Prostate cancer happens when cells in the prostate grow and divide without control. Sometimes these cells are cancerous and can spread to other parts of the body.
The doctor can do a biopsy to find out if you have prostate cancer and how serious it is. A biopsy also helps doctors know what treatment is best for you.
Prostate cancer occurs when prostate cells grow uncontrollably, forming a mass of tissue called a tumor. The first signs of prostate cancer are usually a rise in PSA levels, though these may also be caused by other conditions, such as an enlarged prostate (benign). To confirm a diagnosis of prostate cancer, a doctor will need to do a biopsy of the prostate. A pathologist will examine the biopsy sample to determine if the tumor is cancerous and, if so, what kind of prostate cancer it is. The Gleason score of a prostate cancer identifies the type and severity of the tumor.
A Gleason score of 6 or less indicates a low-grade tumor. A score of 7 or more suggests a high-grade tumor. Other tests can help doctors decide how to treat a person with prostate cancer. These include imaging tests, such as a CT scan or an MRI scan, and a blood test that measures PSA levels.
These tests can show if the cancer has spread outside of the prostate (metastasized). In addition, doctors can look at a lymph node in the pelvis to see if it has spread. They can also do a positron emission tomography (PET) scan, which tracks an injection of a radioactive substance to detect cancer that has spread to the bones.
Doctors can use other tools to find the right place to perform a biopsy. A urologist can feel for abnormal areas of the prostate with a digital rectal exam (DRE). They may also use ultrasound or magnetic resonance imaging (MRI) to help guide the biopsy. MRI is noninvasive and does not use radiation.
MRI fusion biopsy is a technique that uses a combination of MRI and transrectal ultrasound to identify the best area to perform the biopsy. A cystoscope — a tube-like instrument with a light and video camera — is then passed through the urethra to reach the prostate, where the doctor can collect samples with tools passed through the cystoscope.
If a man has low-risk prostate cancer that grows slowly and doesn’t cause symptoms, the doctor may recommend active surveillance instead of treatment. This involves getting screenings, scans and biopsies every one to three years to monitor the growth of prostate cancer. If the cancer begins to spread, your doctor will start treatment.
The treatment you receive depends on the type of prostate cancer, its stage and whether it has spread. Your healthcare team, which usually includes a urologist and medical oncologist, will discuss your options and choose a treatment plan.
The most common treatment is surgery to remove your prostate gland and tissue around it (radical prostatectomy). You might also have other treatments that affect the cancer’s growth or spread, such as radiation therapy, hormonal therapy or cryosurgery.
Radiation therapy uses high-energy beams from outside your body (external beam radiation), or it might be done using a technique called brachytherapy, which delivers the treatment directly into or near the prostate tumor. This may be used after surgery to kill any cancer cells that might remain, or it might be used as the main treatment if your doctor thinks your cancer is likely to grow again.
Hormonal therapy uses drugs to stop your sex hormones from stimulating your prostate to grow. This is usually used with other treatments, such as surgery or radiation, to treat more advanced cancers.
Cryosurgery uses an instrument to freeze and destroy prostate cancer cells. It’s not a standard treatment, and it can have side effects, such as impotence and urine or stool leakage from the bladder or rectum.
Targeted therapy uses medicines to specifically attack cancer cells without harming normal ones. Examples of targeted therapies for prostate cancer include rucaparib and olaprib, which are PARP inhibitors. These block the pathway that cancer cells with a mutated BRCA gene use to repair their DNA, so they die.
Immunotherapy strengthens your immune system so it can better identify and fight cancer cells. Your doctor might recommend immunotherapy for advanced or recurrent prostate cancer that has spread or is growing quickly.
Prostate cancer is a disease that usually starts in the prostate and may spread to other parts of the body. Many people with prostate cancer do not have any symptoms in the early stages. Screening tests can detect cancer before it causes any problems. The most common treatment for prostate cancer is surgery, radiation and hormone therapy. Many people can be cured with these treatments.
Your risk of getting prostate cancer increases as you get older. You are also more likely to get prostate cancer if your father or brother had the disease. Your race and genetics also influence your risk. People of African descent have twice as much chance of getting prostate cancer and are more likely to die from the disease.
You can lower your risk of prostate cancer by not smoking and eating a healthy diet. Choose vegetables and fruits, especially those with dark colors. These vegetables contain sulforaphane, which helps to prevent cancer. You should try to eat five servings of these vegetables each week.
Other ways to lower your risk include staying physically active, keeping a healthy weight and not drinking alcohol. It is important to talk to your doctor before deciding whether to get screened for prostate cancer. He can tell you how often you should have screenings based on your age and other factors.
Several clinical trials are studying ways to prevent prostate cancer or slow its progression. The goal of these clinical trials is to reduce the number of men who need treatment. Some of these strategies are removing or blocking androgens, a hormone that stimulates prostate cancer growth. Others involve boosting the immune system to help fight the cancer. For example, scientists are testing an experimental vaccine that prompts the body’s immune cells to attack cancerous prostate tissue. Another approach is to use substances that mimic the effects of testosterone. They can be given in a pill or injected.
The cells in the prostate develop changes (mutations) that make them grow and divide faster than normal. This means that abnormal cells build up until they crowd out healthy ones, forming a lump called a tumor. The cancer cells can also break away and spread (metastasize) to other parts of the body.
Prostate cancer is most common in men over 50. It usually starts in gland cells that line the prostate and the seminal vesicles. The prostate is a walnut-sized gland that lies beneath the bladder and in front of the rectum. It produces fluid that makes up part of semen.
Different people have different symptoms. They include a frequent or urgent need to pee, pain or burning when you pee, and trouble or blood in the urine. The cancer can also affect the urethra or bladder, causing problems with urinating or sexual function. The symptoms may also be caused by health problems or conditions that don’t cause cancer, such as enlarged prostate (benign prostatic hyperplasia) and bladder infections.
Your doctor will ask you about your symptoms and how often they occur. He or she will also check your height and weight and take a medical history. Your doctor will also do a physical exam and use a tool to feel your prostate from below. He or she will also examine the area around your hips and groin.
A PSA test measures the amount of PSA, a protein made by the prostate, in your blood. A PSA level above 10 is high and may indicate cancer. PSA levels are higher in men with advanced prostate cancer than in those with early stage disease.
Other tests can help diagnose the type of prostate cancer you have and how far it has spread. Your doctor will probably order an MRI or other types of imaging tests to find out if your cancer is in the early stages or has spread outside the prostate.
If your cancer has not spread at the time of diagnosis, it may be cured by surgery or other treatments. If your cancer has spread, the treatment will depend on where it has gone and what kind of cancer it is.
Most men don’t have any symptoms in the early stages of prostate cancer. But some do, especially if the tumor gets bigger and puts pressure on the bladder or tube that carries urine out of the penis (urethra).
Your treatment depends on whether the cancer is in your whole prostate, how aggressive it is, and if it has spread. Your healthcare team will talk with you about your treatment options.
Most men don’t have pain from prostate cancer. But when they do, it may be mild or severe. It may be in one spot or all over the body. It might be achy or sharp, or it may feel like a burning sensation.
The pain may be from a bacterial infection or from the tumor itself. Bacterial prostatitis is a sudden infection that comes on fast and can be very painful. It may also cause blood in the urine or semen. It can also lead to weak or interrupted erections.
Other kinds of pain can happen when the cancer grows and presses on nerves. This is called neuropathic pain. It can make you feel a shooting, stabbing, or burning feeling in your back, hips, and pelvis. It can also be achy, tight, or heavy. You might also have referred pain, which happens when a tumor presses on a nerve in another area of the body.
The first step to diagnosing a possible prostate problem is a doctor’s exam. This includes a digital rectal examination (DRE). With a gloved finger, your healthcare provider feels the prostate from inside the rectum.
Cancer treatment can cause bone pain and make you feel weak. Drugs called bisphosphonates can help strengthen your bones and prevent pain. They can also be used to treat pain if prostate cancer has spread to your bones. If your cancer has spread to other parts of the body, you may have different symptoms.
For example, if your cancer is near the urethra, it can cause problems with urination or erectile function. These are often caused by a non-cancerous condition called benign prostatic hyperplasia, and they do not always mean you have prostate cancer.
Sometimes the cancer can grow to be so big that it presses on the bladder or urethra. This can lead to a feeling of weakness, as well as other problems such as a slow or weak urine flow, painful urination or erectile dysfunction. This is called metastatic prostate cancer. It is less common than prostate cancer that does not spread. Other possible symptoms are bowel problems (although these are more likely to be caused by radiotherapy or other treatments than by the cancer itself) and fatigue.
Men who notice blood in semen should see their doctor, even if the symptoms go away on their own. The doctor will take a history of the symptoms, how long they’ve been around and how often they occur. They’ll also do a physical exam of the genital area. This includes feeling the prostate to check for any lumps or tenderness. The doctor may also do a PSA test, which measures the level of prostate-specific antigen (PSA), which can be a sign of prostate cancer.
If the doctor can’t find a cause for the bleeding, the patient will need further urological tests, such as a urine analysis, a sexually transmitted disease (STD) test and a transrectal ultrasound. Antibiotics may be prescribed if the symptom is caused by an infection.
Some cancers can spread to the urethra and bladder, leading to problems with urinating or having an erection. Other conditions, such as a blocked urethra from the natural aging process or benign prostatic hyperplasia, can also lead to blood in semen. Cancer that has metastasized, or spread to other parts of the body, can also cause these symptoms.
Many men with prostate cancer do not have any symptoms at first, particularly in the early stages. This is because the tumour can grow without affecting nearby tissues, and it may not cause any problems until it becomes too large to fit into the tube that carries urine from the bladder out of the penis (urethra).
Prostate cancer cells can also spread to other parts of the body (metastasize), especially the bones. This can cause back pain and bone fractures, but these are rare.
If the cancer spreads to the bones, it may also press on nerves in the area. This can cause pain that feels like shooting or burning, or that makes an area feel numb.
In some cases, the cancer can grow so large that it pushes on the tube that carries urine from the bladder to the penis (urethra). This can cause a loss of appetite and weight loss. If you are losing appetite, try eating small meals more often or using dietary supplements to increase your protein intake. If you are feeling sick, there are anti-sickness medicines that your doctor can prescribe.
A low appetite and unexplained weight loss are common symptoms associated with prostate cancer. They can also be a sign of other health problems, so it’s important to talk to your doctor if you are experiencing these signs.
If you have trouble getting enough protein in your diet, ask your doctor to recommend a healthy source of protein such as beans, pulses, eggs or fish. It’s important to get plenty of fluids too – 1.5 to 2 litres (3 to 4 pints) a day, mainly water and fruit juices. You may also find that having a regular bowel movement, such as after each meal, can help prevent constipation.
It is usually safe for people with prostate cancer and those receiving treatment to be physically active, but it’s best to speak to your GP or nurse before you begin an exercise programme. You should avoid falling if you have advanced cancer or are on hormone therapy because this can make bones more likely to break. Your doctor may offer you drugs called bisphosphonates to help protect your bones and relieve pain caused by bone damage.
Many men with a localized prostate cancer have several treatment options. They can choose to be watched without treatment (watchful waiting or active surveillance) or treat their disease with drugs, radiation or surgery.
These treatments vary in cost. Men who have health insurance should consider their deductibles and copays for these medications.
Radiation therapy uses x-rays to kill cancer cells and shrink tumors. It is one of the most common treatments for prostate cancer, and it can be used to treat early-stage and advanced disease.
There are several types of radiation therapy for prostate cancer. External beam radiation is the most common type. It is given on an outpatient basis, and you may receive treatment five days a week for several weeks.
The most recent type of radiation therapy for prostate cancer is called hypofractionated radiation therapy (HRT). In this type of radiation therapy, you are treated with fewer treatments over a longer period of time. It was shown to be noninferior to conventional radiation in a multicenter, randomized, phase III study by Shipley et al.
Your doctor will discuss the benefits and side effects of different treatments with you before deciding which to use. The decision will be based on your stage of disease, PSA level, and Gleason score. Other factors may include your age, general health conditions, and interests.
You may choose to use watchful waiting or active surveillance to manage your disease. With this approach, your doctor will closely monitor your condition without giving you any treatment until there are changes in your test results. Watchful waiting is especially helpful for older men, and it can be used for men whose cancer was found during screening.
If your prostate cancer spreads to the bones, a medicine called denosumab can help prevent bone metastases. This medicine is injected into a vein and travels through the blood to the bones. It then collects in areas of the bone where cancer cells are growing and kills them.
Another way to treat metastatic prostate cancer is with a type of radiation called alpha emitter radiation therapy. This treatment uses a radioactive substance injected into a vein. The substance travels through the blood and collects in areas of the bone with cancer. Then, it releases radiation that kills the cancer cells in the area of the bone where they are growing.
Other options for treating advanced prostate cancer are cryosurgery and high-intensity focused ultrasound (HIFU). These treatments use a machine to direct heat energy to your prostate to destroy cancer cells and reduce symptoms without surgery.
When a doctor determines that you have prostate cancer, the next step is to find out how far it has spread (stage). This is done with a test called the Gleason score. The score describes how much the cancer cells look different from normal cells and how likely they are to grow and spread. The stage of the prostate cancer can help your doctor decide which treatments are best for you.
Staging can also help you understand how aggressive your cancer is and whether it might recur after treatment. A doctor uses a combination of tests and procedures to find out the stage of your cancer. The tests and procedures include a blood test and an ultrasound exam of the prostate. A magnetic resonance imaging (MRI) scan can also be done to take pictures of your prostate and nearby tissue. This is done with a machine that has a large magnet, radio waves and a computer. A probe that gives off a small amount of radiation is placed inside your rectum to make clearer pictures. MRI can also be used during a biopsy procedure to guide the needle into the tumor.
Chemotherapy may be used alone or in combination with ADT to treat advanced prostate cancer that has spread outside the prostate and into other parts of the body, such as the bones. The chemotherapy drug docetaxel is given into a vein (intravenously, or IV). It has been shown that adding this drug to ADT improves outcomes compared with ADT alone. Abiraterone or darolutamide are other newer drugs that are being studied in combination with ADT.
Side effects of chemotherapy may include nausea, vomiting and fatigue. A doctor can prescribe medications to prevent or manage these side effects. Medicines can help with constipation or diarrhea, and numbing gel can be used to soothe mouth sores caused by the chemotherapy medications.
Some doctors may recommend watchful waiting or active surveillance for men who have early prostate cancer that is confined to the prostate and not causing any symptoms. During this time, the doctor closely watches the cancer to see if it grows or causes symptoms, and then provides treatment.
Cancers that use hormones to grow may be treated with drugs that block or remove these substances. These drugs can be given by mouth or injection. They can also be used in combination with surgery, radiation therapy or other treatments. The types of drugs used depend on the type of cancer, how much it has grown and whether it has spread. Hormone therapy can slow or stop cancer growth and lower the chance that the cancer will return (recur).
The first step in diagnosing prostate cancer is a biopsy, which involves taking a small sample of cells from the prostate. A lab then examines the cells to see if they are cancerous. If they are, the doctor assigns a score that indicates how aggressive the cancer is. The scores range from 2 (non-aggressive) to 10 (very aggressive). The higher the score, the more likely it is that the cancer will spread quickly.
A second test can determine how much hormones are being made and whether they are being used by the cancer cells. This is called the Gleason score. The test results can help doctors decide the best treatment for you.
Doctors may suggest removing the prostate completely, or removing the part of the prostate that contains the tumor. They may also recommend removing the lymph nodes in the area where the cancer has spread. These operations are called robotic prostatectomy, robot-assisted laparoscopy or laparoscopic radical prostatectomy.
Another way to treat prostate cancer is to use a technique called cryosurgery, which kills cancer cells by freezing them. Cryosurgery is usually done along with other therapies, such as radiation or surgery.
The final stage of prostate cancer is when the cancer has spread to other parts of the body. Several tests can show if the cancer has spread, including a pelvic CT scan and a bone scan. A radioactive substance called 18F-fluciclovine may also be used to look for cancer cells in the bones. This drug is sometimes combined with other cancer drugs to increase their effectiveness.
If your prostate cancer hasn’t spread, your doctor may recommend surgery to remove the diseased tissue. This is called radical prostatectomy. During the operation, your surgeon might use medicine to prevent pain and put you into a sleep-like state (general anesthesia). Before the surgery, doctors do tests to check for signs of prostate cancer, such as a urine test and a blood test to measure your red blood cell count. They also do a procedure called cystoscopy, in which they insert a tool into your urethra and bladder to look for the size of the prostate and other problems.
After the surgery, you might need radiation therapy to kill any cancer cells that remain. It can be given from outside your body (external beam radiation therapy) or by inserting radioactive “seeds” into or near the prostate gland (brachytherapy). You might receive radiation therapy for five days a week for several weeks.
Radiation therapy can cause side effects, including a decrease in erectile function and urinary incontinence. However, these symptoms often go away on their own after treatment ends. Urinary incontinence usually goes away within several months, and erectile function returns to normal for most men.
Your doctor might suggest hormone therapy after surgery to slow the growth of any cancer that remains. This could be in the form of pills or injections (decadron). It’s also possible to use new types of hormonal therapy, such as abiraterone, apalutamide, and darolutamide. They work by stopping the body from producing testosterone or blocking its effect on cancer cells.
Your doctor might also suggest a biopsy to find out whether your prostate cancer is likely to spread. A biopsy is when your doctor removes a small amount of tissue from the prostate to examine for cancer cells under a microscope. Your doctor might also use a procedure called transrectal magnetic resonance imaging (MRI) to help with the diagnosis of prostate cancer that has spread to other parts of the body. During this procedure, your doctor uses a large magnet and radio waves to make detailed pictures of your prostate and nearby tissue.
