Prostate Cancer Symptoms, Stages, Diagnosis, Treatment, and More

Prostate cancer is the fourth most commonly diagnosed cancer in the world and the second most common cancer (after skin cancer) in men, according to the American Cancer Society. In the United States, about 1 in 8 men will be diagnosed with prostate cancer in his lifetime.

Most American men with this cancer, however, do not die from it. Prostate cancer is treatable and survivable, depending on the stage at which a person is diagnosed, as well as the person’s age and general health and the effectiveness of treatment. Overall, prostate cancer has one of the highest survival rates among all types of cancer. In fact, more than three million men who have been diagnosed with prostate cancer at some point are alive today, per the American Cancer Society.

There are some factors that may increase the risk of developing prostate cancer, including:

• Age Nearly 60 percent of all prostate cancers are diagnosed in men over age 65, according to the Prostate Cancer Foundation. Because it is often a slow-growing cancer, it could start in younger men but not show up on screening tests.
• Race It is not clear why, but Black American men are far more likely to develop prostate cancer than white men, and are more than twice as likely as white men to die of prostate cancer.
• Family History The more closely related a family member diagnosed with prostate cancer is to you, the greater the risk. For example, having a father with prostate cancer puts you at higher risk than if your grandfather had prostate cancer.
• Obesity is associated with more dangerous, high-grade tumors. One study by Oxford Population Health concluded that every five-point increase in body mass index (BMI) raises the risk of dying from prostate cancer by 10 percent.

According to the American Cancer Society, you should see your doctor if you experience:

• Problems with urination, including weak or interrupted flow, frequent urination, or inability to empty the bladder completely
• Pain or burning during urination
• Blood in the urine or semen
• Trouble getting an erection
• Pain in the hips, spine, or ribs
• Numbness in the legs or feet, or loss of bladder control

These issues may be a sign of advanced prostate cancer. Or, more likely, they are caused by something else, such as a noncancerous growth of the prostate. In fact, early-stage prostate cancer usually causes no symptoms, which underscores the importance of screening, especially if you’re at high risk for prostate cancer.

Your doctor may perform a number of tests to diagnose prostate cancer or to determine how advanced the cancer is, including:

• Digital Rectal Exam A doctor uses a gloved finger to feel for abnormalities in the prostate.
• Prostate-Specific Androgen (PSA) Blood Test This measures the amount of PSA circulating in the body. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate. Generally, PSA levels are higher for more advanced prostate cancers.
• Biopsy Cancerous tissue is extracted and examined and compared with normal prostate tissue. The Gleason scale will be used to estimate how likely it is to spread.
• Imaging Tests Various tests may be performed, such as computerized tomography (CT) and magnetic resonance imaging (MRI) scans.
• Bone Scans These can determine if cancer has spread to the bones.

PSA Levels

PSA levels can spike due to reasons other than prostate cancer, including inflammation, infection, certain medications, or even heavy exercise. For this reason, there is no specific level of PSA that’s considered normal or abnormal.

In general, higher PSA levels mean a higher likelihood of cancer, and PSA levels over 4 nanograms per milliliter (ng/mL) might be cause for concern. At that level, your doctor might order another PSA test to confirm the finding. If your PSA level continues to be high, your doctor might schedule more PSA tests at regular intervals or a digital rectal exam.

According to the American Cancer Society, a PSA level between 4 and 10 is associated with a 1 in 4 chance of having prostate cancer, and a PSA level greater than 10 is associated with a more than 50 percent chance of having prostate cancer.

Learn More About PSA Screening

There are four prostate cancer stages, which are based on how advanced the cancer is, how big it is in the prostate, and how far it has spread.

• Stage 1 In this stage, the cancer can’t be felt and isn’t likely to be picked up with typical screening tools.
• Stage 2 The tumor has grown but is still small and hasn’t spread beyond the prostate. Cancer at this stage may or may not be picked up by PSA screening, as PSA levels will be low to medium.
• Stage 3 PSA levels are high and the tumor is growing. The cancer may have spread to nearby tissues, the seminal vesicles, or the bladder or rectum.
• Stage 4 Also called advanced prostate cancer or metastatic prostate cancer, stage four means that the cancer has spread beyond the prostate to other parts of the body, including the distant lymph nodes, liver, bladder, or bones.

Learn More About Prostate Cancer Stages

Cancer affects each person differently. It’s important to discuss treatment options with your oncologist to determine the best plan for you. Some traditional treatment options include:

• Observation and Active Surveillance Because prostate cancer is often slow-growing, sometimes a treatment plan involves not actively treating the cancer, at least at first. Your doctor may recommend keeping track of the tumor’s growth through active surveillance, which includes digital-rectal exams, PSA testing, or transrectal ultrasounds to see if the cancer has grown. Your doctor may also recommend watchful waiting, which means tracking symptoms without undergoing testing.
• Surgery If the cancer has not spread beyond the prostate gland, your doctor may recommend either a prostatectomy, which removes the prostate, or radical retropubic prostatectomy, which removes the prostate and the surrounding tissues and seminal vesicles.
• Radiation High-energy rays are used to destroy the cancer. They can be delivered externally, with a machine outside the body directing radiation at the cancer cells, or internally, by surgically placing radioactive pellets into or near the cancer. Radiation is typically used in conjunction with hormone therapy.
• Hormone Therapy The male sex hormones (testosterone) that can cause prostate cancer cells to grow are removed or blocked. This therapy is often used in conjunction with chemotherapy or radiation to shrink the cancer. Hormone therapy can be prescribed with drugs, or through surgery to remove one or both testicles, called orchiectomy or surgical castration. Hormone therapy using drugs is sometimes called medical castration.
• Chemotherapy Medicines are given intravenously or as a pill to kill or shrink the cancer.

There are other cancer treatments that are typically used if the cancer hasn’t responded to traditional therapies or it has returned:

• Immunotherapy uses the body's immune system to kill prostate cancer cells.
• High-intensity focused ultrasound uses a focused beam of energy to destroy any or all of the prostate gland.
• Targeted drug therapy is often used when chemo and hormone therapy don’t work.
• Bisphosphonate therapy is used when prostate cancer has spread to the bones.

Learn More About Prostate Cancer Treatments

Complications From Prostate Cancer Treatment

Treatment options for prostate cancer come with potential side effects.

• Surgery may have side effects such as erectile dysfunction, changes in orgasms, urinary incontinence, and loss of fertility.
• Radiation therapy can lead to fatigue, hair loss, skin discomfort, erectile dysfunction, and urinary and bowel issues. There is also an increased risk for cancers of the gastrointestinal or urinary tracts.
• Hormone therapy, either through drugs or surgery, can lead to lower libido and erectile dysfunction. Other potential side effects include weakened bones, loss of muscle mass, hot flashes, gastrointestinal issues, and breast growth.
• Chemotherapy side effects may include hair loss, digestive issues, fatigue, and greater chance of infections.

RELATED: Maintaining an Active Sex Life With Prostate Cancer

Prostate cancer is often slow-progressing, and the majority of men diagnosed with prostate cancer are over age 65. For these reasons, it’s often said that men with a prostate cancer diagnosis are more likely to die with prostate cancer but from other causes.

The American Cancer Society estimates five-year survival based on whether the cancer is localized, regional, or distant. If the cancer is localized, meaning there is no sign that the cancer has spread beyond the prostate, or if it is regional, meaning it has spread only to nearby structures or lymph nodes, the five-year survival rate is greater than 99 percent. If the cancer is distant, meaning it has spread to farther parts of the body — including the lungs, liver, or bones — the five-year survival rate drops to 32 percent.

The five-year survival rates is the percentage of men who are alive five years after a diagnosis of prostate cancer, no matter how advanced the cancer is. It’s important to understand that these estimates apply only to the stage of cancer when it is diagnosed and they don’t suggest how long you will survive with prostate cancer. Every case of prostate cancer is unique, and life expectancy is affected by age, overall health, and how well the body responds to treatment.

RELATED: Understanding Prostate Cancer Survival Rates

Earlier diagnosis increases the chance of effective treatment. The American Cancer Society recommends discussing the benefits of prostate cancer screening with your doctor at the following ages:

• Age 40 for men at highest risk of developing prostate cancer, which means you have more than one close relative (father or brother) diagnosed with prostate cancer at a young age
• Age 45 for men at high risk, which means you have one close relative diagnosed with prostate cancer at a young age, or you are a Black American
• Age 50 for men at average risk, which is everyone else

The American Urological Association recommends making individualized decisions on whether to screen for prostate cancer for men younger than age 55 who are Black American or who have a positive family history. A PSA blood test will be performed if you and your doctor agree that screening should be done.

Because the development of prostate cancer is largely determined by factors out of your control, including age, race, and family history, there is no surefire way to prevent it. However, the American Cancer Society does have some recommendations that might lower your risk, including:

• Maintaining a healthy weight
• Avoiding dairy, especially milk, which some studies have linked to an increased risk for prostate cancer
• Eating a healthy diet and avoiding or limiting red and processed meats and highly processed foods