Prostate cancer is one of the most common cancers affecting men, particularly in older age. While early stages often show no signs, advanced stages can lead to urinary issues, sexual dysfunction, and even life-threatening complications if left untreated. Fortunately, advances in screening and treatment have significantly improved survival rates and quality of life for patients.

This comprehensive guide covers everything you need to know about prostate cancer, from types and symptoms to diagnosis, treatment, prevention, and living with the condition.

Types

Prostate cancer is categorized based on the type of cells where it originates. Determining the specific type helps doctors tailor the most effective treatment plan.

Adenocarcinoma
The most common form—over 90%—starts in the glandular cells of the prostate. There are two types:

  • Acinar adenocarcinoma: Begins in the prostate’s lining and tends to grow slowly.
  • Ductal adenocarcinoma: Arises in the ducts and is typically more aggressive.

Transitional Cell Carcinoma
This rare form begins in the cells lining the urethra and may spread into the prostate. It accounts for around 1–5% of prostate cancers.

Small Cell Carcinoma
A highly aggressive and uncommon type that begins in neuroendocrine cells. It accounts for less than 2% of cases and spreads quickly.

Squamous Cell Carcinoma
The rarest form, developing in flat cells lining the prostate. It grows rapidly and makes up less than 1% of all cases.

Symptoms

Early prostate cancer rarely causes symptoms. As the tumor grows, it can affect the urinary tract due to the prostate’s location just below the bladder.

Common symptoms include:

  • Difficulty starting or stopping urination
  • Weak or interrupted urine stream
  • Blood in urine or semen
  • Pain during urination or ejaculation
  • Erectile dysfunction
  • Frequent or urgent urination, especially at night

If cancer spreads (metastasizes), additional symptoms may develop:

  • Bone pain (back, hips, chest)
  • Leg swelling
  • Numbness or weakness (especially in the legs)
  • Unexplained weight loss
  • Fatigue or shortness of breath if cancer spreads to the lungs

Causes

Prostate cancer begins when cells in the prostate undergo changes (mutations) and grow uncontrollably.

Acquired gene mutations—not inherited—are the most common cause. The exact trigger for these changes remains unknown.

Inherited gene mutations account for 5–10% of cases. These include mutations in:

  • BRCA1 and BRCA2
  • HOXB13
  • MSH2, MSH6, MLH1, PMS2 (related to Lynch syndrome)

Risk Factors

Several factors may increase a man's risk of developing prostate cancer:

  • Age: Risk increases significantly after age 50.
  • Family history: Having a father or brother with prostate cancer doubles your risk.
  • Race: Black men are more likely to develop and die from prostate cancer.
  • Geography: More common in North America, Europe, and Australia.
  • Diet: High intake of red meat and high-fat dairy may increase risk.
  • Obesity: Linked to aggressive forms of the disease.

Diagnosis

Early detection through routine screening can save lives. Common tests include:

Digital Rectal Exam (DRE)
A physical exam where a doctor feels the prostate via the rectum to check for abnormalities.

PSA Blood Test
Measures levels of prostate-specific antigen. High PSA may indicate cancer, but also other conditions like prostatitis or BPH.

If screenings raise concern, further tests are done:

  • MRI fusion biopsy: Combines MRI and ultrasound to guide biopsy.
  • Multiparametric MRI (mp-MRI): Provides detailed imaging for more accurate detection.
  • TRUS (transrectal ultrasound): Uses sound waves to visualize the prostate.
  • Prostate biopsy: Confirms the diagnosis by examining tissue samples.

Stages

Staging helps determine how far the cancer has spread and guides treatment decisions.

  • Stage 1: Cancer is small and confined to one part of the prostate.
  • Stage 2: Cancer is still localized but may be larger or present in both sides.
  • Stage 3: Cancer has spread outside the prostate to nearby tissues or seminal vesicles.
  • Stage 4: Advanced stage where cancer has spread to lymph nodes, bones, or other organs.

Staging may be clinical (based on tests) or pathologic (based on tissue after surgery).

Treatments

Prostate cancer treatments depend on the stage, type, health status, and patient preference.

Active Surveillance

For slow-growing, low-risk cancers. Involves regular monitoring without immediate treatment.

Surgery

Radical prostatectomy removes the prostate and possibly surrounding tissues. Minimally invasive (laparoscopic or robotic) surgery often reduces recovery time.

Radiation Therapy

Includes:

  • External beam radiation: Targets the prostate from outside.
  • Brachytherapy: Radioactive seeds implanted into the gland.

Hormone Therapy

Reduces or blocks testosterone, which fuels cancer growth. Methods include:

  • Medications (oral or injectable)
  • Rarely, surgical removal of testicles (orchiectomy)

Chemotherapy

Used in advanced or hormone-resistant cancer. It doesn’t cure but helps manage disease and improve life expectancy.

Immunotherapy

Sipuleucel-T (Provenge) is FDA-approved for advanced, treatment-resistant prostate cancer.

Targeted Therapy

PARP inhibitors (e.g., olaparib) treat cancers with BRCA mutations by blocking the cells’ DNA repair process.

Prevention

While there's no guaranteed way to prevent prostate cancer, lifestyle changes may reduce risk:

  • Healthy Diet: Focus on fruits, vegetables, whole grains; reduce red and processed meats.
  • Exercise: Helps maintain a healthy immune system and reduces inflammation.
  • Weight Control: Obesity is linked to aggressive prostate cancer.
  • Screening: Talk with your doctor about when to begin PSA testing, especially if at high risk.

Related Conditions

Prostate cancer and its treatments can increase the risk of:

  • Diabetes: Hormone therapy may impair glucose metabolism.
  • Heart Disease: Cancer survivors are more prone to cardiovascular events.
  • Osteoporosis: Hormone therapy may lead to bone thinning.
  • Secondary Cancers: Including bladder, colon, skin, and thyroid cancer.

Living With Prostate Cancer

Receiving a diagnosis can be life-changing, but many people with prostate cancer live full lives. Key tips for navigating life with the condition include:

  • Stay informed about your treatment options.
  • Maintain open communication with your healthcare team.
  • Consider counseling or support groups to address emotional impacts.
  • Address sexual health concerns with professionals.
  • Prioritize sleep, exercise, and nutrition for overall well-being.

Thanks to early detection and advanced therapies, the five-year survival rate for localized prostate cancer is nearly 100%. Even with advanced stages, new treatments continue to improve outcomes.