erectile problems, may improve with time and can be treated.

How To Prevent Prostate Cancer? 

You cannot 100% prevent cancer, but there are some ways to lower the risk of prostate cancer. See below for tips for reducing risk.

Diet and Lifestyle Choices

• Eat a healthy diet. Specific foods such as broccoli, tomatoes, cauliflower, or soy are not proven to lower prostate cancer risk. Doctors recommend eating a balanced diet including fruits, vegetables, whole grains, lean proteins, low-fat dairy, nuts and seeds. Limit the amount of saturated fat and processed food in your diet.

• Regular exercise at least 5 days a week will help maintain a healthy weight. Obesity is one of the risk factors for prostate cancer. 

• Stop smoking if you smoke. Talk to your healthcare professional about getting help with quitting.

Regular Prostate Screenings  

Prostate cancer screening tests look for signs of prostate cancer in people who don’t have any symptoms. They include:

• PSA: This blood test measures a specific protein in the blood. PSA is often elevated in people with prostate cancer. It is the gold standard for detecting prostate cancer. However, other conditions like prostatitis can also lead to a high PSA.

• Digital rectal exam: Your doctor can insert a lubricated, gloved finger into your rectum to examine the prostate gland.

The general recommendation is to start prostate cancer screening at age 55. However, your healthcare provider may recommend you begin prostate cancer screening at a younger age based on factors such as family history of a first-degree relative with prostate cancer or African-American ethnicity.

Medications

People who are at a high risk of prostate cancer may benefit from taking medications such as finasteride (Propecia, Proscar) and dutasteride (Avodart) to lower this risk. These drugs are commonly prescribed to treat benign prostatic enlargement (BPH). Discuss the benefits versus risks of these medicines with your provider. If prostate cancer occurs while on these medicines, it may grow faster.

Support and Resources  

Here are some tips on coping with a diagnosis and treatment for prostate cancer:

• Stay informed. Learning about your condition and treatment options can help you cope and make informed healthcare decisions.

• Seek support from support groups. This will help in decision-making and you will feel less alone.

• Get second opinions if you’re not sure how you want to proceed with prostate cancer treatment. Consulting additional doctors can help you fully understand your options. Specialists to consider include radiation oncologists, medical oncologists, and urologic surgeons.

• Maintain good medical records to get the most out of your medical consultations and second opinions.

• Involve your family in gathering information and decision-making about treatment.

• Talk to adult male relatives (father, brothers, sons) about getting screening for prostate cancer. 

• Seek counseling if you are having trouble dealing with sexual function and intimacy. Potential side effects of treatment for prostate cancer include a decreased sex drive and impotence, which can lead to stress and anxiety in a relationship. 

• Manage stress. A cancer diagnosis and treatment can be overwhelming and distressing. Consider meditation, mindfulness, visualization techniques, deep breathing, yoga, tai-chi, relaxation exercises, and massage. 

• Stay positive. Learn about your cancer, talk to others in support groups, keep communication open with loved ones, and seek prompt care for side effects. 

Support for Patients and Families  

Here are some support groups for people affected by prostate cancer:

• Prostate Cancer Foundation (PCF)

• Zero Prostate Cancer

• Cancer Care

• UCSF Cancer Support Center

Here are some resources for further information:

• Prostate Tests (National Institute of Diabetes and Digestive and Kidney Diseases)

• Guidelines for Patients (National Comprehensive Cancer Network)

• Prostate Cancer Prevention (National Cancer Institute)