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Prostate cancer is one of the most common types of cancer to affect American men. When identified early, the prognosis is often good. The longer patients wait for treatment, however, the fewer options are available, and the less effective they may be.
Regional Cancer Care Associates (RCCA) is one of the nation’s largest networks of cancer specialists. Our experienced and compassionate medical oncologists deliver cutting-edge care at more than 20 locations near you in New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area. Learn more about prostate cancer, its symptoms and stages, and the treatment options available at RCCA.
Prostate cancer affects the prostate. This walnut-sized gland surrounds the urethra and is responsible for producing the seminal fluid that nourishes and transports sperm. Prostate cancer occurs when prostate cells mutate. The mutated cells reproduce too quickly, creating a malignant tumor.
Prostate cancer is one of the most common types of cancer in men, exceeded only by skin cancer. About 333,830 new cases are diagnosed every year in the United States. About 1 in 8 men will be diagnosed with prostate cancer in their lifetime, while roughly 1 in 44 men will die of prostate cancer. The death rate has declined by almost half over the last three decades, due to both earlier detection and the development of new, effective treatment approaches.
While any man can develop prostate cancer, certain individuals are at higher risk than others. By understanding the risk factors for prostate cancer, individuals can make informed decisions about screenings.
Age is the strongest risk factor for prostate cancer. The condition is rare in men younger than 40, with incidence rates rising rapidly after age 50. Most prostate cancer cases are diagnosed after age 65, with the average age of diagnosis being 66.
Prostate cancer is more common in African American men and in Caribbean men of African lineage. Further, men in these racial/ethnic groups often develop prostate cancer at an earlier age than men of other backgrounds. Conversely, prostate cancer is less common in Asian American, Hispanic, and Latino men.
Having a father or brother with prostate cancer can increase a person’s risk of developing the disease by more than double. The risk is even higher for men with multiple affected relatives.
Some cases of prostate cancer are connected to genetic changes or mutations. Inherited mutations of the BRCA1 or BRCA2 gene increase a person’s risk of many types of cancer, including prostate cancer. Lynch syndrome, an inherited genetic condition, also increases prostate cancer risk.
The earlier prostate cancer is detected, the more successful its treatment is likely to be. This is why men should understand the signs and symptoms of prostate cancer, which include:
Prostate cancer does not always show symptoms in its early stages. New tumors are not large enough to cause noticeable changes, and many are not detected until the cancer becomes more advanced. Routine screenings are the most reliable method for identifying prostate cancer before it causes symptoms.
The first signs of prostate cancer are usually urinary changes. This is because the prostate is located beneath the bladder and wraps around the urethra. As the tumor grows, it presses against these organs and impedes their function. Patients often experience problems such as:
When prostate cancer advances into its late stages, it spreads to other parts of the body. This results in new symptoms. Signs of advanced prostate cancer include:
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate. It can cause symptoms very similar to those of prostate cancer. Because of the broad overlap in symptoms, prostate cancer and BPH are sometimes confused with each other. In general, if a man experiences new urinary changes, he should contact a physician for an evaluation. A medical assessment will determine whether the patient’s symptoms are caused by prostate cancer or BPH.
Prostate cancer is often first identified through a simple blood test that screens for prostate-specific antigen (PSA). Symptoms of prostate cancer do not usually develop until Stage III. If men speak to a physician only after symptoms appear, their cancer may already be too advanced to treat easily. This is why physicians recommend routine prostate cancer screening. Regular PSA tests can detect cancer before symptoms develop, giving oncologists and patients a head start on treatment.
According to most screening recommendations, average-risk men should begin routine PSA screenings at age 50. Men should be screened every two years if their PSA levels are less than 2.5 ng/mL, or every year if levels are more than 2.5 ng/mL. Higher-than-average-risk men should begin screenings between the ages of 40 and 45. Men at higher risk who should consider earlier screening include those who have a first-degree relative with a history of prostate cancer and men of African or Caribbean ancestry.
Prostate-specific antigen, also called PSA, is a protein produced by the prostate gland. All men have some PSA in the bloodstream. Prostate cancer tumors often produce more PSA than usual, making this protein an effective early indicator for prostate cancer.
Having a high PSA level does not always mean cancer. PSA levels rise and fall depending on age, hormones, and health. If PSA levels are extremely elevated, however, the patient may have a condition that affects PSA. Possible causes include:
After an abnormal PSA test, physicians may either repeat the test to see if the patient has a persistently elevated PSA level or refer the patient to a urologist for additional testing, such as a prostate biopsy. This test involves taking small samples of prostate tissue to study under a microscope. The test results are used to determine whether prostate cancer is present and, if so, to assess how aggressive it is.
PSA Level | What It Means | Next Steps |
< 2.5 ng/mL | Low chance of prostate cancer | Continue routine screenings every other year |
2.5-4 ng/mL | Low chance of prostate cancer | Continue routine screenings annually |
4-10 ng/mL | 25% chance of prostate cancer; BPH or inflammation more likely | Medical evaluation recommended to rule out cancer |
>10 ng/mL | 50% chance of prostate cancer | Prostate biopsy |
The Gleason Score describes how abnormal the cancer cells obtained from a prostate biopsy look under a microscope. The more mutated the cells are, the more aggressive the cancer is. Gleason scores can be classified as follows:
In addition to confirming the presence of cancer, a prostate biopsy also helps oncologists determine the cancer type. The types of prostate cancer are categorized based on where they form. Different types behave differently, so identifying the correct one is crucial to planning appropriate treatment.
Acinar adenocarcinoma forms in the glandular tissue, which is responsible for producing seminal fluid. This type spreads slowly and is the most common type of prostate cancer.
Ductal adenocarcinoma forms in the prostate ducts, or the tubes that transport seminal fluid from the prostate to the penis. It is less common but more aggressive than acinar adenocarcinoma.
Neuroendocrine carcinoma forms in neuroendocrine cells that produce hormones. It can develop independently (de novo), but it is more likely to start as an adenocarcinoma that transforms after unsuccessful hormone therapy treatment. Neuroendocrine carcinoma is rare but highly aggressive.
Sarcoma forms in the connective tissue that is found in and around the prostate. This type of prostate cancer is extremely rare but highly aggressive. It also does not cause a PSA spike, making it difficult to detect before the cancer metastasizes (spreads).
Small cell carcinoma forms in the cells that line the prostate. It is rare and highly aggressive and, like other non-adenocarcinomas, does not cause a PSA spike.
Transitional cell carcinoma starts in the transitional cells, which line the ureter. The ureter transports urine from the kidneys into the bladder. While transitional cell carcinoma is technically a type of urethral cancer, it frequently spreads into the prostate.
Once prostate cancer is diagnosed, oncologists try to determine how large the tumor is and whether it has spread. This process is called staging. Oncologists consider the following factors when determining a cancer’s stage:
There are four stages of prostate cancer:
Stage I is the earliest stage of prostate cancer. At this stage, the tumor is found only in the prostate gland and may be too small to feel with a digital rectal exam (DRE), which entails a physician gently inserting a gloved, lubricated finger into the rectum to feel for an enlarged prostate gland. Stage I prostate cancer has the following characteristics:
Stage I prostate cancer is typically slow to spread. If the cancer is detected in Stage I, patients have a five-year survival rate of almost 100%.
Stage II prostate cancer is still confined to the prostate gland, but the tumor is larger than in Stage I and may begin to cause symptoms. It is also more likely to spread than Stage I cancer. It has the following characteristics:
While the five-year survival rate for Stage II prostate cancer is still nearly 100%, cancer is more likely to come back after treatment. For this reason, oncologists are more likely to suggest aggressive treatment.
Stage III prostate cancer has grown through the walls of the prostate gland and may have also spread to nearby tissues and lymph nodes. Most noticeable symptoms appear at this stage. The cancer has these characteristics:
The five-year survival rate for Stage III prostate cancer is still nearly 100%, but aggressive treatment is required. The cancer also has a high chance of recurring after treatment.
Stage IV, or metastatic, prostate cancer is the most advanced form of prostate cancer. At this stage, the cancer has spread through the blood or lymph vessels to other organs such as the bladder, rectum, bones, lungs, or liver. Stage IV prostate cancer cannot be eliminated. Instead, the goals of treatment are to control the disease’s spread and extend the patient’s survival while preserving a high quality of life.
|
Stage |
Tumor Location |
Grade Group |
5-Year Survival Rate |
|
I |
Only in the prostate |
<6 |
100% |
|
II |
Only in the prostate |
<7 |
Nearly 100% |
|
III |
Through the prostate wall; sometimes in nearby lymph nodes |
6-8, rarely 9 or 10 |
Nearly 100% |
|
IV |
Distant parts of the body |
Any |
37% |
When choosing the best treatment for prostate cancer, urologists and oncologists weigh several factors. They consider the cancer’s type, its stage, the patient’s overall health, and the patient’s own values and preferences. Options may include:
Active surveillance is also called watchful waiting. In Stage I prostate cancer, the tumor is growing slowly and is not an immediate danger. Rather than starting treatment right away, oncologists may simply monitor the cancer. Treatment can begin if and when the cancer worsens. Active surveillance is most often recommended for low-risk or elderly patients.
During active surveillance, oncologists monitor the prostate cancer tumor with regular tests. Patients typically undergo a PSA test every few months, a digital rectal examination (DRE) annually, and a prostate MRI every one to two years.
Surgery is the first treatment recommended for most stages of prostate cancer. The standard procedure is a radical prostatectomy, which removes the entire prostate and surrounding tissue. Surgery alone can often eradicate tumors that have not spread.
Early recovery from a radical prostatectomy takes between four and six weeks. Regaining full urinary continence and sexual function can take as long as two years. Patients must initially use a catheter, then later perform exercises to rebuild their pelvic muscles. Some patients experience long-term bladder control issues or erectile dysfunction after prostate cancer surgery.
Radiation therapy uses high-energy particles to kill cancer cells. It may be used instead of surgery, or it may be used to shrink a tumor before surgery or eliminate tumor cells that remain after surgery.
External beam radiation therapy (EBRT) involves targeting the tumor with a highly focused beam of energy. Stereotactic body radiotherapy (SBRT) is an advanced form of EBRT that targets the tumor from multiple angles simultaneously, allowing for fewer treatment sessions.
Brachytherapy, or internal radiation, involves implanting a tiny seed of radioactive material directly into the tumor. This method can minimize radiation exposure to healthy tissue when treating small tumors.
Hormone therapy is a standard treatment for controlling late-stage prostate cancer or preventing its recurrence after surgery. Many types of prostate cancer require androgens, or male hormones, to grow. Androgen deprivation therapy (ADT) works by lowering androgen levels or inhibiting their effectiveness. This approach effectively deprives the cancer of what it needs to spread. Meanwhile, androgen receptor pathway inhibitor (ARPi) therapy, the other main type of hormone therapy employed in treating prostate cancer, interferes with the biochemical pathways and processes that enable androgen to fuel prostate cancer. It is typically used in later stages of prostate cancer.
Chemotherapy is used to control late-stage prostate cancer, often following surgery. This method kills cancer with drugs that are highly toxic to fast-dividing cells. Because cancer cells divide rapidly, they are extremely susceptible to the drugs. Chemotherapy is typically administered in waves with periods of rest so the patient may recover.
Targeted therapy is a recent development in prostate cancer treatment that can greatly improve outcomes for patients with late-stage prostate cancer. It uses drugs that target cells with certain characteristics, killing cancer cells without harming healthy tissue.
Prostate-specific membrane antigen (PSMA) is a protein that is found on the surface of most prostate cancer cells. PSMA-targeted therapy attaches a radioactive particle to a molecule that seeks out and binds to PSMA, thus delivering radiation directly to the cancer cells.
Radium RA-223 dichloride is a radioactive therapy used in the treatment of metastatic prostate cancer that is not responding to attempts to medically lower androgen levels. It binds to bone metastases to damage the DNA of cancerous cells, preventing their spread. The treatment is delivered by six infusions spaced one month apart.
The PARP enzyme is used by cells to repair damaged DNA. PARP inhibitors block this enzyme. Unable to repair themselves, cells with DNA defects will eventually accumulate damage and die. PARP inhibitors are specifically used for metastatic cancers with a BRCA mutation.
Immunotherapy empowers the patient’s own immune system to identify and destroy cancer cells.
Sipuleucel-T is the first therapeutic vaccine approved for prostate cancer. The treatment works by harvesting the patient’s own immune cells, then modifying them in a laboratory to attack cancer. The cells are returned to the patient’s body to combat his cancer.
Cancer cells produce proteins that disguise the cells as normal cells. Instead of recognizing the cancer as a threat, the immune system ignores it. Checkpoint inhibitors block these proteins so that the immune system recognizes and attacks the cancer cells.
Treatment | Best Used For | How It Is Given | Potential Side Effects | |
Active Surveillance | Stage I cancer | N/A | N/A | |
Surgery | Most cancers | Surgery | Pain Swelling Itching Urinary incontinence Erectile dysfunction Infection | |
Radiation Therapy | EBRT | Early- to middle-stage cancer | External beam | Fatigue Skin irritation Hair loss |
Brachytherapy | Early- to middle-stage cancer | Implanted seed | Fatigue Skin irritation Hair loss | |
Hormone Therapy | Androgen deprivation therapy (ADT) | Middle-stage to metastatic cancer | Oral or injection | Hot flashes Erectile dysfunction Decreased libido Fatigue Muscle loss Hair loss Genital shrinkage Weight gain Mood swings |
Androgen receptor pathway inhibitors | Middle-stage to metastatic cancer | Oral | Fatigue Hypertension Rash Diarrhea Joint pain Low blood cell counts | |
Chemotherapy | Metastatic cancer | Intravenous infusion | Fatigue Hair loss Nausea Constipation Diarrhea Mouth sores Appetite changes Weakened immune system | |
Targeted Therapy | PSMA Therapies | Metastatic cancer that resists other treatments | Intravenous infusion | Fatigue Dry mouth Nausea Appetite loss Joint pain Constipation |
Radium RA-223 dichloride | Metastatic cancer that resists other treatments | Intravenous infusion | Fatigue Nausea and vomiting Diarrhea | |
PARP Inhibitors | Metastatic cancer with BRCA mutations | Oral | Fatigue Nausea Diarrhea Anemia Leukopenia | |
Immunotherapy | Sipuleucel-T | Metastatic cancer | Intravenous infusion | Chills Fever Fatigue Joint pain Nausea Headaches |
Checkpoint Inhibitors | Metastatic cancer | Oral | Fatigue Joint pain Skin rashes Nausea Coughing | |
Prostate cancer is a serious condition, and treatment can be demanding and stressful. RCCA relieves some of the difficulty by offering high-quality care at convenient locations. Our board-certified oncologists deliver advanced treatments at more than 20 community-based care centers, letting patients get the care they need close to home. We keep abreast of the latest developments in prostate cancer research, offering access to targeted therapies and clinical trials to secure the best outcomes.
If you have been diagnosed with prostate cancer, get treatment from the best. Regional Cancer Care Associates offers comprehensive and compassionate care at more than 20 locations near you across New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area. Contact RCCA today to learn more about prostate cancer or to request an appointment with one of our medical oncologists.
What are the first symptoms of prostate cancer?
The first symptoms of prostate cancer are usually urinary or sexual changes. Patients may experience frequent urination, urinary incontinence, a weak urine flow, straining or pain during urination, blood in urine or semen, and erectile dysfunction.
What is a normal PSA level by age?
PSA levels increase as a person ages. While there is no ideal number that fits all patients, physicians generally look for results under the following thresholds:
Is an elevated PSA always a sign of cancer?
No. An elevated PSA does not always mean cancer. Benign conditions, such as benign prostatic hyperplasia (BPH) and prostate inflammation, can also cause heightened PSA levels. Further testing is required to confirm the cause of the PSA increases.
At what age should men start prostate cancer screening?
Average-risk men should start screening at around age 50, depending on their doctor’s advice. High-risk men, such as African Americans or individuals with a strong family history of prostate cancer, should start at age 45 or even 40.
What is the Gleason score, and what does it mean?
The Gleason score quantifies how aggressive prostate cancer is based on how abnormal the cancerous cells look. In general, a higher Gleason score corresponds with a more aggressive cancer.
Does prostate cancer always need to be treated?
Prostate cancer does not always need to be treated. If the cancer is slow-growing and still in Stage I, oncologists may instead choose to monitor the cancer. Active treatment will begin if and when the cancer shows signs of spreading.
What is the survival rate for prostate cancer caught early?
If prostate cancer is caught early, the five-year survival rate is nearly 100%. This percentage drops significantly in later stages.
Can prostate cancer spread to the bones?
Yes, metastatic prostate cancer can spread to the bones. In fact, bone is one of the most common sites of prostate cancer metastases.
Is prostate cancer hereditary?
No, prostate cancer is not hereditary. However, a strong family history can increase a person’s risk of prostate cancer. The condition is also linked to several gene mutations that are inherited.
What should I ask my prostate cancer doctor at my first visit?
Ask your urologist or oncologist what type and stage of cancer you have, what treatment options are recommended, what your expected outcomes are, and what side effects to expect from your care.
After a prostate cancer diagnosis, it’s important to find skilled and experienced cancer physicians who are committed to your health and will provide the highest-quality care to help meet your individual needs. It’s all a part of our patient-centered approach to treating the whole person. Plus, with over 25 care centers throughout the New Jersey, Connecticut, Massachusetts, and the Washington, DC area, you’ll be able to receive the care you need at a location that’s convenient for you.
Contact RCCA today at 844-346-7222 to schedule an appointment with our highly specialized team of oncologists, and give yourself the best fighting chance against prostate cancer.
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