Prostate cancer is the most common major cancer in men. It’s highly treatable, especially if found early. Important things to know:

• The vast majority of patients can expect to live at least five years after diagnosis (excluding the risk of dying from another cause).
• Prostate cancer usually grows slowly. 
• Routine screening tests can catch it early.
• Most patients are older than 40 when diagnosed.
• Patients may show no symptoms, or symptoms may be similar to those of less-serious conditions.

What is prostate cancer?

Prostate cancer starts in the prostate gland, a walnut-size organ under the bladder that makes part of the fluid in semen. Prostate cancer occurs when cells in the prostate gland grow out of control. 

If not found early, prostate cancer can spread to the seminal vesicles, which also help produce semen, or  other parts of the body.

Who gets prostate cancer?

Survival rates

A key concept in understanding survival is five-year relative survival rate. This is the percentage of people who are alive five years after they were first diagnosed, compared to the general population. (It doesn’t count death from other causes.)

The five-year survival rate for prostate cancer is 97.5%. The rate rises to 100% for cases that are caught in the early stages.

It's important to remember that these are averages and can’t predict the outcome for a single patient.  Even advanced or incurable cancers can be managed with newer medicines.

Symptoms of prostate cancer

Early on, prostate cancer often causes no symptoms. If there are symptoms, they may be related to a health issue other than prostate cancer. Talk with your doctor if you have any of the following symptoms.

As prostate conditions worsen, you may have:

• Difficulty or pain urinating 
• Increased need to urinate, particularly at night
• Blood in urine or semen
• Trouble getting an erection 
• Pain with ejaculation 
• Loss of bladder or bowel control 
• Pain in the hips, spine or ribs
• Weakness in the legs or feet

Prostate cancer screening

Prostate cancer often grows slowly, so your doctor may suggest screening tests at certain ages:

• 50 for men of average risk
• 45 for men at high risk, including black men and men who have a close relative diagnosed with prostate cancer before age 65
• 40 for men who have more than one close relative with a prostate cancer diagnosis before age 65

PSA test: This blood test detects the amount of prostate-specific antigen, a substance made by the prostate gland. As the level of PSA goes up, so does the risk of prostate cancer. At OHSU,  we recommend PSA testing and offer additional blood tests to detect prostate cancer. 

Digital rectal exam: In this test, also called DRE, your doctor will briefly insert a gloved finger into your rectum to feel for lumps that could be early signs of a tumor.

Types of prostate cancer

Adenocarcinoma: Most prostate cancers develop from cells in the prostate gland. These slow-growing cancers are known as adenocarcinomas. They make up 99% of prostate cancers.

Rare forms include:

• Sarcoma, an extremely rare cancer of the connective tissues in the prostate.
• Small cell carcinoma, an aggressive type that may be hard to detect because it usually doesn’t increase PSA levels.
• Prostatic transitional cell carcinoma, which occurs in the urethra or in a duct that moves fluid from the prostate to the urethra. Often, these tumors are a secondary disease to bladder cancer. 
• Neuroendocrine tumors that are not small cell carcinomas. These are rare cancers of the hormone-producing cells in the prostate. 

If the cancer spreads (metastasizes) to other parts of the body, it’s called metastatic prostate cancer.

Precancerous conditions

There is evidence that prostate cancer may begin as a precancerous state. If tests show either of these two conditions, your doctor will discuss it with you:

• Prostatic intraepithelial neoplasia, or PIN, is when doctors identify abnormal cells that are not growing into the prostate the way cancer would. Low-grade PIN cells appear almost normal. High-grade PIN cells indicate a 20% chance of prostate cancer.
• Proliferative inflammatory atrophy, or PIA, occurs when prostate cells appear smaller than normal or inflamed. PIA may become high-grade PIN or develop into prostate cancer. 

Prostate cancer stages

Your doctors will assign a stage to your prostate cancer. The stage indicates how much your cancer has grown and how far it has spread. This helps your care team decide on treatment options. To identify the stage, your team combines information such as:

PSA levels: PSA is measured in nanograms per milliliter. 

• A level below 10 is low. 
• A level of 10 to 20 is intermediate
• A level over 20 is high.

Gleason score: Doctors look at tissue samples under a microscope. They use a measure called the Gleason score to rate how normal or abnormal the cell patterns look. The score ranges from 2 to 10. The more abnormal the patterns, the higher the score and the more likely the cancer is aggressive.

Grade: Doctors use the Gleason score to place the cancer into a grade group. The ISUP (International Society of Urological Pathologists) Grade Group system ranges from 1 to 5.

• Grade Group 1: Low risk
• Grade Group 2: Intermediate favorable risk
• Grade Group 3: Intermediate unfavorable risk
• Grade Groups 4 and 5: High risk

This is the staging for an adenocarcinoma prostate cancer:

Learn more

• Understanding Prostate Changes: A Health Guide for Men, National Cancer Institute
• Prostate Cancer, American Cancer Society
• About Prostate Cancer, Prostate Cancer Foundation
• What is Prostate Cancer? Urology Care Foundation