Prostate cancer is the fourth most commonly diagnosed cancer in the world and the second most common cancer (after skin cancer) in men, according to the American Cancer Society. In the United States, about 1 in 8 men will get a prostate cancer diagnosis in his lifetime.
However, most men with prostate cancer in the United States do not die from it. Prostate cancer is treatable and survivable, depending on the stage at which a person is diagnosed and their age, general health, and the effectiveness of treatment.
Overall, prostate cancer has one of the highest survival rates among all types of cancer. At least 3.5 million men who’ve had a prostate cancer diagnosis at some point remain alive to this day because of advances in detection and treatment.
Types of Prostate Cancer
Most prostate cancers are carcinomas, meaning they start in tissue that lines the prostate gland, known as epithelial tissue. Knowing your type of prostate cancer influences your outlook and how a cancer care team may recommend treating it.
Adenocarcinomas
Adenocarcinoma is the most common type of prostate cancer, accounting for more than 95 percent of cases. It starts in the cells of the gland.
Acinar Adenocarcinoma This is the most common subtype, starting in the parts of the gland that make the fluid in semen, known as the acini. Variations of this type include pleomorphic giant cell adenocarcinoma, signet ring cell-like carcinoma, and sarcomatoid carcinoma.
Ductal Adenocarcinoma This rare, aggressive type starts in the tubes that carry secretion to the urethra. Some prostate cancers have both types of acinar and ductal cells.
Neuroendocrine or Small Cell Carcinomas
These rare cancers start in neuroendocrine cells, which share traits with both nerve and hormone-producing cells. Neuroendocrine carcinomas of the prostate are sometimes called small cell carcinoma. This is a highly uncommon type of prostate cancer. It can occur at first diagnosis, or it can occur later in the course of treatment, as the cancer changes from adenocarcinoma to neuroendocrine carcinoma.
- Small Cell Carcinoma The most common type of neuroendocrine prostate cancer, this aggressive type consists of cells that appear small under a microscope.
- Treatment-Related Neuroendocrine Carcinoma This type also has the same aggressive variant of prostate cancer and can develop from adenocarcinoma after hormone therapy.
Other Rare Types
Several other forms of cancer rarely develop in the prostate, including the following:
- Squamous cell carcinoma
- Adenoid cystic carcinoma, or basal cell carcinoma
- Lymphoma
- Urothelial carcinoma
- Sarcoma
Signs and Symptoms of Prostate Cancer
Early-stage prostate cancer usually causes no symptoms. According to the American Cancer Society, advanced prostate cancer can cause the following symptoms:
- Problems with peeing, including weak or interrupted flow, peeing more often than usual, or feeling like you can’t completely empty your bladder
- Pain or burning while peeing
- Blood in your pee or semen
- Pain in the hips, spine, or ribs because some types of prostate cancer can spread to the bones
These may be signs of prostate cancer. Or, more likely, they are caused by something else, such as benign prostate hyperplasia (BPH), a noncancerous growth of the prostate. However, you should see your doctor if you experience these symptoms.
Causes and Risk Factors for Prostate Cancer
There are some factors that may increase the risk of developing prostate cancer, including:
- Age Nearly 60 percent of all prostate cancers are diagnosed in men who are over 65 years of age, according to the American Medical Association. However, around 1 in 10 new prostate cancer diagnoses occur in men under 55 years of age, and the outlook is often worse for men who have a prostate cancer diagnosis at a younger age.
- Race It is not clear why, but Black men in the United States are far more likely to develop prostate cancer than white men, and often at a younger age. Black men are also more than twice as likely as white men to die of prostate cancer.
- Family History Having a father or brother can more than double a person’s prostate cancer risk. The risk increases if you have multiple relatives with prostate cancer, especially if they were younger than average at diagnosis. And you’re at a higher risk of prostate cancer if you have a brother with it than if you’ve got a father with the disease.
- Obesity This has links to more dangerous, higher-grade tumors. One study concluded that every five-point increase in body mass index (BMI) raises the risk of death from prostate cancer by 10 percent.
How Is Prostate Cancer Diagnosed?
Your doctor may perform a number of tests to diagnose prostate cancer, including:
- Digital Rectal Exam A doctor uses a gloved finger to feel for abnormalities in the prostate. This is useful in men who have symptoms as well as those who don’t. It can also help a doctor decide if further tests are necessary after a cancer diagnosis or check how prostate cancer is responding to treatment.
- Prostate-Specific Androgen (PSA) Blood Test This measures the amount of PSA circulating in the body. PSA is a protein that both cancerous and noncancerous tissue in the prostate produces. Generally, PSA levels are higher for more advanced prostate cancers.
- Biopsy A doctor specializing in cancer treatment, known as an oncologist, extracts cancerous tissue, examines it under a microscope, and compares it with normal prostate tissue. They will use the Gleason score to estimate how likely it is to spread.
- Imaging Tests Various tests are available, such as computerized tomography (CT), magnetic resonance imaging (MRI) scans, and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scanning. PSMA PET scans check if the prostate cancer has spread.
- Bone Scans These can determine if cancer has spread to the bones.
Not everyone needs prostate cancer screening. However, the American Cancer Society guidelines suggest that men with an average prostate cancer risk should discuss with their doctors whether they’d benefit from screening after 50 years of age, as long as they have a life expectancy of more than 10 years.
Men in high-risk groups, such as Black men or those with a family history, should have these discussions from age 45 onward. Men in the highest risk groups (those with multiple close relatives who had prostate cancer at an early age) should discuss screening at 40 years of age.
A PSA blood test is a common screening tool, and a doctor may also use a digital rectal examination.
PSA Levels
PSA levels can spike due to reasons other than prostate cancer, including inflammation, infection, certain medications, or even strenuous exercise like cycling, running, or heavy lifting. For this reason, there is no specific level of PSA that’s considered normal or abnormal.
In general, higher PSA levels mean a higher likelihood of cancer, and PSA levels over 4 nanograms per milliliter (ng/mL) might be cause for concern. At that level, your doctor might order another PSA test to confirm the finding. If your PSA level stays high, your doctor might schedule more PSA tests at regular intervals or a digital rectal exam.
A PSA level between 4 and 10 is associated with a 1-in-4 chance of having prostate cancer, and a PSA level greater than 10 is associated with a more than 50 percent chance of having prostate cancer.
Stages of Prostate Cancer
A cancer care team will assign prostate cancer one of
four stages based on how advanced the cancer is, how much it has grown in the prostate, and how far it has spread. The PSA level and Gleason score also help a doctor determine the stage of prostate cancer.
- Stage 1 In this stage, a doctor can’t feel the cancer, and typical screening tools aren’t likely to pick it up.
- Stage 2 The tumor has grown but is still small and hasn’t spread beyond the prostate. PSA screening may not detect cancer at this stage because PSA levels will be low to medium.
- Stage 3 PSA levels are high, and the Gleason score may be higher. The cancer may have spread to nearby tissues, the seminal vesicles, or the bladder or rectum.
- Stage 4 Also called advanced prostate cancer or metastatic prostate cancer, stage four means that the cancer has spread beyond the prostate to other parts of the body, including the distant lymph nodes, liver, bladder, or bones.
These stages also have different grade groups and relate to different Gleason scores, depending on a combination of where the cancer has spread and the PSA level. Prostate cancer staging is complex and affects both your treatment and outlook, so ask your doctor to explain what this means for you.
If prostate cancer hasn’t spread, a doctor might also assign a risk group to it. This can help them decided if prostate cancer needs immediate treatment and which treatments might be suitable.
Treatment and Medication Options for Prostate Cancer
Different types of treatment are available for men with prostate cancer. Some treatments are standard, while other treatments may be available to you through clinical trials to expand or improve the standard treatments that are currently available.
The choice of treatment often depends on the cancer’s stage, type, and location, the individual’s age and overall health, and the expected side effects.
Medication Options
A cancer care team prescribes medications for prostate cancer to block hormones, kill cancer cells, or boost the immune system.
Hormone Therapy This treatment, also called androgen deprivation therapy (ADT), removes or blocks the action of male sex hormones called androgens that cause prostate cancer to grow.
Medications include:
- Luteinizing hormone-releasing hormone agonists, such as leuprolide (Lupron, Lupron Depot, Eligard, Prostap, Viadur), goserelin (Zoladex), degarelix (Firmagon), and relugolix (Orgovix), to stop the testicles from making testosterone
- Antiandrogens, such as apalutamide (Erleada), darolutamide (Nubeqa), flutamide (Euflex, Euflexin), and enzalutamide, to block the action of androgens
- Abiraterone acetate (Zytiga) to prevent cancer cells from making androgens
Chemotherapy This treatment uses drugs to stop the growth of cancer cells, either by killing them or by stopping them from dividing. A person may take chemotherapy medications by mouth or receive them by infusion or injection into a vein or muscle.
For people with prostate cancer, the most common chemotherapy drug is docetaxel (Taxotere). A doctor often gives this along with steroids. They may prescribe cabazitaxel (Jevtana) if this isn’t effective.
Targeted Therapy These drugs identify and attack specific targets on cancer cells. PARP inhibitors, such as olaparib (Lynparza), block an enzyme involved in DNA repair with links to prostate cancer. Doctors recommend them for some men with mutations in genes like BRCA1
or BRCA2.
Immunotherapy This therapy uses an individual’s own immune system to fight cancer. Sipuleucel-T (Provenge) is a type of immunotherapy oncologists use to treat prostate cancer that has spread.
Bone Health Therapy Doctors prescribe drugs like zoledronate (Reclast, Zometa).
Surgery
Your doctor may recommend surgery to treat prostate cancer in men with otherwise good health whose tumor hasn’t spread from the prostate gland. Surgical methods might include the following:
- Radical Prostatectomy A surgeon removes the prostate, surrounding tissue, and seminal vesicles. They can perform this procedure through a cut in the abdomen or perineum or by using keyhole (laparoscopic) or robot-assisted surgery.
- Pelvic Lymphadenectomy This procedure involves removing lymph nodes in the pelvis to check their tissue for cancer cells.
- Transurethral Resection of the Prostate (TURP) A surgeon removes tissue from the prostate using a tool they insert through the urethra. They may perform this to relieve symptoms like a blocked urine flow before trying other treatments.
- Cryosurgery or Cryotherapy This treatment is currently only available in clinical trials and uses an instrument to freeze and destroy prostate cancer cells.
Radiation Therapy
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells.
- External Radiation Therapy A machine outside the body sends radiation toward the cancer. Approaches include conformal radiation (shaping beams to the tumor) and hypofractionated radiation (larger doses over fewer days). Proton therapy is a form of external radiation therapy that is more precise than other formats and may reduce the side effects of radiation.
- Internal Radiation Therapy Also known as brachytherapy, this uses radioactive seeds, needles, or wires placed directly into or near the cancer.
- Radiopharmaceutical Therapy A radioactive substance is used to treat cancer. For example, radium-223 (an alpha emitter) is injected into the bloodstream to treat prostate cancer that has spread to the bone.
Watchful Waiting and Active Surveillance
These approaches both involve deferring an immediate treatment but differ in their intensity of monitoring. They may be helpful for older men without symptoms or those with other medical conditions.
Watchful waiting involves closely monitoring the condition without giving treatment until signs or symptoms develop. Doctors usually use it for men with limited life expectancy due to age or other health problems, usually for advanced prostate cancer.
During active surveillance, a cancer care team may follow early-stage cancer in healthy men who’d prefer to avoid the side effects of treatment but are still looking to cure the disease. Active surveillance essentially postpones radiation therapy or surgery until the first sign that the cancer is progressing.
Erectile Dysfunction Management
Nearly every man who has prostate cancer treatment will have some issues with getting or maintaining an erection, known as erectile dysfunction. After two years, between 3 and 6 in 10 men will have returned to their pretreatment sexual function, although this can vary with the type of treatment a man receives.
Options for achieving an erection are available, including:
- Oral medications
- Locally applied therapies like prostaglandin, sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra)
- A device known as a penis pump that pulls blood into the penis using a vacuum seal
- Implants under general anesthesia that allow a man to press a release button and achieve an erection
Which measure you use may depend on your preferences, other health conditions, and your doctor’s advice. Many people who’ve had prostate cancer treatment have active and fulfilling sex lives afterward.
Disparities and Inequities in Prostate Cancer
Black men have specific gene changes that might have links to more aggressive cancers, higher levels of certain hormones linked to prostate cancer growth, and more inflammation in the area around the prostate.
More research could help cancer care teams understand and manage the differences in risk and close the life-expectancy gap in broader society.
In the United States, Black men are nearly twice as likely to be diagnosed with prostate cancer and more than twice as likely to die from it compared with white men.
A review suggests that some social factors, including unequal access to medical facilities, financial and insurance factors, and changing guidelines, may have led to this difference in survival rates.
For example, in the Veterans Affairs system, where Black men have access to the same level of care as white men, the gap in survival rates is much closer than in the general population. Also, when the screening guidelines recommended less testing for prostate cancer, this led to fewer screenings in Black men. In turn, more Black men died from prostate cancer because doctors didn’t identify their disease early enough to give them life-extending treatment.
Genes, hormones, and inflammation could play a key role in the differences in cancer development between races, even in situations in which Black men have comprehensive insurance and access to good medical care.
Lifestyle Changes and Prevention of Prostate Cancer
Because the development of prostate cancer is largely determined by factors beyond your control, including age, race, and family history, no surefire method exists that can prevent it. However, some recommendations might lower your risk.
For example, quitting or avoiding smoking and limiting alcohol intake to no more than two drinks daily for men or one for women if you do drink can help you reduce the risk of getting other cancers.
Manage Your Body Weight Through Diet and Exercise
Excess body weight may have links to increased risk of advanced prostate cancer. Managing your body weight can help you reduce your risk of advanced or fatal prostate cancers. You might be able to support this with the following steps:
- Moving more and engaging in physical activity
- Eating a healthy diet full of fruits, vegetables, and whole grains
- Avoiding or limiting red and processed meats and highly processed foods
Some studies have linked high dietary calcium intake through food groups like dairy to an increased risk for prostate cancer. However, not all studies agree, and others have suggested it can help reduce your risk. More research is necessary.
Get Emotional Support for Side Effects
Prostate cancer treatment can affect sexual function, and it can also lead to long-term bladder or bowel problems in some men. This can contribute to anxiety, worry, and depression for many people with this cancer.
Hormone therapy can also lead to mood changes.
If you feel this way and are comfortable doing so, speak to your partner, friends, family, support groups, religious leaders, or a professional counselor.
Prostate Cancer Outlook
Prostate cancer often progresses slowly, and most men with a prostate cancer diagnosis are over 65 years of age. For these reasons, it’s often said that men with a prostate cancer diagnosis are more likely to die
with prostate cancer but
from other causes.
A doctor will only treat prostate cancer if they believe it will have a real impact on quality of life and life expectancy — but these treatments are available, and they can help.
The American Cancer Society’s five-year relative survival rates compare the percentage of men who are alive five years after a diagnosis of prostate cancer with the general population. They estimate five-year relative survival based on whether the cancer is localized, regional, or distant, known as their Surveillance, Epidemiology, and End Results (SEER) stages.
If the cancer is localized, meaning there is no sign that the cancer has spread beyond the prostate, or if it is regional, meaning it has spread only to nearby structures or lymph nodes, the five-year survival rate is greater than 99 percent. So, on average, men with cancer at these stages are only 1 percent less likely than those without to still be alive five years later.
If the cancer is distant, meaning it has spread to farther parts of the body — including the lungs, liver, or bones — the five-year survival rate drops to 38 percent. Accounting for all SEER stages, the average estimated survival rate is around 98 percent.
No matter how advanced the cancer is, these estimates apply only to the stage of cancer at the point of diagnosis. They don’t suggest how long you will survive with prostate cancer. Every case of prostate cancer is unique, and your age, your overall health, and your body’s response to treatment can all affect your outlook.
Prostate Cancer Complications
Prostate cancer has several possible complications that can lead to further health problems and affect quality of life. These can include:
- Spreading Cancer Prostate cancer can move into other areas, such as other organs or the bones, and lead to pain or fractures in areas like the hips or spine. This is known as metastatic prostate cancer.
- Erectile Dysfunction Both prostate cancer and the surgeries, radiation therapy, and medications that treat prostate cancer can cause problems getting or maintaining an erection.
- Leaking Urine The cancer and treatment can also cause issues with how your bladder works, leading to leaking urine or urinary incontinence.
Support for People With Prostate Cancer
The Prostate Cancer Foundation (PCF) provides simple handbooks and videos that explain your diagnosis without the medical jargon. They connect men who have prostate cancer with an online community of people who truly understand the journey, while providing down-to-earth advice on diet and exercise and finding available doctors and clinical trials. They also offer guidance and support on paying for treatment and other costs of care.
Zero Prostate Cancer helps people with prostate cancer find support. They have a dedicated helpline, ZERO360, which you can call for support in navigating insurance and payment challenges. They also have a mentorship program called MENtor that pairs you with someone who’s already had prostate cancer and can guide you through the journey. Zero Prostate Cancer also connects people with financial grants and assistance and has a massive network of local and online support groups for caregivers and partners as well as patients.
The Takeaway
- Prostate cancer is one of the most common cancers among men, but advancements in detection and treatment contribute to a high survival rate.
- It often progresses slowly, allowing time for effective treatment, but if symptoms like difficulty urinating develop, consult with a healthcare professional as soon as possible.
- If you are over 50 years old, discuss with your doctor whether prostate cancer screening is right for you.
- Different treatment options are available, from surgery to targeted therapies, and many men maintain a good quality of life after treatment — but, depending on the cancer and individual, some men don’t need prostate cancer treatment right away.
