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What is the PSA test?

Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man's blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.

The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration (FDA) in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing (along with a DRE) to help doctors determine the nature of the problem.

In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man's PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.

Is the PSA test recommended for prostate cancer screening?

Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.

Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.

What is a normal PSA test result?

There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.

However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer ( 1). In addition, various factors can cause a man's PSA level to fluctuate. For example, a man's PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs-including finasteride (Proscar) and dutasteride (Avodart), which are used to treat BPH -lower a man's PSA level. PSA level may also vary somewhat across testing laboratories.

Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.

In general, however, the higher a man's PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a man's PSA level over time may also be a sign of prostate cancer.

What if a screening test shows an elevated PSA level?

If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time.

If a man's PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.

If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum ( transrectal biopsy). A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.

What are some of the limitations and potential harms of the PSA test for prostate cancer screening?

Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a man's chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a man's life. Detecting tumors that are not life-threatening is called " overdiagnosis," and treating these tumors is called " overtreatment."

Overtreatment exposes men unnecessarily to the potential complications and harmful side effects of treatments for early prostate cancer, including surgery and radiation therapy. The side effects of these treatments include urinary incontinence (inability to control urine flow), problems with bowel function, erectile dysfunction (loss of erections, or having erections that are inadequate for sexual intercourse), and infection.

In addition, finding cancer early may not help a man who has a fast-growing or aggressive tumor that may have spread to other parts of the body before being detected.

The PSA test may give false-positive or false-negative results. A false-positive test result occurs when a man's PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety for a man and his family and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.

Most men with an elevated PSA level turn out not to have prostate cancer; only about 25% of men who have a prostate biopsy due to an elevated PSA level actually are found to have prostate cancer when a biopsy is done ( 2).

A false-negative test result occurs when a man's PSA level is low even though he actually has prostate cancer. False-negative test results may give a man, his family, and his doctor false assurance that he does not have cancer, when he may in fact have a cancer that requires treatment.

What research has been done to study prostate cancer screening?

Several randomized clinical trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a man's chances of dying from prostate cancer.

The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease ( 3). Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.

A second large trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer ( 4, 5).

A recent paper analyzed data from the PLCO using a complicated statistical model to account for the fact that some men in the PLCO trial who were assigned to the control group had nevertheless undergone PSA screening. This analysis suggested that the level of benefit in the PLCO and ERSPC trials were similar and that both trials were consistent with some reduction in prostate cancer death in association with prostate cancer screening ( 6). Such statistical modeling studies have important limitations and rely on unverified assumptions that can render their findings questionable (or more suitable for further study than to serve as a basis for screening guidelines). More importantly, the model could not provide an assessment of the balance of benefits versus harms from screening.

The United States Preventive Services Task Force has analyzed the data from all reported prostate cancer screening trials, principally from the PLCO and ERSPC trials, and estimated that, for every 1,000 men ages 55 to 69 years who are screened every 1 to 4 years for 10 to 15 years ( 7):

About 1 death from prostate cancer would be avoided.

120 men would have a false-positive test result that leads to a biopsy, and some men who get a biopsy would experience at least moderately bothersome symptoms from the biopsy.

100 men would be diagnosed with prostate cancer. Of those, 80 would be treated (either immediately or after a period of active surveillance) with surgery or radiation. At least 60 of these men would have a serious complication from treatment, such as erectile dysfunction and/or urinary incontinence.

How is the PSA test used in men who have been treated for prostate cancer?

The PSA test is often used to monitor patients who have a history of prostate cancer to see if their cancer has recurred (come back). If a man's PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a " biochemical relapse " typically appears months or years before other clinical signs and symptoms of prostate cancer recurrence.

However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.

What does an increase in PSA level mean for a man who has been treated for prostate cancer?

If a man's PSA level rises after prostate cancer treatment, his doctor will consider a number of factors before recommending further treatment. Additional treatment based on a single PSA test is not recommended. Instead, a rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead a man's doctor to recommend further treatment.

How are researchers trying to improve the PSA test?

Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:

Free versus total PSA. The amount of PSA in the blood that is "free" (not bound to other proteins) divided by the total amount of PSA (free plus bound) is denoted as the proportion of free PSA. Some evidence suggests that a lower proportion of free PSA may be associated with more aggressive cancer.

PSA density of the transition zone. The blood level of PSA divided by the volume of the transition zone of the prostate. The transition zone is the interior part of the prostate that surrounds the urethra. Some evidence suggests that this measure may be more accurate at detecting prostate cancer than the standard PSA test.

Age-specific PSA reference ranges. Because a man's PSA level tends to increase with age, it has been suggested that the use of age-specific PSA reference ranges may increase the accuracy of PSA tests. However, age-specific reference ranges have not been generally favored because their use may delay the detection of prostate cancer in many men.

PSA velocity and PSA doubling time. PSA velocity is the rate of change in a man's PSA level over time, expressed as ng/mL per year. PSA doubling time is the period of time over which a man's PSA level doubles. Some evidence suggests that the rate of increase in a man's PSA level may be helpful in predicting whether he has prostate cancer.

Pro-PSA. Pro-PSA refers to several different inactive precursors of PSA. There is some evidence that pro-PSA is more strongly associated with prostate cancer than with BPH. One recently approved test combines measurement of a form of pro-PSA called [-2]proPSA with measurements of PSA and free PSA. The resulting "prostate health index" can be used to help a man with a PSA level of between 4 and 10 ng/mL decide whether he should have a biopsy.

IsoPSA. PSA exists in different structural forms (called isoforms) in the blood. The IsoPSA test, which measures the entire spectrum of PSA isoforms rather than the concentration of PSA in the blood, may improve the selection of men with prostate cancer for biopsy (8).

PSA in combination with other biomarkers. Tests that combine measurements of PSA in blood with measurements of other biomarkers linked to prostate cancer in blood or urine are being studied for their ability to distinguish high-risk disease. These other biomarkers include kallikrein-related peptidase 2, prostate cancer antigen 3 (PCA3), and the TMPRSS2-ERG gene fusion.

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On This Page What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man's blood. For this test, a blood sample is sent to a laboratory for analysis.

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Screening is testing to find cancer in people before they have symptoms. It's not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.

The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests can't tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy (discussed below) to know for sure if you have cancer.

Prostate-specific antigen (PSA) blood test

Prostate-specific antigen (PSA) is a protein made by cells in the prostate gland (both normal cells and cancer cells). PSA is mostly found in semen, but a small amount is also found in blood.

The PSA level in blood is measured in units called nanograms per milliliter (ng/mL). The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesn't have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.

Most men without prostate cancer have PSA levels under 4 ng/mL of blood. When prostate cancer develops, the PSA level often goes above 4. Still, a level below 4 is not a guarantee that a man doesn't have cancer. About 15% of men with a PSA below 4 will have prostate cancer if a biopsy is done.

Men with a PSA level between 4 and 10 (often called the "borderline range") have about a 1 in 4 chance of having prostate cancer.

If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, you might need further tests to look for prostate cancer (see 'If screening tests results aren't normal', below).

Factors that might affect PSA levels

One reason it's hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.

Factors that might raise PSA levels include:

An enlarged prostate: Conditions such as benign prostatic hyperplasia(BPH), a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.

Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.

Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.

Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.

Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time (possibly because the seat puts pressure on the prostate), although not all studies have found this.

Certain urologic procedures: Some procedures done in a doctor's office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam (DRE) might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.

Certain medicines: Taking male hormones like testosterone (or other medicines that raise testosterone levels) may cause a rise in PSA.

Some things might lower PSA levels (even if a man has prostate cancer):

5-alpha reductase inhibitors: Certain drugsused to treat BPH or urinary symptoms, such as finasteride (Proscar or Propecia) or dutasteride (Avodart), can lower PSA levels. These drugs can also affect prostate cancer risk (discussed in Can Prostate Cancer Be Prevented?). Tell your doctor if you are taking one of these medicines. Because they can lower PSA levels, the doctor might need to adjust for this.

Herbal mixtures: Some mixturesthat are sold as dietary supplements might mask a high PSA level. This is why it's important to let your doctor know if you are taking any type of supplement, even ones that are not necessarily meant for prostate health. Saw palmetto (an herb used by some men to treat BPH) does not seem to affect PSA.

Certain other medicines: Some research has suggested that long-term use of certain medicines, such as aspirin, statins (cholesterol-lowering drugs), and thiazide diuretics (such as hydrochlorothiazide) might lower PSA levels. More research is needed to confirm these findings. If you take any of the medicines regularly, talk to your doctor before you stop taking it for any reason.

For men who might be screened for prostate cancer, it's not always clear if lowering the PSA is helpful. In some cases the factor that lowers the PSA may also lower a man's risk of prostate cancer. But in other cases, it might lower the PSA level without affecting a man's risk of cancer. This could actually be harmful, if it were to lower the PSA from an abnormal level to a normal one, as it might result in not detecting a cancer. This is why it's important to talk to your doctor about anything that might affect your PSA level.

Special types of PSA tests

The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA (described below). If you decide to get a PSA screening test and the result isn't normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isn't normal, ask your doctor to discuss your cancer risk and your need for further tests.

Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free (unattached). The percent-free PSA (%fPSA) is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.

If your PSA test result is in the borderline range (between 4 and 10), the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.

Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.

Complexed PSA: This test directly measures the amount of PSA that is attached to other proteins (the portion of PSA that is not "free"). This test could be done instead of checking the total and free PSA, and it could give the same amount of information, but it is not widely used.

Tests that combine different types of PSA: Some newer tests combine the results of different types of PSA to get an overall score that reflects the chance a man has prostate cancer (particularly cancer that might need treatment).These tests include:

The Prostate Health Index (PHI), which combines the results of total PSA, free PSA, and proPSA

The 4Kscore test, which combines the results of total PSA, free PSA, intact PSA, and human kallikrein 2 (hK2), along with some other factors

These tests might be useful in men with a slightly elevated PSA, to help determine if they should have a prostate biopsy. These tests might also be used to help determine if a man who has already had a prostate biopsy that didn't find cancer should have another biopsy.

PSA velocity: The PSA velocity is not a separate test. It is a measure of how fast the PSA rises over time. Normally, PSA levels go up slowly with age. Some research has found that these levels go up faster if a man has cancer, but studies have not shown that the PSA velocity is more helpful than the PSA level itself in finding prostate cancer. For this reason, the ACS guidelines do not recommend using the PSA velocity as part of screening for prostate cancer.

PSA density: PSA levels are higher in men with larger prostate glands. The PSA density (PSAD) is sometimes used for men with large prostate glands to try to adjust for this. The doctor measures the volume (size) of the prostate gland with transrectal ultrasound (discussed in Tests to Diagnose and Stage Prostate Cancer) and divides the PSA number by the prostate volume. A higher PSA density indicates a greater likelihood of cancer. PSA density has not been shown to be as useful as the percent-free PSA test.

Age-specific PSA ranges: PSA levels are normally higher in older men than in younger men, even when there is no cancer. A PSA result within the borderline range might be worrisome in a 50-year-old man but cause less concern in an 80-year-old man. For this reason, some doctors have suggested comparing PSA results with results from other men of the same age.

But the usefulness of age-specific PSA ranges is not well proven, so most doctors and professional organizations (as well as the makers of the PSA tests) do not recommend their use at this time.

Digital rectal exam (DRE)

For a digital rectal exam (DRE), the doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer. As shown in the picture below, the prostate is just in front of the rectum. Prostate cancers often begin in the back part of the gland, and can sometimes be felt during a rectal exam. This exam can be uncomfortable (especially for men who have hemorrhoids), but it usually isn't painful and only takes a short time.

DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, it might be included as a part of prostate cancer screening.

If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesn't always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:

Waiting a while and having a second PSA test

Getting another type of test to get a better idea of if you might have cancer (and therefore should get a prostate biopsy)

Getting a prostate biopsy to find out if you have cancer

It's important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:

Your age and overall health

The likelihood that you have prostate cancer (based on tests done so far)

Your own comfort level with waiting or getting further tests

If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist (a doctor who treats cancers of the genital and urinary tract, which includes the prostate gland) for this discussion or for further testing.

A man's blood PSA level can vary over time (for a number of reasons), so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range (typically 4 to 7 ng/mL). For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.

If the initial PSA result is abnormal, another option might be to get another type of test (or tests) to help you and your doctor get a better idea if you might have prostate cancer (and therefore need a biopsy). Some of the tests that might be done include:

A digital rectal exam (DRE), if it hasn't been done already

One or more of the other special types of PSA tests discussed above, such as the Prostate Health Index (PHI), 4Kscore test, or percent-free PSA, or other lab tests, such as the ExoDx Prostate(IntelliScore) (described in What's New in Prostate Cancer Research?)

An imaging test of the prostate gland, such as MRI (especially multiparametric MRI) or transrectal ultrasound (TRUS) (discussed in Tests to Diagnose and Stage Prostate Cancer)

(If the initial abnormal test was a DRE, the next step is typically to get a PSA blood test (and possibly other tests, such as a TRUS).)

For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.

For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.

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If Prostate Cancer Screening Test Aren't Normal

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Screening is testing to find cancer in people before they have symptoms. It's not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.

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The prostate is a small gland located midline in the body, inferiorly to the bladder and anterior to the rectum. The prostate surrounds the urethra which carries both urine and seminal fluid to the distal urethra. The prostate is a part of the male reproductive system, responsible for making and storing seminal fluid.

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The three options for early-stage/low-risk prostate cancer include surgery, radiation therapy (either external beam radiation or radioactive tumor seeding [brachytherapy]), and active surveillance, also known as expectant management or watchful waiting

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https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087

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Overview

Learn more about prostate cancer from Mayo Clinic urologist Mitchell Humphreys, M.D.

Hi. I'm Dr. Humphreys, a urologist at Mayo Clinic. In this video, we'll cover the basics of prostate cancer: What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers about your own health or that of someone you love, we're here to provide you with the best information available. Prostate cancer, unfortunately, is common. It affects one in seven men, making it the second most common cancer among men worldwide. The good news is, is that prostate cancer can be curable, especially when identified and treated early. That is why I and most urologists and medical professionals you talk to encourage men over a certain age to get regular prostate screenings. First, let's talk about what the prostate is and how it functions. The prostate is a small gland that is involved in reproduction and makes some of the essential components in semen. While it is small, it has an important role in reproductive health and can cause voiding or urinary symptoms as men age, as well becoming a source of cancer. Like other kinds of cancer, prostate cancer starts when cells mutate. These small changes in DNA cause the cells to grow faster and live longer than they normally would. As these abnormal cells accumulate, they monopolize resources from normal cells, which can damage surrounding tissue. These cancerous cells can then spread to other parts of the body.

Who gets it?

By definition, prostate cancer only affects bodies with male reproductive organs. But in addition, there are some other risk factors that we can monitor. Age is a big one, as prostate cancer is more prevalent in older men, which is why testing is encouraged as men age. For reasons that are unclear, Black men also have a greater risk compared to other races or ethnicities. Being at a higher weight as another possible risk factor. Genetics can also play a role in prostate cancer. A family history of prostate cancer or certain kinds of breast cancer increases the likelihood of being diagnosed with prostate cancer. Well, it's not a guarantee, there are plenty of steps you can take to reduce your risk. A healthy diet and exercise helps your body's overall well-being and can lower your chances of getting prostate cancer.

What are the symptoms?

A big reason to get regular testing is that prostate cancer usually has no presenting symptoms. And when they do show up, it generally indicates a worse stage of cancer. When symptoms do occur, they can include: trouble urinating or decreased force of stream, blood in the urine or semen, bone pain, unexpected weight loss, and unexplained fevers. If you consistently notice any of these symptoms, you should see your doctor right away. How is it diagnosed? There are a variety of ways to detect prostate cancer in both physical exam and from the blood. For starters, there's the DRE, the digital rectal exam. Just like the name suggests, the doctor inserts their finger and your rectum to feel the prostate to detect any abnormalities. You can also get a blood test to look for prostate-specific antigen, or PSA. It is recommended that you have this as well as the physical exam. And if there are any abnormalities, there are additional tests that can be used. If prostate cancer is detected, the next step is figuring out how fast it grows. Fortunately, prostate cancer often doesn't grow very fast. Prostate cancer is graded by a Gleason score, which measures how abnormal or different from normal cells are. There are also other tests to see if the cancer has spread: bone scan, CT scan, MRI, and even specific PET scans. Your doctor will be able to determine which, if any, is appropriate for you.

How is it treated?

Treatments are most effective when the cancer is caught early. In fact, immediate treatment isn't always necessary. Keeping an eye on the cancer until it grows bigger is sometimes enough. When cancer is localized only to the prostate, surgery to remove the prostate, or a radical prostatectomy, could be your best option. Radiation is another possibility. With external beam radiation, high-energy beams that deliver photons, target and kill the abnormal cells of the prostate from outside your body. Another treatment is chemotherapy, which uses powerful chemicals, destroy the cancer cells. Cryotherapy, which freezes the cancer cells, or heat, can be used to kill the cancer cells with high-intensity focused ultrasound. Consider that prostate cancer uses male hormone or testosterone as an important factor for growth. In some prostate cancers, it may be beneficial to block that hormone with androgen deprivation therapy, or ADT, which can slow the cancer or even put it in remission. It is generally not curative and usually the cancer will find a way to grow even with the lack of testosterone. Sometimes ADT is used in combination to enhance the treatment success of other therapies, such as with radiation. All of these treatments have side effects of various degrees and have different success rates of treating prostate cancer. It's important that you have a candid discussion with your family and your care team and weigh all that information to make the best choice for you. Support groups for cancer survivors can be helpful in dealing with the stress of the diagnosis and treatments.

What now?

As we've seen here, research and scientific advancement has provided us with a host of options for this extremely treatable form of cancer. And with early detection, your chances are even better. While it may not be a thing people want to think about, it's an important part of your health and an expert medical care team can guide you to the solutions that are most tailored for you, your wishes and your body. If you'd like to learn even more about prostate cancer, watch our other related videos or visit mayoclinic.org. We wish you well.

Prostate cancer is cancer that occurs in the prostate. The prostate is a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

Prostate cancer that's detected early - when it's still confined to the prostate gland - has the best chance for successful treatment.

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Symptoms

Prostate cancer may cause no signs or symptoms in its early stages.

Prostate cancer that's more advanced may cause signs and symptoms such as:

Trouble urinating

Decreased force in the stream of urine

Blood in the urine

Blood in the semen

Bone pain

Losing weight without trying

Erectile dysfunction

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

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Causes

It's not clear what causes prostate cancer.

Doctors know that prostate cancer begins when cells in the prostate develop changes in their DNA. A cell's DNA contains the instructions that tell a cell what to do. The changes tell the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die.

The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. In time, some abnormal cells can break away and spread (metastasize) to other parts of the body.

Risk factors

Factors that can increase your risk of prostate cancer include:

Older age. Your risk of prostate cancer increases as you age. It's most common after age 50.

Race. For reasons not yet determined, Black people have a greater risk of prostate cancer than do people of other races. In Black people, prostate cancer is also more likely to be aggressive or advanced.

Family history. If a blood relative, such as a parent, sibling or child, has been diagnosed with prostate cancer, your risk may be increased. Also, if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer, your risk of prostate cancer may be higher.

Obesity. People who are obese may have a higher risk of prostate cancer compared with people considered to have a healthy weight, though studies have had mixed results. In obese people, the cancer is more likely to be more aggressive and more likely to return after initial treatment.

Complications

Complications of prostate cancer and its treatments include:

Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as your bladder, or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it's unlikely to be cured.

Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery.

Erectile dysfunction. Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.

Prevention

You can reduce your risk of prostate cancer if you:

Choose a healthy diet full of fruits and vegetables. Eat a variety of fruits, vegetables and whole grains. Fruits and vegetables contain many vitamins and nutrients that can contribute to your health.

Whether you can prevent prostate cancer through diet has yet to be conclusively proved. But eating a healthy diet with a variety of fruits and vegetables can improve your overall health.

Choose healthy foods over supplements. No studies have shown that supplements play a role in reducing your risk of prostate cancer. Instead, choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of vitamins in your body.

Exercise most days of the week. Exercise improves your overall health, helps you maintain your weight and improves your mood. Try to exercise most days of the week. If you're new to exercise, start slow and work your way up to more exercise time each day.

Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, add more exercise and reduce the number of calories you eat each day. Ask your doctor for help creating a plan for healthy weight loss.

Talk to your doctor about increased risk of prostate cancer. If you have a very high risk of prostate cancer, you and your doctor may consider medications or other treatments to reduce the risk. Some studies suggest that taking 5-alpha reductase inhibitors, including finasteride (Propecia, Proscar) and dutasteride (Avodart), may reduce the overall risk of developing prostate cancer. These drugs are used to control prostate gland enlargement and hair loss.

However, some evidence indicates that people taking these medications may have an increased risk of getting a more serious form of prostate cancer (high-grade prostate cancer). If you're concerned about your risk of developing prostate cancer, talk with your doctor.

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Prostate cancer care at Mayo Clinic

Show references

1. AskMayoExpert. Prostate cancer (adult). Mayo Clinic; 2018.

2. Niederhuber JE, et al., eds. Prostate cancer. In: Abeloff's Clinical Oncology. 6th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed May 29, 2020.

3. Partin AW, et al., eds. In: Campbell-Walsh-Wein Urology. 12th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 29, 2020.

4. AskMayoExpert. Prostate biopsy (adult). Mayo Clinic; 2019.

5. Prostate cancer. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed May 29, 2020.

6. AskMayoExpert. Radical prostatectomy (adult). Mayo Clinic; 2019.

7. Rock CL, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians. 2020; doi:10.3322/caac.21591.

8. Distress management. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed May 29, 2020.

9. Thompson RH, et al. Radical prostatectomy for octogenarians: How old is too old? Journal of Urology. 2006; doi:10.1016/j.urology.2006.05.031.

10. Choline C-11 injection (prescribing information). Mayo Clinic PET Radiochemistry Facility; 2012. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=203155. Accessed June 23, 2020.

11. Woodrum DA, et al. Targeted prostate biopsy and MR-guided therapy for prostate cancer. Abdominal Radiology. 2016; doi:10.1007/s00261-016-0681-3.

12. Agarwal DK, et al. Initial experience with da Vinci single-port robot-assisted radical prostatectomies. European Urology. 2020; doi:10.1016/j.eururo.2019.04.001.

13. Gettman MT, et al. Current status of robotics in urologic laparoscopy. European Urology. 2003; doi:10.1016/S0302-2838(02)00579-1.

14. Krambeck AE, et al. Radical prostatectomy for prostatic adenocarcinoma: A matched comparison of open retropubic and robot-assisted techniques. BJU International. 2008; doi:10.1111/j.1464-410X.2008.08012.x.

15. Warner KJ. Allscripts EPSi. Mayo Clinic. Feb. 4, 2020.

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Learn about detection, diagnostic approaches, treatment options and advances for prostate cancer, including robotic prostatectomy and current research.

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You tube on symptoms and diagnosis

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What are the Signs and Symptoms of Prostate Cancer? | Cancer Research UK

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When you're being treated for cancer, it's more important than ever to eat right and get adequate nutrition -- but it can also be more difficult than ever to adhere to a balanced cancer diet. Your body is working overtime to fight the cancer, while it's also doing extra duty to repair healthy cells that may have been damaged as a side effect of treatments like chemotherapy and radiation. At the same time, many cancer treatments -- especially chemotherapy -- come with side effects that drain your strength and sap your appetite. So how can you make sure you're getting all the essential nutrients, vitamins, and minerals you need to keep a balanced cancer diet?

1. Participate in regular exercise. Walking is best.

2. Limit your calorie intake. Excess calories are bad for cancer growth. Eat what you need to get to the next meal, not the usual American style of eating all you can as if you are never going to eat again.

3. Get sunshine daily. Darker-skinned people need more sunshine.

4. Don't follow these or any guidelines to excess. Moderation is the key.

5. Heart healthy is prostate healthy.Heart disease is still the No. 1 killer, even in men with prostate cancer.

6. Variety in the foods you eat is important. Increase the diversity.

7. Remember supplements are supplements. They are not intended to replace an intelligent diet; their purpose is to supplement an intelligent diet. Supplements are a poor alternative to eating foods that are high in the desired nutrients.

8. See a doctor regularly for early detection and preventative care. Be proactive rather than reactive.

Nutritional Recommendations

The two diets known to be associated with longevity and reduced risks for prostate cancer are the traditional Japanese diet and a Southern Mediterranean diet. The Japanese diet is high in green tea, soy, vegetables, and fish, as well as low in calories and fat. The Mediterranean diet is high is fresh fruits and vegetables, garlic, tomatoes, red wine, olive oil, and fish. Both are low in red meat.

Specifically, you should incorporate these principles when reevaluating your daily diet:

1. Reduce animal fat in your diet. Studies show that excess fat, primarily red meat and high-fat dairy, stimulates prostate cancer to grow.

2. Avoid trans fatty acids, which are known to promote cancer growth. These are high in margarines, and fried and baked foods.

3. Increase your fresh fish intake, which is high in the very beneficial alpha omega-3 fatty acids. Ideally eat cold-water fish such as salmon, sardines, mackerel, and trout, at least two to three times a week. The fish should be poached, baked, or grilled (not burned or charred). Avoid fried fish.

4. Significantly increase your fresh fruit, herb, and vegetable consumption daily. Powerful anticancer nutrients are being discovered regularly in colorful fruits and vegetables, fresh herbs, leafy green vegetables, nuts, berries, and seeds.

5. Avoid high-calcium diets, which have been shown to stimulate prostate cancer growth.

6. Take a multivitamin with B complex and folic acid daily.

7. Avoid high-dose zinc supplements.

8. Increase your natural vitamin C consumption -- this includes citrus, berries, spinach, cantaloupe, sweet peppers, and mango.

9. Drink green tea several times each week.

10. Avoid excess preserved, pickled, or salted foods.

11. Eat red grapes, drink red grape juice, or red wine regularly.

12. Eat leafy dark-green vegetables frequently.

13. Cruciferous vegetables are cancer protective. These include cabbage, broccoli, and cauliflower.

14. Tomatoes and especially tomato products are very high in lycopene, a powerful anticancer substance. This includes pizza sauce, tomato paste, and ketchup.

15. Avoid flax seed oil. This can stimulate prostate cancer to grow. You can obtain the very healthy alpha omega-3 fatty acids you need through fresh fish and nuts.

16. Use olive oil, which is very healthy and rich in vitamin E and antioxidants. Avocado oil is also good. Avoid oils high in polyunsaturated fats such as corn, canola, or soybean.

17. Take vitamin E, 50 to 100 IU of gamma and d-alpha, only with the approval of your doctor. Some recent studies have raised concerns over serious risks with vitamin E intake. Natural sources include nuts, seeds, olive oil, avocado oil, wheat germ, peas, and nonfat milk.

18. Selenium is a very powerful antioxidant and the backbone molecule of your body's immune system. Most studies support a daily selenium supplement of 200 micrograms a day. The benefits appear to be only for those who have low selenium levels, which is difficult and expensive to measure. Since it only costs about 7 cents a day and is not toxic at these levels, it is reasonable for all men to take selenium. Natural sources include Brazil nuts, fresh fish, grains, mushrooms, wheat germ, bran, whole-wheat bread, oats, and brown rice.

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When it comes to nutrition and cancer, confusion abounds. A week doesn't go by without a headline about another food that is either "good" or "bad" for us. What we do know is that study after study confirms a relationship between diet and nutrition and the prevention and treatment of prostate cancer.

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Prostate Cancer - StatPearls - NCBI Bookshelf

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Worldwide, prostate cancer is the most commonly diagnosed male malignancy and the fifth leading cause of cancer death in men.[1][2] This amounted to 1,414,249 newly diagnosed cases and 375,000 deaths worldwide yearly from this disease in 2020.[1][2][3][4][5] Globally, prostate cancer is the most commonly diagnosed malignancy in more than fifty percent of countries (112 of 185).[6]

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Diagnosis

Patient consult on prostate diagnosis

Screening for prostate cancer

Testing healthy men with no symptoms for prostate cancer is controversial. There is some disagreement among medical organizations whether the benefits of testing outweigh the potential risks.

Most medical organizations encourage men in their 50s to discuss the pros and cons of prostate cancer screening with their doctors. The discussion should include a review of your risk factors and your preferences about screening.

You might consider starting the discussions sooner if you're a Black person, have a family history of prostate cancer or have other risk factors.

Prostate screening tests might include:

Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than usual level is found, it may indicate prostate infection, inflammation, enlargement or cancer.

Diagnosing prostate cancer

If prostate cancer screening detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as:

Ultrasound. During a transrectal ultrasound, a small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.

Magnetic resonance imaging (MRI). In some situations, your doctor may recommend an MRI scan of the prostate to create a more detailed picture. MRI images may help your doctor plan a procedure to remove prostate tissue samples.

Collecting a sample of prostate tissue. To determine whether there are cancer cells in the prostate, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.

Determining whether prostate cancer is aggressive

When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. A doctor in a lab examines a sample of your cancer cells to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly.

Techniques used to determine the aggressiveness of the cancer include:

Gleason score. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer), though the lower part of the range isn't used as often.

Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.

Genomic testing. Genomic testing analyzes your prostate cancer cells to determine which gene mutations are present. This type of test can give you more information about your prognosis. But it's not clear who might benefit most from this information, so the tests aren't widely used. Genomic tests aren't necessary for every person with prostate cancer, but they might provide more information for making treatment decisions in certain situations.

Determining whether the cancer has spread

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, one or more of the following imaging tests may be recommended:

Bone scan

Ultrasound

Computerized tomography (CT) scan

Magnetic resonance imaging (MRI)

Positron emission tomography (PET) scan

Not every person should have every test. Your doctor will help determine which tests are best for your individual situation.

Your doctor uses the information from these tests to assign your cancer a stage. Prostate cancer stages are indicated by Roman numerals ranging from I to IV. The lowest stages indicate the cancer is confined to the prostate. By stage IV, the cancer has grown beyond the prostate and may have spread to other areas of the body.

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Treatment

Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, whether it has spread and your overall health, as well as the potential benefits or side effects of the treatment.

Immediate treatment may not be necessary

Low-grade prostate cancer may not need treatment right away. For some, treatment may never be needed. Instead, doctors sometimes recommend active surveillance.

In active surveillance, regular follow-up blood tests, rectal exams and prostate biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation.

Active surveillance may be an option for cancer that isn't causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult.

Surgery to remove the prostate

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes.

Surgery is an option for treating cancer that's confined to the prostate. It's sometimes used to treat advanced prostate cancer in combination with other treatments.

To access the prostate, surgeons may use a technique that involves:

Making several small incisions in your abdomen. During robot-assisted laparoscopic prostatectomy, surgical instruments are attached to a mechanical device (robot) and inserted through several small incisions in your abdomen. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Most prostate cancer operations are done using this technique.

Making one long incision in your abdomen. During retropubic surgery, the surgeon makes one long incision in your lower abdomen to access and remove the prostate gland. This approach is much less common, but may be necessary in certain situations.

Discuss with your doctor which type of surgery is best for your specific situation.

Radiation therapy

Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy treatments may involve:

Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. Some medical centers offer a shorter course of radiation therapy that uses higher doses of radiation spread over fewer days.

External beam radiation is an option for treating cancer that's confined to the prostate. It can also be used after surgery to kill any cancer cells that might remain if there's a risk that the cancer could spread or come back. For prostate cancer that spreads to other areas of the body, such as the bones, radiation therapy can help slow the cancer's growth and relieve symptoms, such as pain.

Radiation placed inside your body (brachytherapy). Brachytherapy involves placing radioactive sources in your prostate tissue. Most often, the radiation is contained in rice-sized radioactive seeds that are inserted into your prostate tissue. The seeds deliver a low dose of radiation over a long period of time. Brachytherapy is one option for treating cancer that hasn't spread beyond the prostate.

In some situations, doctors may recommend both types of radiation therapy.

Freezing or heating prostate tissue

Ablative therapies destroy prostate tissue with cold or heat. Options may include:

Freezing prostate tissue. Cryoablation or cryotherapy for prostate cancer involves using a very cold gas to freeze the prostate tissue. The tissue is allowed to thaw and the procedure repeats. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.

Heating prostate tissue. High-intensity focused ultrasound (HIFU) treatment uses concentrated ultrasound energy to heat the prostate tissue and cause it to die.

These treatments may be considered for treating very small prostate cancers when surgery isn't possible. They may also be used to treat advanced prostate cancers if other treatments, such as radiation therapy, haven't helped.

Researchers are studying whether cryotherapy or HIFU to treat one part of the prostate might be an option for cancer that's confined to the prostate. Referred to as "focal therapy," this strategy identifies the area of the prostate that contains the most aggressive cancer cells and treats that area only. Studies have found that focal therapy reduces the risk of side effects. But it's not clear whether it offers the same survival benefits as treatment to the entire prostate.

Hormone therapy

Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly.

Hormone therapy options include:

Medications that stop your body from producing testosterone. Certain medications - known as luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) agonists and antagonists - prevent your body's cells from receiving messages to make testosterone. As a result, your testicles stop producing testosterone.

Medications that block testosterone from reaching cancer cells. These medications, known as anti-androgens, usually are given in conjunction with LHRH agonists. That's because LHRH agonists can cause a temporary increase in testosterone before testosterone levels decrease.

Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body quickly and significantly. But unlike medication options, surgery to remove the testicles is permanent and irreversible.

Hormone therapy is often used to treat advanced prostate cancer to shrink the cancer and slow its growth.

Hormone therapy is sometimes used before radiation therapy to treat cancer that hasn't spread beyond the prostate. It helps shrink the cancer and increases the effectiveness of radiation therapy.

Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.

Chemotherapy may be a treatment option for treating prostate cancer that has spread to other areas of the body. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Prostate cancer immunotherapy can involve:

Engineering your cells to fight cancer. Sipuleucel-T (Provenge) treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer and then injects the cells back into your body through a vein. It's an option for treating advanced prostate cancer that no longer responds to hormone therapy.

Helping your immune system cells identify cancer cells. Immunotherapy drugs that help the immune system cells identify and attack the cancer cells are an option for treating advanced prostate cancers that no longer respond to hormone therapy.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Targeted therapy drugs may be recommended to treat advanced or recurrent prostate cancer if hormone therapy isn't working.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

No complementary or alternative treatments will cure prostate cancer. However, complementary and alternative prostate cancer treatments may help you cope with the side effects of cancer and its treatment.

Nearly everyone diagnosed with cancer experiences some distress at some point. If you're distressed, you may feel sad, angry or anxious. You may experience difficulty sleeping or find yourself constantly thinking about your cancer.

Several complementary medicine techniques may help you cope with your distress, including:

Art therapy

Dance or movement therapy

Exercise

Meditation

Music therapy

Relaxation techniques

Spirituality

Discuss your feelings and concerns with your doctor. In some cases, treatment for distress may require medications.

Coping and support

When you receive a diagnosis of prostate cancer, you may experience a range of feelings - including disbelief, fear, anger, anxiety and depression. With time, each person finds his own way of coping with a prostate cancer diagnosis.

Until you find what works for you, try to:

Learn enough about prostate cancer to feel comfortable making treatment decisions. Learn as much as you need to know about your cancer and its treatment in order to understand what to expect from treatment and life after treatment. Ask your doctor, nurse or other health care professional to recommend some reliable sources of information to get you started.

Keep your friends and family close. Your friends and family can provide support during and after your treatment. They may be eager to help with the small tasks you won't have energy for during treatment. And having a close friend or family member to talk to can be helpful when you're feeling stressed or overwhelmed.

Connect with other cancer survivors. Friends and family can't always understand what it's like to face cancer. Other cancer survivors can provide a unique network of support. Ask your health care providers about support groups or community organizations that can connect you with other cancer survivors. Organizations such as the American Cancer Society offer online chat rooms and discussion forums.

Take care of yourself. Take care of yourself during cancer treatment by eating a diet full of fruits and vegetables. Try to exercise most days of the week. Get enough sleep each night so that you wake feeling rested.

Continue sexual expression. If you experience erectile dysfunction, your natural reaction may be to avoid all sexual contact. But consider touching, holding, hugging and caressing as ways to continue sharing sexuality with your partner.

Preparing for your appointment

If you have signs or symptoms that worry you, start by seeing your family doctor.

If your doctor suspects you may have a problem with your prostate, you may be referred to a urinary tract specialist (urologist). If you're diagnosed with prostate cancer, you may be referred to a cancer specialist (oncologist) or a specialist who uses radiation therapy to treat cancer (radiation oncologist).

Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready and what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements that you're taking.

Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For prostate cancer, some basic questions to ask your doctor include:

Do I have prostate cancer?

How large is my prostate cancer?

Has my prostate cancer spread beyond my prostate?

What's my Gleason score?

What's my prostate-specific antigen (PSA) level?

Will I need more tests?

What are my treatment options?

Is there one treatment option you think is best for me?

Do I need cancer treatment right away, or is it possible to wait and see if the cancer grows?

What are the potential side effects of each treatment?

What is the chance that my prostate cancer will be cured with treatment?

If you had a friend or family member in my situation, what would you recommend?

Should I see a specialist? What will that cost, and will my insurance cover it?

Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

When did you first begin experiencing symptoms?

Have your symptoms been continuous or occasional?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

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Patient consult on prostate diagnosis Testing healthy men with no symptoms for prostate cancer is controversial. There is some disagreement among medical organizations whether the benefits of testing outweigh the potential risks. Most medical organizations encourage men in their 50s to discuss the pros and cons of prostate cancer screening with their doctors.

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doi: 10.1007/978-3-030-32656-2_1.

Affiliations

¹ Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. kwilson@hsph.harvard.edu.

² Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.

doi: 10.1007/978-3-030-32656-2_1.

Affiliations

¹ Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. kwilson@hsph.harvard.edu.

² Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.

Abstract

A variety of diet and lifestyle factors have been studied with respect to prostate cancer risk in large, prospective cohort studies. In spite of this work, and in contrast to other common cancers, few modifiable risk factors have been firmly established as playing a role in prostate cancer. There are several possible explanations for the lack of well-established risk factors. First, prostate cancer has among the highest heritability of all common cancers; second, early life exposures may play an important role in risk, rather than mid- and later-life exposures assessed in most epidemiological studies. Finally, prostate-specific antigen (PSA) screening plays a critical role in prostate cancer detection and incidence rates, which has important implications for epidemiological studies.Among modifiable risk factors, smoking and obesity are consistently associated with higher risk specifically of advanced prostate cancer. There is also considerable evidence for a positive association between dairy intake and overall prostate cancer risk, and an inverse association between cooked tomato/lycopene intake and risk of advanced disease. Several other dietary factors consistently associated with risk in observational studies, including selenium and vitamin E, have been cast into doubt by results from clinical trials. Results for other well-studied dietary factors, including fat intake, red meat, fish, vitamin D, soy and phytoestrogens are mixed.In practical terms, men concerned with prostate cancer risk should be encouraged to stop smoking, be as physically active as possible, and achieve or maintain a healthy weight. These recommendations also have the advantage of having a positive impact on risk of type 2 diabetes, cardiovascular disease, and other chronic diseases. Reducing dairy intake while increasing consumption of fish and tomato products is also reasonable advice.

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national center for biotechnology information

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Diet and Lifestyle in Prostate Cancer - PubMed

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A variety of diet and lifestyle factors have been studied with respect to prostate cancer risk in large, prospective cohort studies. In spite of this work, and in contrast to other common cancers, few modifiable risk factors have been firmly established as playing a role in prostate cancer. There ar ...

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Prostate Cancer Part 1: Diagnosis and Referral in Primary Care

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Effective Date: April 15, 2020 This guideline provides recommendations for primary care providers for the investigation and management of adult male patients (≥19 years of age) who present with signs or symptoms that could lead to a diagnosis of prostate cancer.

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The prostate is the gland below a man's bladder that produces fluid for semen. Cancer screening is looking for cancer before you have any symptoms. Cancer found early may be easier to treat.

There is no standard screening test for prostate cancer. Researchers are studying different tests to find those with the fewest risks and most benefits. One test is the digital rectal exam (DRE). The doctor or nurse inserts a lubricated, gloved finger into your rectum to feel the prostate for lumps or anything unusual. Another test is the prostate-specific antigen (PSA) blood test. Your PSA level may be high if you have prostate cancer. It can also be high if you have an enlarged prostate (BPH) or other prostate problems. If your screening results are abnormal, your doctor may do more tests, such as an ultrasound, MRI, or a biopsy.

Prostate cancer screening has risks:

Finding prostate cancer may not improve your health or help you live longer

The results can sometimes be wrong

Follow-up tests, such as a biopsy, may have complications

You and your doctor should discuss your risk for prostate cancer, the pros and cons of the screening tests, and whether you should get them.

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Prostate Cancer Screening | PSA Test | MedlinePlus

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The prostate is the gland below a man's bladder that produces fluid for semen. Cancer screening is looking for cancer before you have any symptoms. Cancer found early may be easier to treat. There is no standard screening test for prostate cancer. Researchers are studying different tests to find those with the fewest risks and most benefits.

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Prostate cancer is a form of cancer that develops in the prostate gland. Stay aware of the signs and symptoms of prostate cancer and take immediate action. After all, early diagnosis always gives a better chance to cure it. #ProstateCancer #ZydusCancerCentre #CancerCare #Urologist #ZydusHospitalsCares #ZydusHospitals #Ahmedabad #SmileofGoodHealth

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Symptoms

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What are the Symptoms of Prostate Cancer

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If you've been diagnosed with prostate cancer, your cancer care team will discuss your treatment options with you. It's important to think about the benefits of each treatment option compared to the possible risks and side effects.

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If you've been diagnosed with prostate cancer, your cancer care team will discuss your treatment options with you. It's important to think about the benefits of each treatment option compared to the possible risks and side effects.

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ADT is for patients with prostate cancer who are hormone-sensitive, while chemotherapy is reserved primarily for the treatment of men with advanced or recurrent prostate cancer that does not respond to hormone therapy [10, 73, 74]. There are promising findings but, as with the early-stage type, no effective systemic therapies for the treatment of late-stage prostate cancer exist.

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Prostate Cancer Foundation

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If you've recently been diagnosed with prostate cancer, you may be asking yourself if there were warning signs or symptoms you should have noticed earlier.

So what are the warning signs of prostate cancer?

Unfortunately, there usually aren't any early warning signs for prostate cancer. The growing tumor does not push against anything to cause pain, so for many years the disease may be silent. That's why screening for prostate cancer is such an important topic for all men and their families.

In rare cases, prostate cancer can cause symptoms. Contact your doctor for an evaluation if you experience any of the following:

A need to urinate frequently, especially at night, some- times urgently

Difficulty starting or holding back urination

Weak, dribbling, or interrupted flow of urine

Painful or burning urination

Difficulty in having an erection

A decrease in the amount of fluid ejaculated

Painful ejaculation

Blood in the urine or semen

Pressure or pain in the rectum

Pain or stiffness in the lower back, hips, pelvis, or thighs

Remember: urinary symptoms don't necessarily mean you have cancer. Prostatitis or BPH (Benign Prostatic Hypertrophy, also known as enlargement of the prostate) are benign diseases but can cause similar symptoms and are very common.

What about difficulty in having an erection? Again, this is most likely not caused by cancer but by other factors such as diabetes, smoking, cardiovascular disease, or just plain getting older.

That said: Symptoms are symptoms, and no matter what's most likely to be causing them, you should get them checked out by a doctor.

Download or order your free copy of the Prostate Cancer Patient Guide now with COVID-19 Appendix.

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What are Prostate Cancer Symptoms / Signs? Prostate Cancer Foundation

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If you've recently been diagnosed with prostate cancer, you may be asking yourself if there were warning signs or symptoms you should have noticed earlier. Unfortunately, there usually aren't any early warning signs for prostate cancer. The growing tumor does not push against anything to cause pain, so for many years the disease may be silent.

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Most prostate cancers are first found as a result of screening. (See Screening Tests for Prostate Cancer.) Early prostate cancers usually don't cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.

If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If you're seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.

The actual diagnosis of prostate cancer can only be made with a prostate biopsy (discussed below).

Medical history and physical exam

If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.

Your doctor will also examine you. This might include a digital rectal exam (DRE), during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if it's only on one side of the prostate, if it's on both sides, or if it's likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.

After the exam, your doctor might then order some tests.

PSA blood test

Prostate-specific antigen (PSA) is a protein made by cells in the prostate gland (both normal cells and cancer cells). PSA is mostly in semen, but a small amount is also in the blood.

Use in men who might have prostate cancer

The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. It's also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

PSA in the blood is measured in units called nanograms per milliliter (ng/mL). The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesn't have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.

Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesn't have cancer.

Men with a PSA level between 4 and 10 (often called the "borderline range") have about a 1 in 4 chance of having prostate cancer.

If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, you might need further tests to look for prostate cancer.

To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.

Use in men already diagnosed with prostate cancer

The PSA test can also be useful if you have already been diagnosed with prostate cancer.

In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade (determined on the biopsy, described further on) to help decide if other tests (such as CT scans or bone scans) are needed.

The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments (such as surgery and radiation) are not likely to be helpful if the cancer has spread to other parts of the body.

PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment (see Following PSA Levels During and After Treatment).

Prostate biopsy

If the results of a PSA blood test, DRE, or other tests suggest that you might have prostate cancer, you will most likely need a prostate biopsy.

A biopsy is a procedure in which small samples of the prostate are removed and then looked at with a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by a urologist.

During the biopsy, the doctor usually looks at the prostate with an imaging test such as transrectal ultrasound (TRUS) or MRI, or a 'fusion' of the two (all discussed below). The doctor quickly inserts a thin, hollow needle into the prostate. This is done either through the wall of the rectum (a transrectal biopsy) or through the skin between the scrotum and anus (a transperineal biopsy). When the needle is pulled out it removes a small cylinder (core) of prostate tissue. This is repeated several times. Most often the doctor will take about 12 core samples from different parts of the prostate.

Though the procedure sounds painful, each biopsy usually causes only some brief discomfort because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second. Most doctors who do the biopsy will numb the area first by injecting a local anesthetic alongside the prostate. You might want to ask your doctor if he or she plans to do this.

The biopsy itself takes about 10 minutes and is usually done in the doctor's office. You will likely be given antibiotics to take before the biopsy and possibly for a day or 2 after to reduce the risk of infection.

For a few days after the procedure, you may feel some soreness in the area and might notice blood in your urine. You may also have some light bleeding from your rectum, especially if you have hemorrhoids. Many men notice blood in their semen or have rust colored semen, which can last for several weeks after the biopsy, depending on how often you ejaculate.

Getting the results of the biopsy

Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results (in the form of a pathology report) usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:

Positive for cancer: Cancer cells were seen in the biopsy samples.

Negative for cancer: No cancer cells were seen in the biopsy samples.

Suspicious: Something abnormal was seen, but it might not be cancer. (Different types of suspicious results are discussed below.)

If the biopsy is negative

If the prostate biopsy results are negative (that is, if they don't show cancer), and the chance that you have prostate cancer isn't very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests (and possibly DREs) sometime later.

But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer (because your PSA level is very high, for example), your doctor might suggest:

Getting other lab tests (of blood, urine, or the prostate biopsy samples) to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index (PHI), 4Kscore test, PCA3 tests (such as Progensa), and ConfirmMDx. These tests are discussed in What's New in Prostate Cancer Research?

Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI (described below) to look more closely for abnormal areas to target.

Prostate cancer grade (Gleason score or Grade Group)

If prostate cancer is found on a biopsy, it will be assigned a grade. The grade of the cancer is based on how abnormal the cancer looks under the microscope. Higher grade cancers look more abnormal, and are more likely to grow and spread quickly. There are 2 main ways to describe the grade of a prostate cancer.
Gleason score
The Gleason system, which has been in use for many years, assigns grades based on how much the cancer looks like normal prostate tissue.

If the cancer looks a lot like normal prostate tissue, a grade of 1 is assigned.

If the cancer looks very abnormal, it is given a grade of 5.

Grades 2 through 4 have features in between these extremes.

Almost all cancers are grade 3 or higher; grades 1 and 2 are not often used.

Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score (also called the Gleason sum).

The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7.

Although most often the Gleason score is based on the 2 areas that make up most of the cancer, there are some exceptions when a biopsy sample has either a lot of high-grade cancer or there are 3 grades including high-grade cancer. In these cases, the way the Gleason score is determined is modified to reflect the aggressive (fast-growing) nature of the cancer.

In theory, the Gleason score can be between 2 and 10, but scores below 6 are rarely used.

Based on the Gleason score, prostate cancers are often divided into 3 groups:

Cancers with a Gleason score of 6 or less may be called well-differentiated or low-grade.

Cancers with a Gleason score of 7 may be called moderately-differentiated or intermediate-grade.

Cancers with Gleason scores of 8 to 10 may be called poorly-differentiated or high-grade.

Grade Groups
In recent years, doctors have come to realize that the Gleason score might not always be the best way to describe the grade of the cancer, for a couple of reasons:

Prostate cancer outcomes can be divided into more than just the 3 groups mentioned above. For example, men with a Gleason score 3+4=7 cancer tend to do better than those with a 4+3=7 cancer. And men with a Gleason score 8 cancer tend to do better than those with a Gleason score of 9 or 10.

The scale of the Gleason score can be misleading for patients. For example, a man with a Gleason score 6 cancer might assume that his cancer is in the middle of the range of grades (which in theory go from 2 to 10), even though grade 6 cancers are actually the lowest grade seen in practice. This assumption might lead a man to think his cancer is more likely to grow and spread quickly than it really is, which might affect his decisions about treatment.

Because of this, doctors have developed Grade Groups, ranging from 1 (most likely to grow and spread slowly) to 5 (most likely to grow and spread quickly):

Grade Group 1 = Gleason 6 (or less)

Grade Group 2 = Gleason 3+4=7

Grade Group 3 = Gleason 4+3=7

Grade Group 4 = Gleason 8

Grade Group 5 = Gleason 9-10

The Grade Groups will likely replace the Gleason score over time, but currently you might see either one (or both) on a biopsy pathology report.

Other information in a pathology report

Along with the grade of the cancer (if it is present), the pathology report often contains other information about the cancer, such as:

The number of biopsy core samples that contain cancer (for example, "7 out of 12")

The percentage of cancer in each of the cores

Whether the cancer is on one side (left or right) of the prostate or on both sides (bilateral)

Suspicious results

Sometimes when the prostate cells are seen, they don't look like cancer, but they're not quite normal, either.

Prostatic intraepithelial neoplasia (PIN): In PIN, there are changes in how the prostate cells look, but the abnormal cells don't look like they've grown into other parts of the prostate (like cancer cells would). PIN is often divided into 2 groups:

Low-grade PIN: The patterns of prostate cells appear almost normal.

High-grade PIN: The patterns of cells look more abnormal.

Many men begin to develop low-grade PIN at an early age, but low-grade PIN is not thought to be related to prostate cancer risk. If low-grade PIN is reported on a prostate biopsy, the follow-up for patients is usually the same as if nothing abnormal was seen.

If high-grade PIN is found on a biopsy, there is a greater chance that you might develop prostate cancer over time. This is why doctors often watch men with high-grade PIN carefully and may advise another prostate biopsy (or lab tests to help determine the risk of having cancer, such as the Prostate Health Index (PHI), 4Kscore test, PCA3 tests (such as Progensa), or ConfirmMDx). This is especially true if high-grade PIN is found in different parts of the prostate (multifocal high-grade PIN), or if the original biopsy did not take samples from all parts of the prostate.

Atypical small acinar proliferation (ASAP): This might also be calledglandular atypia or atypical glandular proliferation. It might also just be reported as "suspicious for cancer." All of these terms mean that the cells look like they might be cancer when seen with the microscope, but there are too few of them to be sure. If one of these terms is used, there's a high chance that there is also cancer in the prostate, which is why many doctors recommend repeating the biopsy within a few months.

Proliferative inflammatory atrophy (PIA): In PIA, the prostate cells look smaller than normal, and there are signs of inflammation in the area. PIA is not cancer, but researchers believe that PIA may sometimes lead to high-grade PIN or to prostate cancer directly.

For more information about how prostate biopsy results are reported, see the Prostate Pathology section of our website.

Genetic testing for some men with prostate cancer

Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome (such as a BRCA gene mutation or Lynch syndrome) is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.

Imaging tests for prostate cancer

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:

To look for cancer in the prostate

To help the doctor see the prostate during certain procedures (such as a prostate biopsy or certain types of prostate cancer treatment)

To look for spread of prostate cancer to other parts of the body

Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound (TRUS) and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread. (Men with a normal DRE result, a low PSA, and a low Gleason score may not need any other tests because the chance that the cancer has spread is so low.)

The imaging tests used most often to look for prostate cancer spread include:

Transrectal ultrasound (TRUS)

For this test, a small probe about the width of a finger is lubricated and placed in your rectum. The probe gives off sound waves that enter the prostate and create echoes. The probe picks up the echoes, and a computer turns them into a black and white image of the prostate.

The procedure often takes less than 10 minutes and is done in a doctor's office or outpatient clinic. You will feel some pressure when the probe is inserted, but it is usually not painful. The area may be numbed before the procedure.

TRUS might be used in different situations:

It is sometimes used to look for suspicious areas in the prostate in men who have an abnormal DRE or PSA test result (although it can miss some cancers).

It can be used during a prostate biopsy to guide the needles into the correct area of the prostate.

It can be used to measure the size of the prostate gland, which can help determine the PSA density (described in Screening Tests for Prostate Cancer).

It can be used as a guide during some forms of treatment such as brachytherapy (internal radiation therapy) or cryotherapy.

Newer forms of TRUS, such as color Doppler ultrasound, might be even more helpful in some situations. (See What's New in Prostate Cancer Research?)

Magnetic resonance imaging (MRI)

MRI scans create detailed images of soft tissues in the body using radio waves and strong magnets. MRI scans can give doctors a very clear picture of the prostate and nearby areas. A contrast material called gadolinium may be injected into a vein before the scan to better see details.

MRI might be used in different situations:

It can be used to help determine if a man with an abnormal screening test or with symptoms that might be from prostate cancer should get a prostate biopsy. (The type of MRI often used for this, known as multiparametric MRI, is described below.)

If a prostate biopsy is planned, an MRI might be done to help locate and target areas of the prostate that are most likely to contain cancer. This is often done as an MRI/ultrasound fusion biopsy, which is described below.

MRI can be used during a prostate biopsy to help guide the needles into the prostate.

If prostate cancer has been found, MRI can be done to help determine the extent (stage) of the cancer. MRI scans can show if the cancer has spread outside the prostate into the seminal vesicles or other nearby structures. This can be very important in determining your treatment options. But MRI scans aren't usually needed for newly diagnosed prostate cancers that are likely to be confined to the prostate based on other factors.

To improve the accuracy of the MRI, you might have a probe, called an endorectal coil, placed inside your rectum for the scan. This can be uncomfortable for some men. If needed, you can be given medicine to make you feel sleepy (sedation).

Multiparametric MRI: This newer MRI technique can be used to help better define possible areas of cancer in the prostate, as well as to get an idea of how quickly a cancer might grow. It can also help show if the cancer has grown outside the prostate or spread to other parts of the body. For this test, a standard MRI is done to look at the anatomy of the prostate, and then at least one other type of MRI (such as diffusion weighted imaging [DWI], dynamic contrast enhanced [DCE] MRI, or MR spectroscopy) is done to look at other parameters of the prostate tissue. The results of the different scans are then compared to help find abnormal areas.

When this test is done to help determine if a man might have prostate cancer, the results are typically reported using the Prostate Imaging Reporting and Data System, or PI-RADS. In this system, abnormal areas in the prostate are assigned a category on a scale ranging from PI-RADS 1 (very unlikely to be a clinically significant cancer) to PI-RADS 5 (very likely to be a clinically significant cancer).

MRI/ultrasound fusion-guided prostate biopsy: In this approach, a man gets an MRI scan a few days or weeks before the biopsy to look for abnormal areas in the prostate. During the biopsy itself, TRUS is used to view to prostate, and a special computer program is used to fuse the MRI and TRUS images on a computer screen. This can help ensure the doctor gets biopsy samples from any suspicious areas seen on the images.

Bone scan

If prostate cancer spreads to distant parts of the body, it often goes to the bones first. A bone scan can help show if cancer has reached the bones.

For this test, you are injected with a small amount of low-level radioactive material, which settles in damaged areas of bone throughout the body. A special camera detects the radioactivity and creates a picture of your skeleton.

A bone scan might suggest cancer in the bone, but to make an accurate diagnosis, other tests such as plain x-rays, CT or MRI scans, or even a bone biopsy might be needed.

Positron emission tomography (PET) scan

A PET scan is similar to a bone scan, in that a slightly radioactive substance (known as a tracer) is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isn't very useful in finding prostate cancer cells in the body.

However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.

Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl (also known as piflufolastat F 18 or Pylarify), attach to prostate-specific membrane antigen (PSMA), a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.

These newer types of PET scans are most often used if it's not clear if (or exactly where) prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan aren't clear, or if a man has a rising PSA level after initial treatment but it's not clear where the cancer is in the body.

The pictures from a PET scan aren't as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI (PET-MRI) or a CT scan (PET-CT) at the same time, which can give more detail about areas that show up on the PET scan.

Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.

Computed tomography (CT) scan

A CT scan uses x-rays to make detailed, cross-sectional images of your body. This test isn't often needed for newly diagnosed prostate cancer if the cancer is likely to be confined to the prostate based on other findings (DRE result, PSA level, and Gleason score). Still, it can sometimes help tell if prostate cancer has spread into nearby lymph nodes. If your prostate cancer has come back after treatment, the CT scan can often tell if it is growing into other organs or structures in your pelvis.

CT scans are not as useful as magnetic resonance imaging (MRI) for looking at the prostate gland itself.

Lymph node biopsy

In a lymph node biopsy, also known as lymph node dissection or lymphadenectomy, one or more lymph nodes are removed to see if they have cancer cells. This isn't done very often for prostate cancer, but it might be used to find out if the cancer has spread from the prostate to nearby lymph nodes.

Biopsy during surgery to treat prostate cancer

If there is more than a very small chance that the cancer might have spread (based on factors such as a high PSA level or a high Gleason score), the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy (see Surgery for Prostate Cancer).

The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.

Lymph node biopsy as a separate procedure

A lymph node biopsy is rarely done as a separate procedure. It's sometimes used when a radical prostatectomy isn't planned (such as for some men who choose treatment with radiation therapy), but when it's still important to know if the lymph nodes contain cancer.

Most often, this is done as a needle biopsy. To do this, the doctor uses an image (such as from an MRI or CT scan) to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.

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Tests for Prostate Cancer | Prostate Cancer Diagnosis

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Most prostate cancers are first found as a result of screening. (See Screening Tests for Prostate Cancer.) Early prostate cancers usually don't cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause. If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure.

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United States Cancer Statistics Data Visualizations

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The terms "complementary" and "alternative" are sometimes used to refer to non-traditional methods of diagnosing, preventing, or treating cancer or its symptoms. Here you'll find general information to help you better understand what these terms mean and how to decide if using them is right for you. You'll also find a wealth of information on specific complementary and alternative treatments, grouped into the five categories below.

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Complementary and Alternative Medicine | American Cancer Society

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The terms "complementary" and "alternative" are sometimes used to refer to non-traditional methods of diagnosing, preventing, or treating cancer or its symptoms. Here you'll find general information to help you better understand what these terms mean and how to decide if using them is right for you.

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Abstract

Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide. Prostate cancer may be asymptomatic at the early stage and often has an indolent course that may require only active surveillance. Based on GLOBOCAN 2018 estimates, 1,276,106 new cases of prostate cancer were reported worldwide in 2018, with higher prevalence in the developed countries. Differences in the incidence rates worldwide reflect differences in the use of diagnostic testing. Prostate cancer incidence and mortality rates are strongly related to the age with the highest incidence being seen in elderly men (> 65 years of age). African-American men have the highest incidence rates and more aggressive type of prostate cancer compared to White men. There is no evidence yet on how to prevent prostate cancer; however, it is possible to lower the risk by limiting high-fat foods, increasing the intake of vegetables and fruits and performing more exercise. Screening is highly recommended at age 45 for men with familial history and African-American men. Up-to-date statistics on prostate cancer occurrence and outcomes along with a better understanding of the etiology and causative risk factors are essential for the primary prevention of this disease.

Keywords: Epidemiology; Etiology; Incidence; Mortality; Prevention; Prostate cancer; Risk factors; Survival; Trends.

Conflict of interest statement

None of the authors have conflict of interest.

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Ferlay J EM, Lam F, Colombet M, Mery L, Pineros M, Znaor A, Soerjomataram I. et al. Global cancer observatory: cancer tomorrow. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/tomorrow, Accessed 02 February 2019. [Internet]

Chan JM, Gann PH, Giovannucci EL. Role of diet in prostate cancer development and progression. J Clin Oncol. 2005;23(32):8152-8160. doi: 10.1200/JCO.2005.03.1492. - DOI - PubMed

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national center for biotechnology information

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Epidemiology of Prostate Cancer - PubMed

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Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide. Prostate cancer may be asymptomatic at the early stage and often has an indolent course that may require only active surveillance. Based on GLOBOCAN 2018 estimates, 1,276,106 new ...

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Roswell Park Comprehensive Cancer Center

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What are the Symptoms of Prostate Cancer?

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https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.goldjournal.net%2Farticle%2FS0090-4295%252816%252900070-4%2Fabstract&psig=AOvVaw1tBV0iXW2XPATkFDwhb-P8&ust=1625760781620000&source=images&cd=vfe&ved=0CAoQjRxqFwoTCOC5k4St0fECFQAAAAAdAAAAABAD

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Centers for Disease Control and Prevention

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Clinical Trials

Clinical trials use new treatment options to see if they are safe and effective. If you have cancer, you may want to take part. Visit the sites listed below for more information.

Complementary and Alternative Medicine

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.

Which Treatment Is Right for Me?

Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects. Side effects are how your body reacts to drugs or other treatments.

Sometimes people get an opinion from more than one cancer doctor. This is called a "second opinion." Getting a second opinionexternal icon may help you choose the treatment that is right for you.

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Clinical trials use new treatment options to see if they are safe and effective. If you have cancer, you may want to take part. Visit the sites listed below for more information. Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments.

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Nebraska Medicine Nebraska Medical Center

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What Causes Prostate Cancer? - The Nebraska Medical Center

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https://www.pcf.org/patient-resources/family-cancer-risk/prostate-cancer-prevention/

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Centers for Disease Control and Prevention (CDC)

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Should I Get Tested for Prostate Cancer?

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Other than skin cancer, prostate cancer is one of the most common cancers for American men. One in nine men will be diagnosed with prostate cancer during his lifetime, according to data from the American Cancer Society.

Just because prostate cancer is so common, that doesn't mean the symptoms you've been experiencing are, in fact, cancer. Many symptoms of prostate cancer are the same for other conditions like infections or abnormal cell growth, also known as BPH. The symptoms of BPH vs prostate cancer can be similar. This is what you need to know and when to see a doctor.

The Basics of Prostate Cancer

occurs when the cells in the prostate, a male reproductive gland, begin to grow out of control and develop into cancerous cells.

The prostate gland is only found in males and is the gland that creates some of the fluid that is in semen. It is a walnut-sized gland located below the bladder and in front of the rectum. The urethra - the tube that carries urine and semen to the penis - travels through the center of the prostate.

Nearly all prostate cancers are adenocarcinomas, which grow from the gland cells and grow slowly.

BPH and Other Conditions

There are other conditions that affect the prostate that can have similar symptoms as prostate cancer. Those conditions include benign prostatic hyperplasia (BPH) and prostatitis. BPH is a noncancerous enlargement of the prostate gland caused by aging, testosterone and genetics.

is not cancer but has similar symptoms.

Another condition is prostatitis, an inflammation of the prostate gland that occurs from bacterial infection. Roughly half of all men will be affected by prostatitis during their lives.

Is BPH cancer?

The next logical question is if an enlarged prostate can mean cancer.

If BPH is an enlargement of the gland, does an enlarged prostate mean you have cancer? No, BPH is not cancer.

Can BPH develop into cancer? No, BPH will not develop into cancer. BPH is a separate condition.

Furthermore, having an enlarged prostate gland does not mean you have cancer or will get cancer.

The National Cancer Institute indicates the prostate gland will grow larger with age. The gland starts out the size of a walnut when a man is 20. By the age of 40 it grows to the size of an apricot and by 60 it grows to the size of a lemon. Because of this natural growth progression throughout a man's life, it may begin pressing against the bladder and the urethra, making a man feel like he has to urinate more frequently, which is one of the symptoms of prostate cancer.

BPH vs. Prostate Cancer Symptoms

So what are the symptoms of prostate cancer and BPH? If you have a lump or hard prostate, does that mean you have cancer? Symptoms of both are often similar.

Symptoms of Prostate Cancer

Problems urinating

A slow or weak urinary stream

Needing to urinate more often

Blood in the urine or semen

Difficulty getting an erection

Pain in the hips, back or chest

Weakness or numbness in the legs or feet

Loss of bladder or bowel control

Symptoms of BPH

Symptoms of BPH are similar, but mostly affect urination:

Trouble starting a urine stream or making more than a dribble

Urinating frequently

The feeling the bladder is not fully emptied

Strong or sudden urge to go

Pushing or straining to begin urinating

Difficulty getting an erection or difficulty ejaculating

Blood in the urine

Pain in the hips and back is often a result of cancer spreading or pushing on the spinal cord. This is typically not experienced in patients who have BPH. With BPH, the growing prostate narrows the urethra, leads to hypertrophy of the bladder and impedes the proper flow of urine, which is why BPH primarily has urination-focused symptoms.

Some patients also have a hard prostate. This is an indicator you have a nodule or tumor. Nodules and tumors can be both benign and malignant, so having a hard prostate may be an indicator of cancer, but it can also be prostate stones.

Prostate stones develop around or in the prostate gland and are caused by blockages due to chronic inflammation or BPH. A study published in the World Journal of Men's Health indicated, roughly 80% of prostate stones are made of calcium phosphate. The stones are not cancerous.

When to See a Doctor

The bottom line is if you are experiencing symptoms, there are several conditions this may point to. Catching cancer early is an important part of the prognosis, and because BPH shares so many symptoms, it's best to ensure your safety by having it checked regularly. It is best to see a urologist who can help determine the cause of the symptoms and how best to treat it. Contact the specialists at Advanced Urology to schedule an appointment today.

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Different Symptoms of BPH vs. Prostate Cancer

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Different Symptoms of BPH vs. Prostate Cancer Other than skin cancer, prostate cancer is one of the most common cancers for American men. One in nine men will be diagnosed with prostate cancer during his lifetime, according to data from the American Cancer Society.

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Genetic Testing for Prostate Cancer: What You Should Know

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Doctors have known for decades that genetics can play a vital role in breast and ovarian cancer. Lately, scientists have begun to realize that many of these same genetic changes may lead to a man's risk of developing prostate cancer.

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Statistics at a Glance

At a Glance

Estimated New Cases in 2020 191,930

% of All New Cancer Cases 10.6%

Estimated Deaths in 2020 33,330

% of All Cancer Deaths 5.5%

5-Year
Relative Survival

97.8% 2010-2016

Year

Rate of New Cases - SEER 9

Rate of New Cases - SEER 13

Death Rate - U.S.

5-Year Relative Survival - SEER 9

Observed

Modeled Trend

Observed

Modeled Trend

Observed

Modeled Trend

Observed

Modeled Trend

New cases are also referred to as incident cases in other publications. Rates of new cases are also referred to as incidence rates.

View Data Table

Rate of New Cases and Deaths per 100,000: The rate of new cases of prostate cancer was 109.8 per 100,000 men per year. The death rate was 19.0 per 100,000 men per year. These rates are age-adjusted and based on 2013-2017 cases and 2014-2018 deaths.

Lifetime Risk of Developing Cancer: Approximately 12.1 percent of men will be diagnosed with prostate cancer at some point during their lifetime, based on 2015-2017 data.

Prevalence of This Cancer: In 2017, there were an estimated 3,170,339 men living with prostate cancer in the United States.

Survival Statistics

How Many People Survive 5 Years Or More after Being Diagnosed with Prostate Cancer?

Relative survival is an estimate of the percentage of patients who would be expected to survive the effects of their cancer. It excludes the risk of dying from other causes. Because survival statistics are based on large groups of people, they cannot be used to predict exactly what will happen to an individual patient. No two patients are entirely alike, and treatment and responses to treatment can vary greatly.

5-Year
Relative Survival

97.8%

Survival by Stage

Cancer stage at diagnosis, which refers to extent of a cancer in the body, determines treatment options and has a strong influence on the length of survival. In general, if the cancer is found only in the part of the body where it started it is localized (sometimes referred to as stage 1). If it has spread to a different part of the body, the stage is regional or distant. For prostate cancer, 75.9% are diagnosed at the local stage. The 5-year relative survival for localized prostate cancer is 100.0%.

Percent of Cases & 5-Year Relative Survival by Stage at Diagnosis: Prostate Cancer

Stage

Percent of Cases

5-Year Relative Survival

Percent of Cases by Stage

New Cases and Deaths

How Common Is This Cancer?

Compared to other cancers, prostate cancer is fairly common.

Rank

Common Types of Cancer

Estimated New
Cases 2020

Estimated
Deaths 2020

Prostate cancer represents 10.6% of all new cancer cases in the U.S.
10.6%

In 2020, it is estimated that there will be 191,930 new cases of prostate cancer and an estimated 33,330 people will die of this disease.

Who Gets This Cancer?

Prostate cancer occurs only in men, and it is more common in older men than younger men. It is more likely to occur in men with a family history of prostate cancer and men of African American descent. The rate of new cases of prostate cancer was 109.8 per 100,000 men per year based on 2013-2017 cases, age-adjusted.

Rate of New Cases per 100,000 Persons by Race/Ethnicity: Prostate Cancer

Percent of New Cases by Age Group: Prostate Cancer

Age Range

Percent of New Cases

<20

0.0%

20-34

0.0%

35-44

0.4%

45-54

8.1%

55-64

32.4%

65-74

39.9%

75-84

15.1%

>84

4.1%

Prostate cancer is most frequently diagnosed among men aged 65-74.

Median Age
At Diagnosis

66

Who Dies From This Cancer?

Because we have screening for prostate cancer, most of the time it is caught before it spreads to other parts of the body. Men who have prostate cancer that is characterized as localized or regional are not as likely to die as men whose cancer is distant. In general prostate cancer has excellent survival rates, but death rates are higher in African American men, men who have advanced stage cancer, and men who are between the ages of 75 and 84. Prostate cancer is the fifth leading cause of cancer death in the United States. The death rate was 19.0 per 100,000 men per year based on 2014-2018, age-adjusted.

Death Rate per 100,000 Persons by Race/Ethnicity: Prostate Cancer

Percent of Deaths by Age Group: Prostate Cancer

Age Range

Percent of Deaths

<20

0.0%

20-34

0.0%

35-44

0.1%

45-54

1.4%

55-64

9.3%

65-74

23.0%

75-84

33.3%

>84

33.0%

The percent of prostate cancer deaths is highest among men aged 75-84.

Trends in Rates

Changes Over Time

Keeping track of new cases, deaths, and survival over time (trends) can help scientists understand whether progress is being made and where additional research is needed to address challenges, such as improving screening or finding better treatments.

Using statistical models for analysis, age-adjusted rates for new prostate cancer cases have been falling on average 4.3% each year over 2008-2017. Age-adjusted death rates have been falling on average 1.8% each year over 2009-2018. 5-year relative survival trends are shown below.

New Cases, Deaths and 5-Year Relative Survival

Interactive Statistics with SEER*Explorer

With SEER*Explorer, you can...

Create custom graphs and tables

Download data and images

Share links to results

SEER*Explorer is an interactive website that provides easy access to a wide range of SEER cancer statistics. It provides detailed statistics for a cancer site by gender, race, calendar year, age, and for a selected number of cancer sites, by stage and histology.

Explore Additional Prostate Cancer Statistics

More About This Cancer

Cancer and the Prostate

This cancer forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). The prostate surrounds the urethra, the tube through which urine flows. A healthy prostate is about the size of a walnut. If the prostate grows too large, it squeezes the urethra. This may slow or stop the normal flow of urine. Prostate cancer usually occurs in older men.
Additional Information
More Information

Here are some resources for learning more about prostate cancer.

References

All statistics in this report are based on statistics from SEER and the Centers for Disease Control and Prevention's National Center for Health Statistics. Most can be found within SEER*Explorer.

Suggested Citation

All material in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

SEER Cancer Stat Facts: Prostate Cancer. National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/statfacts/html/prost.html

These stat facts focus on population statistics that are based on the U.S. population. Because these statistics are based on large groups of people, they cannot be used to predict exactly what will happen to an individual patient. To see tailored statistics, browse SEER*Explorer. To see statistics for a specific state, go to the State Cancer Profiles.

The statistics presented in these stat facts are based on the most recent data available, most of which can be found in SEER*Explorer. In some cases, different year spans may be used.

Estimates of new cases and deaths for 2020 are projections made by the American Cancer Society (ACS), based on earlier reported data.

Cancer is a complex topic. There is a wide range of information available. These stat facts do not address causes, symptoms, diagnosis, treatment, follow-up care, or decision making, although links are provided to information in many of these areas.

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Cancer of the Prostate - Cancer Stat Facts

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Estimated New Cases in 2020 191,930 % of All New Cancer Cases 10.6% Estimated Deaths in 2020 33,330 % of All Cancer Deaths 5.5% 5-YearRelative Survival 97.8% 2010-2016 Year Rate of New Cases - SEER 9 Rate of New Cases - SEER 13 Death Rate - U.S.

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Screening

There is no one test or procedure that everyone agrees is helpful for screening men for prostate cancer. Two commonly used tests are:

Digital rectal exam (DRE): A doctor examines your prostate with a gloved finger to look for unusual lumps or growth.

Prostate-specific antigen test (PSA): This blood test looks for higher levels of PSA in the blood, which may indicate the presence of prostate cancer.

A biopsy of the prostate may follow an abnormal DRE or elevated PSA. The decision to get screened depends on many factors, including a man's family history, age, race and symptoms. Discuss the risk and benefits of screening with your doctor.

Signs and Symptoms

Men are often diagnosed with prostate cancer following a digital rectal exam (DRE) or a Prostate-Specific Antigen (PSA) Test. Early prostate cancer usually causes no symptoms. Advanced prostate cancer can cause symptoms such as:

Weak urine stream

Blood in urine or semen

Swelling in the legs

Discomfort or evidence of swollen lymph nodes in the pelvic area

Bone pain

Weight loss

Tiredness

If you experience any of these symptoms, speak with your doctor right away. If your primary care doctor determines that you have prostate cancer, ask to be referred to a specialist in medical oncology, radiation oncology and/or urology for confirmation of your diagnosis and next steps.

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Screening, Signs and Symptoms of Prostate Cancer

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There is no one test or procedure that everyone agrees is helpful for screening men for prostate cancer. Two commonly used tests are: Digital rectal exam (DRE): A doctor examines your prostate with a gloved finger to look for unusual lumps or growth.

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Read more about recommended nutrition for prostate cancer such as eating fruits, vegetables, grains, legumes, and limiting others such as animal fats.

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Diagnosis

Patient consult on prostate diagnosis

Screening for prostate cancer

Testing healthy men with no symptoms for prostate cancer is controversial. There is some disagreement among medical organizations whether the benefits of testing outweigh the potential risks.

Most medical organizations encourage men in their 50s to discuss the pros and cons of prostate cancer screening with their doctors. The discussion should include a review of your risk factors and your preferences about screening.

You might consider starting the discussions sooner if you're a Black person, have a family history of prostate cancer or have other risk factors.

Prostate screening tests might include:

Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than usual level is found, it may indicate prostate infection, inflammation, enlargement or cancer.

Diagnosing prostate cancer

If prostate cancer screening detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as:

Ultrasound. During a transrectal ultrasound, a small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.

Magnetic resonance imaging (MRI). In some situations, your doctor may recommend an MRI scan of the prostate to create a more detailed picture. MRI images may help your doctor plan a procedure to remove prostate tissue samples.

Collecting a sample of prostate tissue. To determine whether there are cancer cells in the prostate, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.

Determining whether prostate cancer is aggressive

When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. A doctor in a lab examines a sample of your cancer cells to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly.

Techniques used to determine the aggressiveness of the cancer include:

Gleason score. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer), though the lower part of the range isn't used as often.

Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.

Genomic testing. Genomic testing analyzes your prostate cancer cells to determine which gene mutations are present. This type of test can give you more information about your prognosis. But it's not clear who might benefit most from this information, so the tests aren't widely used. Genomic tests aren't necessary for every person with prostate cancer, but they might provide more information for making treatment decisions in certain situations.

Determining whether the cancer has spread

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, one or more of the following imaging tests may be recommended:

Bone scan

Ultrasound

Computerized tomography (CT) scan

Magnetic resonance imaging (MRI)

Positron emission tomography (PET) scan

Not every person should have every test. Your doctor will help determine which tests are best for your individual situation.

Your doctor uses the information from these tests to assign your cancer a stage. Prostate cancer stages are indicated by Roman numerals ranging from I to IV. The lowest stages indicate the cancer is confined to the prostate. By stage IV, the cancer has grown beyond the prostate and may have spread to other areas of the body.

More Information

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Treatment

Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, whether it has spread and your overall health, as well as the potential benefits or side effects of the treatment.

Immediate treatment may not be necessary

Low-grade prostate cancer may not need treatment right away. For some, treatment may never be needed. Instead, doctors sometimes recommend active surveillance.

In active surveillance, regular follow-up blood tests, rectal exams and prostate biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation.

Active surveillance may be an option for cancer that isn't causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult.

Surgery to remove the prostate

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes.

Surgery is an option for treating cancer that's confined to the prostate. It's sometimes used to treat advanced prostate cancer in combination with other treatments.

To access the prostate, surgeons may use a technique that involves:

Making several small incisions in your abdomen. During robot-assisted laparoscopic prostatectomy, surgical instruments are attached to a mechanical device (robot) and inserted through several small incisions in your abdomen. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Most prostate cancer operations are done using this technique.

Making one long incision in your abdomen. During retropubic surgery, the surgeon makes one long incision in your lower abdomen to access and remove the prostate gland. This approach is much less common, but may be necessary in certain situations.

Discuss with your doctor which type of surgery is best for your specific situation.

Radiation therapy

Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy treatments may involve:

Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. Some medical centers offer a shorter course of radiation therapy that uses higher doses of radiation spread over fewer days.

External beam radiation is an option for treating cancer that's confined to the prostate. It can also be used after surgery to kill any cancer cells that might remain if there's a risk that the cancer could spread or come back. For prostate cancer that spreads to other areas of the body, such as the bones, radiation therapy can help slow the cancer's growth and relieve symptoms, such as pain.

Radiation placed inside your body (brachytherapy). Brachytherapy involves placing radioactive sources in your prostate tissue. Most often, the radiation is contained in rice-sized radioactive seeds that are inserted into your prostate tissue. The seeds deliver a low dose of radiation over a long period of time. Brachytherapy is one option for treating cancer that hasn't spread beyond the prostate.

In some situations, doctors may recommend both types of radiation therapy.

Freezing or heating prostate tissue

Ablative therapies destroy prostate tissue with cold or heat. Options may include:

Freezing prostate tissue. Cryoablation or cryotherapy for prostate cancer involves using a very cold gas to freeze the prostate tissue. The tissue is allowed to thaw and the procedure repeats. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.

Heating prostate tissue. High-intensity focused ultrasound (HIFU) treatment uses concentrated ultrasound energy to heat the prostate tissue and cause it to die.

These treatments may be considered for treating very small prostate cancers when surgery isn't possible. They may also be used to treat advanced prostate cancers if other treatments, such as radiation therapy, haven't helped.

Researchers are studying whether cryotherapy or HIFU to treat one part of the prostate might be an option for cancer that's confined to the prostate. Referred to as "focal therapy," this strategy identifies the area of the prostate that contains the most aggressive cancer cells and treats that area only. Studies have found that focal therapy reduces the risk of side effects. But it's not clear whether it offers the same survival benefits as treatment to the entire prostate.

Hormone therapy

Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly.

Hormone therapy options include:

Medications that stop your body from producing testosterone. Certain medications - known as luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) agonists and antagonists - prevent your body's cells from receiving messages to make testosterone. As a result, your testicles stop producing testosterone.

Medications that block testosterone from reaching cancer cells. These medications, known as anti-androgens, usually are given in conjunction with LHRH agonists. That's because LHRH agonists can cause a temporary increase in testosterone before testosterone levels decrease.

Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body quickly and significantly. But unlike medication options, surgery to remove the testicles is permanent and irreversible.

Hormone therapy is often used to treat advanced prostate cancer to shrink the cancer and slow its growth.

Hormone therapy is sometimes used before radiation therapy to treat cancer that hasn't spread beyond the prostate. It helps shrink the cancer and increases the effectiveness of radiation therapy.

Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.

Chemotherapy may be a treatment option for treating prostate cancer that has spread to other areas of the body. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Prostate cancer immunotherapy can involve:

Engineering your cells to fight cancer. Sipuleucel-T (Provenge) treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer and then injects the cells back into your body through a vein. It's an option for treating advanced prostate cancer that no longer responds to hormone therapy.

Helping your immune system cells identify cancer cells. Immunotherapy drugs that help the immune system cells identify and attack the cancer cells are an option for treating advanced prostate cancers that no longer respond to hormone therapy.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Targeted therapy drugs may be recommended to treat advanced or recurrent prostate cancer if hormone therapy isn't working.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.

More Information

Show more related information

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

No complementary or alternative treatments will cure prostate cancer. However, complementary and alternative prostate cancer treatments may help you cope with the side effects of cancer and its treatment.

Nearly everyone diagnosed with cancer experiences some distress at some point. If you're distressed, you may feel sad, angry or anxious. You may experience difficulty sleeping or find yourself constantly thinking about your cancer.

Several complementary medicine techniques may help you cope with your distress, including:

Art therapy

Dance or movement therapy

Exercise

Meditation

Music therapy

Relaxation techniques

Spirituality

Discuss your feelings and concerns with your doctor. In some cases, treatment for distress may require medications.

Coping and support

When you receive a diagnosis of prostate cancer, you may experience a range of feelings - including disbelief, fear, anger, anxiety and depression. With time, each person finds his own way of coping with a prostate cancer diagnosis.

Until you find what works for you, try to:

Learn enough about prostate cancer to feel comfortable making treatment decisions. Learn as much as you need to know about your cancer and its treatment in order to understand what to expect from treatment and life after treatment. Ask your doctor, nurse or other health care professional to recommend some reliable sources of information to get you started.

Keep your friends and family close. Your friends and family can provide support during and after your treatment. They may be eager to help with the small tasks you won't have energy for during treatment. And having a close friend or family member to talk to can be helpful when you're feeling stressed or overwhelmed.

Connect with other cancer survivors. Friends and family can't always understand what it's like to face cancer. Other cancer survivors can provide a unique network of support. Ask your health care providers about support groups or community organizations that can connect you with other cancer survivors. Organizations such as the American Cancer Society offer online chat rooms and discussion forums.

Take care of yourself. Take care of yourself during cancer treatment by eating a diet full of fruits and vegetables. Try to exercise most days of the week. Get enough sleep each night so that you wake feeling rested.

Continue sexual expression. If you experience erectile dysfunction, your natural reaction may be to avoid all sexual contact. But consider touching, holding, hugging and caressing as ways to continue sharing sexuality with your partner.

Preparing for your appointment

If you have signs or symptoms that worry you, start by seeing your family doctor.

If your doctor suspects you may have a problem with your prostate, you may be referred to a urinary tract specialist (urologist). If you're diagnosed with prostate cancer, you may be referred to a cancer specialist (oncologist) or a specialist who uses radiation therapy to treat cancer (radiation oncologist).

Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready and what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements that you're taking.

Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For prostate cancer, some basic questions to ask your doctor include:

Do I have prostate cancer?

How large is my prostate cancer?

Has my prostate cancer spread beyond my prostate?

What's my Gleason score?

What's my prostate-specific antigen (PSA) level?

Will I need more tests?

What are my treatment options?

Is there one treatment option you think is best for me?

Do I need cancer treatment right away, or is it possible to wait and see if the cancer grows?

What are the potential side effects of each treatment?

What is the chance that my prostate cancer will be cured with treatment?

If you had a friend or family member in my situation, what would you recommend?

Should I see a specialist? What will that cost, and will my insurance cover it?

Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

When did you first begin experiencing symptoms?

Have your symptoms been continuous or occasional?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

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Patient consult on prostate diagnosis Testing healthy men with no symptoms for prostate cancer is controversial. There is some disagreement among medical organizations whether the benefits of testing outweigh the potential risks. Most medical organizations encourage men in their 50s to discuss the pros and cons of prostate cancer screening with their doctors.

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Prostate cancer is cancer of the prostate gland. It is the second-leading cause of cancer death for men in the United States. About 1 in 35 men will die from it. Growths in the prostate can be benign (not cancer) or malignant (cancer).

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The prostate, an organ located under the bladder, produces semen. Prostate cancer is the second most common cancer among men in the United States. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime.

The risk of developing prostate cancer progressively increases with age. About 60 percent of all prostate cancers in the United States are diagnosed in men aged 65 or older. It is rare for men to develop prostate cancer before age 40.

There's no absolute prostate cancer prevention, but evidence suggests diet plays a key role. Keep reading for diet tips and more information.

Tomatoes, watermelon, and other red foods owe their bright color to a powerful antioxidant called lycopene. Some recent studies show that men who consume this fruit and tomato-based products have a lower risk of prostate cancer than those who don't. However, the American Institute for Cancer Research cautions that studies linking tomatoes to prostate cancer prevention are limited and ongoing.

A 2018 study from Spain suggest that cooking tomatoes makes it easier for your body to absorb lycopene. The redder the tomato, the better because lycopene accumulates during ripening. That means that pale, store-bought tomatoes that are picked too early have less lycopene than vine-ripened tomatoes.

Nutrients and vitamins contained in and vegetables may lower your risk of getting prostate cancer. Green vegetables contain compounds that help your body break down cancer-causing substances called carcinogens. A nutrient-rich diet may also help slow the spread of cancer.

By eating fruits and vegetables throughout the day, you'll be less likely to fill up on processed junk food.

A nutrient called isoflavones has been linked to a reduced risk of prostate cancer, in at least one 2014 review of controlled studies. Isoflavones are found in:

Researchers have long studied the link between green tea and prostate cancer risk, with mixed results. A showed that men who drink green tea, or take green tea extract supplements, have a lower risk of advanced prostate cancer than those who don't.

A 2010 review of clinical studies showed that the cell and animal research confirms a link between the key ingredients of green tea and a lower risk of prostate cancer. It noted that further human clinical trials are needed.

Indulging a serious coffee habit is linked to a decreased risk of fatal prostate cancer:

Drinking four to five cups of coffee every day can lower your chances of fatal and high-grade prostate cancer, according to a 2014 review of clinical studies.

Regardless of how many cups you drink overall, every three cups of coffee you drink can reduce your risk of fatal prostate cancer about 11 percent.

This describes a dose-response relationship between prostate cancer and coffee. That means the effect on prostate cancer goes up or down with the amount of coffee you drink. These effects may not extend to someone who only grabs an occasional cup.

However, high doses of caffeine can cause major health issues, such as irregular heartbeat and seizures. The Mayo Clinic cautions against ingesting more than 400 milligrams of caffeine a day, the equivalent of four cups of brewed coffee.

How coffee is prepared can also be a factor. A 2015 study in Norway looked at coffee brewed with a filter, and boiled coffee, which doesn't use such a filter. Men who drank boiled coffee seemed to have a lower risk of prostate cancer than men who drank coffee prepared another way or not at all.

The chemicals cafestol and kahweol have well-known cancer-fighting abilities. Researchers believe these chemicals are trapped when coffee runs through a paper filter. Boiled coffee may allow these cancer-fighting chemicals to stay in your daily brew.

A notes there may be a link between animal fats and an increased risk of prostate cancer. In addition to meat, animal fats are found in lard, butter, and cheese. Whenever possible, replace animal-based fats with plant-based fats.

This, instead of that:

olive oil instead of butter

fruit instead of candy

fresh vegetables instead of prepackaged foods

nuts or seeds instead of cheese

Also, overcooking meat produces carcinogens, so be careful not to overcook your meat.

Prostate cancer patients who smoke are more likely to have a recurrence of the disease. Smokers also have a higher risk of dying from prostate cancer.

It's not too late to quit. When compared with current smokers, prostate cancer patients who quit smoking for more than 10 years had the same mortality risk as those who never smoked.

Fish and omega-3

Fatty acid, known as omega-3, may help reduce your risk of developing prostate cancer. Omega-3 is found in certain fish including sardines, tuna, mackerel, trout, and salmon.

There was a study in 2013 that suggested that men with high concentrations of omega-3 fatty acids in their blood are more likely to develop prostate cancer.

However, more current research in 2015 found some problems with the research and stated that the study actually did not establish a link between increased intake of omega-3 and increased risk of prostate cancer.

Based on this controversial information, it is best to check with your doctor to discuss what is the best choice for you.

Folate

According the American Cancer Society, some clinical studies in the 1990s found that that low folate levels in your blood can increase your risk for cancer.

However, supplementing with folic acid, a man-made form of folate, may increase the risk of cancer.

Folate is found in many foods, including green vegetables, beans, whole grains, and fortified breakfast cereals. The American Cancer Society recommends getting adequate amounts of folate through eating a variety of these foods.

Dairy

Some studies, according to the Mayo Clinic, have linked dairy products, or diets high in calcium, with an increased risk of prostate cancer. However, studies have been mixed, and this risk is considered minimal.

Being overweight or obese is linked to an increased risk of aggressive prostate cancer.

Regular exercise can help you maintain a healthy weight. Benefits of exercise include increased muscle mass and better metabolism. Try:

Exercise doesn't have to be boring. Vary your routine and invite your friends to participate. You're more likely to work out if it's fun.

Ask your doctor about your risk for developing prostate cancer. Some points to discuss include:

what medical screening tests you should have as you age

family history of cancer

dietary recommendations

Tell your doctor if you're just beginning a new exercise program, or if you have the following symptoms:

discomfort anywhere in your pelvic or rectal areas

difficulty urinating

blood in your urine or semen

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9 Tips to Prevent Prostate Cancer: Coffee, Dairy, and More

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About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. Does what you eat really affect your risk for prostate cancer? If you load up on veggies or love a good cup of coffee, you may be in luck. Learn more.

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Is Prostate Cancer Screening Right for Me?

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About the Prostate

The prostate is a small gland in men. It is part of the male reproductive system. The prostate is about the size and shape of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum. The prostate helps make semen, the milky fluid that carries sperm from the testicles through the penis when a man ejaculates. The prostate surrounds part of the urethra, a tube that carries urine out of the bladder and through the penis.

How the Prostate Changes As You Age

Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren't noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.

Tell your doctor if you have these urinary symptoms:

Are passing urine more during the day

Have an urgent need to pass urine

Have less urine flow

Feel burning when you pass urine

Need to get up many times during the night to pass urine

Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation ( prostatitis), enlarged prostate ( BPH, or benign prostatic hyperplasia), and prostate cancer.

One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.

Prostate Changes That Are Not Cancer

Prostatitis

Prostatitis is an inflammation of the prostate gland that may result from a bacterial infection. It affects at least half of all men at some time during their lives. Having this condition does not increase your risk of any other prostate disease.

Symptoms of prostatitis

Trouble passing urine

A burning or stinging feeling or pain when passing urine

Strong, frequent urge to pass urine, even when there is only a small amount of urine

Chills and high fever

Low back pain or body aches

Pain low in the belly, groin, or behind the scrotum

Rectal pressure or pain

Urethral discharge with bowel movements

Genital and rectal throbbing

Sexual problems and loss of sex drive

Painful ejaculation (sexual climax)

Several tests, such as DRE and a urine test, can be done to see if you have prostatitis. Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. Even if you have no symptoms you should follow your doctor's advice to complete treatment.

Types of Prostatitis and Treatments

Acute bacterial prostatitis: This type is caused by a bacterial infection and comes on suddenly ( acute). Symptoms include severe chills and fever. There is often blood in the urine. Your PSA level (see PSA test) may be higher than normal. You must go to the doctor's office or emergency room for treatment. It's the least common of the four types, yet it's the easiest to diagnose and treat.

Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort. If your PSA level was high, it will likely return to normal once the infection is cleared up.

Chronic bacterial prostatitis: Also caused by bacteria, this type of prostatitis doesn't come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.

Antibiotic treatment over a longer period of time is best for this type. Treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that won't clear up.

Chronic prostatitis or chronic pelvic pain syndrome: This disorder is the most common but least understood type of prostatitis. Found in men of any age from late teens to the elderly, its symptoms can come and go without warning. There can be pain or discomfort in the groin or bladder area. Infection-fighting cells are often present, even though no bacteria can be found.

There are several different treatments for this problem, based on your symptoms. These include anti-inflammatory medications and other pain control treatments, such as warm baths. Other medicines, such as alpha-blockers, may also be given. Alpha-blockers relax muscle tissue in the prostate to make passing urine easier. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.

Asymptomatic inflammatory prostatitis: You don't have symptoms with this condition. It is often found when you are undergoing tests for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this form of prostatitis, your PSA test may show a higher number than normal.

Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.

Enlarged Prostate (BPH)

BPH stands for benign prostatic hyperplasia. Benign means "not cancer," and hyperplasia means abnormal cell growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer-yet the symptoms for BPH and prostate cancer can be similar.

Symptoms of BPH

Trouble starting a urine stream or making more than a dribble

Passing urine often, especially at night

Feeling that the bladder has not fully emptied

A strong or sudden urge to pass urine

Weak or slow urine stream

Stopping and starting again several times while passing urine

Pushing or straining to begin passing urine

At its worst, BPH can lead to: a weak bladder, backflow of urine causing bladder or kidney infections, complete block in the flow of urine and kidney failure.

The prostate gland is about the size of a walnut when a man is in his 20s. By the time he is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon. The enlarged prostate can press against the bladder and the urethra. This can slow down or block urine flow. Some men might find it hard to start a urine stream, even though they feel the need to go. Once the urine stream has started, it may be hard to stop. Other men may feel like they need to pass urine all the time, or they are awakened during sleep with the sudden need to pass urine. Early BPH symptoms take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor.

Treatments for BPH

Some men with BPH eventually find their symptoms to be bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. Talk with your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.

Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach. Watchful waiting means getting annual checkups. Treatment is started only if symptoms become too much of a problem.
If you choose watchful waiting, these simple steps may help lessen your symptoms:

Limit drinking in the evening, especially drinks with alcohol or caffeine.

Empty your bladder all the way when you pass urine.

Use the restroom often. Don't wait for long periods without passing urine.

Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:

Drug Therapy

Many American men with mild to moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s. Two main types of drugs are used. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

Alpha-blockers are drugs that help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days. Possible side effects include dizziness, headache, and fatigue.

5 alpha-reductase inhibitors are drugs that help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates prostate growth. When the action of 5-alpha reductase is blocked, DHT production is lowered and prostate growth slows. This helps shrink the prostate, reduce blockage, and limit the need for surgery.

Taking these drugs can help increase urine flow and reduce your symptoms. You must continue to take these drugs to prevent symptoms from coming back. 5-alpha reductase inhibitors can cause the following side effects in a small percentage of men including: decreased interest in sex, trouble getting or keeping an erection, and smaller amount of semen with ejaculation.

It's important to note that taking these drugs may lower your PSA test number. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear.

Surgery

The number of prostate surgeries has gone down over the years. But operations for BPH are still among the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked well. Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure.

Types of surgery for BPH include:

TURP (transurethral resection of the prostate). The most common surgery for BPH, TURP accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block (anesthesia) is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer. TURP generally avoids the two main dangers linked to another type of surgery called open prostatectomy (complete removal of the prostate gland through a cut in the lower abdomen): including incontinence and/or impotence. However, TURP can have serious side effects, such as bleeding. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery.

TUIP (transurethral incision of the prostate). This surgery, which is similar to TURP, is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.

TUNA (transurethral needle ablation). Radio waves are used to burn away excess prostate tissue. TUNA helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.

TUMT (transurethral microwave thermotherapy). Microwaves sent through a catheter are used to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.

TUVP (transurethral electroevaporation of the prostate). An electrical current is used to vaporize prostate tissue.

Laser surgery. The doctor passes a laser fiber through the urethra into the prostate, using a cystoscope, and then delivers several bursts of laser energy. The laser energy destroys prostate tissue and helps improve urine flow. Like TURP, laser surgery requires anesthesia. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. The recovery period for laser surgery may be shorter too. However, laser surgery may not be effective on larger prostates.

Open prostatectomy. This may be the only option in rare cases, such as when the obstruction is severe, the prostate is very large, or other procedures can't be done. General anesthesia or a spinal block is used, and a catheter remains for 3 to 7 days after the surgery. This surgery carries the highest risk of complications. Tissue is sent to the laboratory to check for prostate cancer.

Prostate Cancer

Prostate cancer means that cancer cells form in the tissues of the prostate. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or even 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread ( metastasize). By the time symptoms appear, the cancer may already be advanced.

By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. Most of these cancers never pose a problem. They may never cause symptoms or become a serious threat to health.

Symptoms of Prostate Cancer

Trouble passing urine

Frequent urge to pass urine, especially at night

Weak or interrupted urine stream

Pain or burning when passing urine

Blood in the urine or semen

Painful ejaculation

Nagging pain in the back, hips, or pelvis

Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.

Risk Factors For Prostate Cancer

Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn't mean that you will get prostate cancer. It just means that your risk of the disease is greater.

Age. Men who are 50 or older have a higher risk of prostate cancer.

Race. African-American men have the highest risk of prostate cancer-the disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.

Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man's relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.

Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.

Prostate Cancer Screening

Screening means testing for cancer before you have any symptoms. A screening test may help find cancer at an early stage, when it is less likely to have spread and may be easier to treat. By the time symptoms appear, the cancer may have started to spread.

The most useful screening tests are those that have been proven to lower a person's risk of dying from cancer. Doctors do not yet know whether prostate cancer screening lowers the risk of dying from prostate cancer. Therefore, large research studies, with thousands of men, are now going on to study prostate cancer screening. The National Cancer Institute is studying the combination of PSA testing and DRE as a way to get more accurate results.

Although some people feel it is best to treat any cancer that is found, including cancers found through screening, prostate cancer treatment can cause serious and sometimes permanent side effects. Some doctors are concerned that many men whose cancer is detected by screening are being treated-and experiencing side effects-unnecessarily. Talk with your doctor about your risk of prostate cancer and your need for screening tests.

Large research studies are looking at how prostate cancer can be prevented. Studies have shown that 5-alpha reductase inhibitors finasteride and dutasteride can lower the risk of developing prostate cancer, but whether they can decrease the risk of dying of prostate cancer is still unclear.

Talk with your doctor about your risk of prostate cancer and your need for screening tests.

Tests Used to Check the Prostate

This first step lets your doctor hear and understand the "story" of your prostate concerns. You'll be asked whether you have symptoms, how long you've had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

Digital Rectal Exam (DRE)

DRE is a standard way to check the prostate. With a gloved and lubricated finger, your doctor feels the prostate from the rectum. The test lasts about 10-15 seconds.

This exam checks for:

The size, firmness, and texture of the prostate

Any hard areas, lumps, or growth spreading beyond the prostate, and

Any pain caused by touching or pressing the prostate

The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check the health of your prostate.

PSA (Prostate-Specific Antigen) Test

The U.S. Food and Drug Administration (FDA) has approved the use of the PSA test along with a DRE to help detect prostate cancer in men age 50 and older. PSA is a protein made by prostate cells. It is normally secreted into ducts in the prostate, where it helps make semen, but sometimes it leaks into the blood. When PSA is in the blood, it can be measured with a blood test called the PSA test. In prostate cancer, more PSA gets into the blood than is normal. However, a high PSA blood level is not proof of cancer, and many other things can cause a false-positive test result. For example, blood PSA levels are often increased in men with prostatitis or BPH. Even things that disturb the prostate gland--such as riding a bicycle or motorcycle, or having a DRE, an orgasm within the past 24 hours, a prostate biopsy, or prostate surgery--may increase PSA levels.

Also, some prostate glands naturally produce more PSA than others. PSA levels go up with age. African-American men tend to have higher PSA levels in general than men of other races. And some drugs, such as finasteride and dutasteride, can cause a man's PSA level to go down. PSA tests are often used to follow men after prostate cancer treatment to check for signs of cancer recurrence. It is not yet known for certain whether PSA testing to screen for prostate cancer can reduce a man's risk of dying from the disease.

Researchers are working to learn more about the PSA test's ability to help doctors tell the difference between prostate cancer and benign prostate problems, and the best thing to do if a man has a high PSA level. For now, men and their doctors use PSA readings over time as a guide to see if more follow-up is needed.

PSA test results

PSA levels are measured in terms of the amount of PSA per volume of fluid tested. Doctors often use a value of 4 nanograms (ng) or higher per milliliter of blood as a sign that further tests, such as a prostate biopsy, are needed. Your doctor may monitor your PSA velocity, which means the rate of change in your PSA level over time. Rapid increases in PSA readings may suggest cancer. If you have a mildly elevated PSA level, you and your doctor may choose to do PSA tests on a scheduled basis and watch for any change in the PSA velocity.

Free PSA test

This test is used for men who have higher PSA levels. The standard PSA test measures total PSA, which includes both PSA that is attached, or bound, to other proteins and PSA that is free, or not bound. The free PSA test measures free PSA only. Free PSA is linked to benign prostate conditions, such as BPH, whereas bound PSA is linked to cancer. The percentage of free PSA can help tell what kind of prostate problem you have.

If both total PSA and free PSA are higher than normal (high percentage of free PSA), this suggests BPH rather than cancer.

If total PSA is high but free PSA is not (low percentage of free PSA), cancer is more likely. More testing, such as a biopsy, should be done.

You and your doctor should talk about your personal risk and free PSA results. Then you can decide together whether to have follow-up biopsies and, if so, how often.

There is no magic PSA level below which a man can be assured of having no risk of prostate cancer nor above which a biopsy should automatically be performed. A man's decision to have a prostate biopsy requires a thoughtful discussion with his physician, considering not only the PSA level, but also his other risk factors, his overall health status, and how he perceives the risks and benefits of early detection.

Dr. Howard Parnes, Chief of the Prostate and Urologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute

Prostate Biopsy

If your symptoms or test results suggest prostate cancer, your doctor will refer you to a specialist (a urologist) for a prostate biopsy. For a biopsy, small tissue samples are taken directly from the prostate. Your doctor will take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that may have cancer cells. Like other cancers, prostate cancer can be diagnosed only by looking at tissue under a microscope. Most men who have biopsies after prostate cancer screening exams do not have cancer.

A positive test result after a biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give it a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less aggressive the tumor is and the less likely it will spread. Treatment options depend on the stage (or extent) of the cancer (stages range from 1 to 4), Gleason score, PSA level, and your age and general health. This information will be available from your doctor and is listed on your pathology report.

Reaching a decision about treatment of your prostate cancer is a complex process. Many men find it helpful to talk with their doctors, family, friends, and other men who have faced similar decisions.

Talking With Your Doctor

Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:

Family doctors and internists

Physician assistants (PAs) and nurse practitioners (NPs)

Urologists, who are experts in diseases of the urinary tract system and the male reproductive system

Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system

Radiation oncologists, who use radiation therapy to treat cancer

Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy

Pathologists, who identify diseases by studying cells and tissues under a microscope

View these professionals as your partners-expert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.

Questions you may want to consider asking your doctor include:

What type of prostate problem do I have?

Is more testing needed and what will it tell me?

If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?

What type of treatment do you recommend for my prostate problem?

For men like me, has this treatment worked?

How soon would I need to start treatment and how long would it last?

Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?

What are the side effects of the medicine?

Are there other medicines that could interfere with this medication?

If I need surgery, what are the benefits and risks?

Would I have any side effects from surgery that could affect my quality of life?

Are these side effects temporary or permanent?

How long is recovery time after surgery?

Will I be able to fully return to normal?

How will this affect my sex life?

How often should I visit the doctor to monitor my condition?

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The prostate is a small gland in men. It is part of the male reproductive system. The prostate is about the size and shape of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum.

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Prostate cancer is the second most common cancer in men worldwide, according to data from the GLOBOCAN database. In developed areas, prostate cancer is increasingly being diagnosed when the tumor is confined to the prostate, due at least in part to screening with prostate-specific antigen (PSA). However, prostate cancers confined to the gland may become less frequent than more invasive tumors as PSA screening rates fall [ 1].

For men with newly diagnosed prostate cancer, the most important factors in selecting the initial treatment include the following:

●Anatomic extent of disease (Tumor, Node, Metastasis [TNM] stage)

●Histologic grade (Gleason score/grade group) and molecular characteristics of the tumor

●Serum PSA level

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of UpToDate content is governed by the UpToDate Terms of Use. ©2021 UpToDate, Inc. All rights reserved.

REFERENCES

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Prostate cancer: Risk stratification and choice of initial treatment - UpToDate

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Prostate cancer is the second most common cancer in men worldwide, according to data from the GLOBOCAN database. In developed areas, prostate cancer is increasingly being diagnosed when the tumor is confined to the prostate, due at least in part to screening with prostate-specific antigen (PSA).

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https://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/prostate-cancer-prevention/art-20045641

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Treatment regimens for prostate cancer include "surgery, radiotherapy, chemotherapy, androgen deprivation therapy (ADT), and 5-alpha reductase inhibitors"

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Nsaids Images, Stock Photos & Vectors | Shutterstock

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Find nsaids stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Thousands of new, high-quality pictures added every day.