Understanding Prostate Cancer

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

  • More than 98% of patients survive at least five years after diagnosis.
  • 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?

    Medical illustration of the prostate and nearby organs, by Alan Hoofring
    The Prostate and Nearby Organs (medical illustration by Alan Hoofring)

    An estimated 174,650 cases of prostate cancer are expected to be diagnosed in the U.S. in 2019. On average, one in nine men will be diagnosed in his lifetime. Over the last decade, rates for new cases have fallen nearly 6%  a year.

    Anyone with a prostate, regardless of gender identity, has some risk of prostate cancer. Other main risk factors include:

    • Age: Prostate cancer is rare before age 40. The prostate tends to get bigger as men age, and most diagnoses occur in men who are 65 or older.
    • Race/ethnicity: Black men have a higher risk for aggressive prostate cancer at a younger age. 
    • Family history: Men who have one or more close relatives (parent, sibling or child) with prostate cancer are at higher risk. 
    • Genetics: People with changes in two genes, known as BRCA1 and BRCA2, are more likely to have prostate cancer and more likely to have a more aggressive form of the disease. OHSU offers expert genetic counseling and testing to help patients learn about and manage their risk.

    Secondary risk factors may include:

    • Diet
    • Obesity
    • Exposure to chemicals used for firefighting or defoliating
    • Having a vasectomy
    • Being diagnosed with an enlarged prostate
    • Having a sexually transmitted disease

    Survival rates

    Prostate Cancer survival rate graphic showing that 98.0% survive at least 5 years

    Overall, 98% of patients live at least five years after diagnosis. Even advanced or incurable cancers can be managed with newer medicines.

    Still, these are averages and can’t predict the outcome for a single patient. Prostate cancer is also the third-leading cause of cancer-related deaths in men. Most prostate cancer deaths occur in men who are 75 or older.

    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

    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 staging

    Staging determines the extent of your cancer and whether it's aggressive. 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:
     

    The cancer is only in the prostate gland. It may be big enough for your doctor to feel, and it may be on one or both sides of the prostate. The PSA level is below 10, and the grade is 1. 

    The cancer is only in the prostate gland. 

    Stage IIA: The grade is 1. In addition, one of the following:

    • The PSA level is at least 10 but less than 20. If the cancer is big enough to be felt, it is on only one side of the prostate.
    • The PSA level is below 20. The cancer is big enough to be felt, and it may be on one or both sides of the prostate. 

    Stage IIB: The grade is 2. The cancer may be big enough to feel, and it may be on one or both sides of the prostate. The PSA level is less than 20.

    Stage IIC: The grade is 3 or 4. The cancer may be big enough to feel, and it may be on one or both sides of the prostate. The PSA level is less than 20.
     

    Stage IIIA: The grade is 1, 2, 3 or 4. The cancer may be big enough to feel, and it may be on one or both sides of the prostate. The PSA level is 20 or higher.

    Stage IIIB: The grade is 1, 2, 3 or 4. The cancer has spread outside the prostate and may have invaded nearby tissue such as the seminal vesicles, the rectum, bladder or pelvic wall. The PSA level can be any.

    Stage IIIC: The grade is 5. The cancer and PSA are at any level.

    Stage IVA: The cancer has spread to nearby lymph nodes.

    Stage IVB: The cancer has spread to distant parts of the body.

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