Prostate cancer occurs when cells in the prostate grow out of control. The prostate is a gland in men that helps produce fluid that goes into semen. The prostate is located in front of the rectum and just below the bladder.
Prostate biopsy is usually performed to diagnose or to rule out prostate cancer. A typical biopsy collects about 12 “core” samples from different parts of the prostate to check for abnormal cells. A prostate biopsy is indicated when:
- Prostate-specific antigen (PSA) levels are abnormal
- Abnormalities are found on a digital rectal examination such as the presence of nodules, hardening of soft tissue, or asymmetry
About 75% of prostate biopsies are negative for cancer. However, prostate biopsies can frequently present with false-negative results, that is, the biopsy does not detect cancer, but cancer is present. In some cases, repeat biopsies may be indicated.
What Are Symptoms of Prostate Cancer?
Prostate cancer often causes no symptoms in the early stages. As the cancer progresses, symptoms may include:
- Problems with urination
- Slow or weak urinary stream
- Urinary urgency, especially at night
- Blood in urine or semen
- Difficulty getting an erection (erectile dysfunction, or ED)
- Weakness or numbness in the legs or feet
- Loss of bladder or bowel control if the cancer presses on the spinal cord
- Pain in the hips, back (spine), chest (ribs), or other areas from cancer that spreads to bones
What Causes Prostate Cancer?
The cause of prostate cancer is unknown but it may be due to inherited or acquired genetic changes.
Risk factors for developing prostate cancer include:
- Age: increased risk in men after age 50
- Family history
- Genetic changes
- Geography: most common in North America, the Caribbean islands, northwestern Europe, and Australia
- Race/ethnicity: more common in African-American men and Caribbean men of African ancestry than in men of other races
- Other factors that might increase the risk of developing prostate cancer — though these links are less clear and have not been conclusively proven — include:
How Is Prostate Cancer Diagnosed?
Prostate cancer is diagnosed with a patient history and physical examination, which includes a digital rectal examination in which a doctor inserts a gloved finger into the rectum to examine the prostate.
Other tests to diagnose prostate cancer include:
What Is the Treatment for Prostate Cancer?
Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if the cancer has spread (metastasized) to other parts of the body, and the age and overall health of the patient. Treatment may include one or more of the following:
- Watchful waiting (active surveillance)
- Surgery: removal of the entire prostate and some nearby tissue
- Radiation therapy
- Brachytherapy (internal radiation)
- External beam radiation
- Cryotherapy (also called cryosurgery or cryoablation), which uses very cold temperatures to freeze and kill prostate cancer cells and most of the prostate
- Hormone therapy
- Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made in the testicles
- Orchiectomy (surgical castration)
- Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles (also called medical castration)
- LHRH antagonists
- Cancer vaccine (doesn’t stop prostate cancer from growing, but may help men live several months longer)
- Immune checkpoint inhibitors
- PD-1 inhibitor
- Targeted therapy
- PARP (poly(ADP)-ribose polymerase) inhibitors
- Treatments for prostate cancer spread to bones
- Pain medicines
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