Prostate cancer

Second to skin cancer, prostate cancer is the most common type of cancer in American men today with about one in six receiving a diagnosis.

Almost all cases are adenocarcinomas, but a few other rare types can occur. Treatments today are very effective and the survival rate is very high—most men successfully beat it and enjoy a life beyond cancer.

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Overview

The prostate gland is found only in men. It is walnut-sized but typically grows larger as men age, which can cause some symptoms in common with cancer, like trouble urinating. The prostate gland and the seminal vesicles behind it make semen, the fluid that transports sperm. The urethra goes through the prostate gland and carries urine and semen out of the body through the penis. Prostate cancer occurs when cells in the prostate gland grow out of control. We still don’t fully understand the cause of prostate cancer.

Most prostate cancers grow slowly and may not present with any symptoms in the early stages. Common symptoms include trouble urinating, blood in the semen and erectile dysfunction. If you’ve been diagnosed with prostate cancer or are concerned about these and other symptoms, make an appointment right away with a UCHealth specialist so we can begin developing the best treatment plan for your case. Patients inspire us every day with their strength and determination to overcome prostate cancer and return to the life they love.

Prostate cancer signs and symptoms

Slow growth still warrants close monitoring

Most prostate cancers grow slowly and may never develop beyond the early stages, and may only require closely monitoring the prostate. The vast majority of prostate cancers are adenocarcinomas, which develop from the gland cells that make the prostate fluid that is added to the semen.

Other types of cancer that can start in the prostate include:

  • Small cell carcinomas.
  • Neuroendocrine tumors (other than small cell carcinomas).
  • Transitional cell carcinomas.
  • Sarcomas.

However, these other types of prostate cancer are quite rare.

Pay attention to symptoms

Prostate cancer may not present with any symptoms in the early stages, but more advanced stages can cause signs and symptoms, including:

  • Trouble urinating.
  • Decreased force in the stream of urine.
  • Blood in semen.
  • Discomfort in the pelvic area.
  • Bone pain.
  • Erectile dysfunction.

Risk factors of prostate cancer

Even though we don’t know the exact cause of prostate cancer, we do know these factors can increase your risk:

  • Age. Risk increases as you get older.
  • Race. Black men carry a greater risk of prostate cancer than do men of other races, and the cancer is more likely to be aggressive or advanced.
  • Family history. If men in your family have had 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. More likely to have an advanced disease.

Questions and answers (FAQs)

What function does the prostate serve?

The prostate makes some of the fluid in semen to help carry sperm through the urethra and out of the penis.

Can prostate cancer kill you?

Yes, in the most serious cases. The 5-year survival rate is nearly 100% for prostate cancer that is found early and has not spread beyond the prostate. However, when prostate cancer has spread to parts of the body like the lungs or liver, those cases have a 5-year survival rate of only 30%.

What about the sexual side effects, like erectile dysfunction (ED) and loss of sex drive? Will I ever get back to normal? When?

Prostate cancer or its treatment, including surgery, radiation and hormone treatments can result in ED and loss of sex drive.

Part of your personalized treatment plan may include medications and/or vacuum devices that can help you achieve erections and restore your libido. You may even decide to have surgery to treat ED. Your provider will discuss the timeline for your recovery.

What is a dangerous prostate-specific antigen (PSA) blood test level? Are PSA tests accurate?

A PSA blood test is a fairly accurate screening test for prostate cancer. PSA is a protein made by cells in the prostate gland, found mostly in semen but a small amount is also found in blood. 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.

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. 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. A PSA of more than 10 means 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.

What is a Gleason score or grade, and how do I interpret it?

The Gleason system assigns a grade based on how much the cancer looks like normal prostate tissue:

  • Grade 1. The cancer looks a lot like normal prostate tissue.
  • Grades 2 through 4. The cancer has features between normal and very abnormal.
  • Grade 5. Cancer looks very abnormal.

Almost all cancers are grade 3 or higher. Because prostate cancers often have areas with different grades, a grade is assigned to the two areas that make up most of the cancer. These two grades are added to yield the Gleason score or Gleason sum. The first number assigned is the grade that is most common in the tumor.

Cancers with a Gleason score of 6 or less are well differentiated or low-grade. Cancers with a Gleason score of 7 are moderately differentiated or intermediate-grade. Cancers with Gleason scores of 8 to 10 are poorly differentiated or high-grade.

How do I decide the best treatment for me?

You will work with your multidisciplinary team to determine the best treatment for your case. We’ll educate you at every step and fully involve you and your family in every decision to help you beat cancer and make the most of your life beyond cancer.

What about incontinence? How bad is it and how long does it last?

Both prostate cancer and its treatment can cause urinary incontinence. Your treatment plan will address this based on the type you have, the severity and the likelihood it will improve over time. Your options may include medications, catheters and surgery.

Does high sexual frequency reduce the risk of prostate cancer?

No, there are no valid studies proving that frequent ejaculations help reduce risk.

Do eggs cause prostate cancer?

This has not been proven. A recent study funded by the U.S. National Institute of Health and carried out through the Harvard School of Public Health, the University of California in San Francisco, Brigham and Women’s Hospital and Harvard Medical School looked at the link between eating two and a half eggs or more per week to lethal forms of prostate cancer. The results were not definitive.

Conversely, it has also not been conclusively proven that you can prevent prostate cancer through diet, but eating a healthy diet with a variety of fruits and vegetables can improve your overall health.

Prostate cancer diagnosis and staging

No two men develop prostate cancer in the same way, so we offer a wide array of resources to properly evaluate your situation and to create a personalized plan that fits your specific needs.

We may use any combination of these tests and procedures to diagnose and stage prostate cancer:

  • 3-D staging biopsy. Maps each area of cancer to a 3-D model of the tissue to determine the precise size, extent and location of the cancer.
  • Bone scan. Takes pictures of the bones to look for areas of rapid growth that may indicate cancer.
  • CT scan (computed tomography). Uses a special type of X-ray and an injectable contrast dye to create detailed, highly accurate cross-sectional pictures of the prostate.
  • PET scan. A scan using a radioactive tracer to search for presence of cancer cells outside the prostate
  • Prostate MRI. Uses a strong magnet and a sensitive detector to create detailed images of the pelvis and prostate. Can find suspicious lesions in the prostate that would require biopsy.
  • Prostate biopsy. Removes a sample of prostate tissue for viewing under a microscope to look for cancer cells.
  • Transrectal ultrasound (TRUS) with or without MRI-fusion targeting. A focused ultrasound that uses sound waves to make an image of the prostate that can be fused with MRI images to better direct prostate biopsies.

Prostate cancer treatment

Treatment for prostate cancer varies greatly from person to person. Your personalized treatment plan may include these leading edge procedures and therapies to help you become cancer-free:

Surgery. Specially trained oncologists remove the prostate and other affected tissues, called a radical prostatectomy.

  • Precision treatment with da Vinci® robotic-assisted surgery. This advanced technology enables our highly experienced physicians to perform minimally invasive procedures for prostate cancer using smaller incisions, more detailed images inside the body and precise control of the instruments. In many cases this means you recover faster and your hospital stay is shorter.

Chemotherapy. Drugs that slow down, damage or kill cancer cells. Chemotherapy is generally used only for advanced forms of prostate cancer. It may involve single drugs or combinations of drugs taken intravenously or by mouth. Chemotherapy is often taken in cycles lasting three or four weeks each. Your team may also prescribe drugs to reduce or eliminate chemotherapy’s side effects.

Radiation therapy or radiotherapy. X-rays and other types of medical radiation aimed at specific parts of the body. The radiation kills cancer cells, prevents cancer cells from developing or recurring, and improves many of cancer’s symptoms. Modern techniques of focusing radiation allow delivery of radiation to the prostate, while minimizing radiation dose to normal non-cancerous tissues. For certain types of prostate cancer, a type of targeted radiation called Stereotactic Ablative Body Radiotherapy (SABR) may allow treatment to be completed in 5 sessions.

Anti-cancer drugs & targeted therapies. Single drugs or combinations of drugs taken through intravenous injections or as prescribed tablets/capsules help fight the cancer itself or the side effects from chemotherapy. Drugs may be taken in repeating patterns (cycles) that usually last three to four weeks.

  • Anti-cancer drugs or other substances that directly interfere with cancer growth and progression at the molecular level may be taken—with few side effects—on their own or combined with standard chemotherapy.
  • Targeted focal therapy (TFT) treats low-grade, early-stage prostate cancer with precisely targeted cryo-probes that kill cancer cells by freezing. The goal is to preserve urinary and erectile function with this minimally invasive procedure that typically lets you return home the same day.

Hormonal therapy. Because the presence of some hormones can cause certain cancers to grow, hormone therapy as a cancer treatment removes hormones or blocks their action to stop cancer cells from growing. If tests show that cancer cells can find places to attach (receptors), various treatments—drugs, surgery, radiation therapy—can be used to reduce hormone production or stop them from working.

Immunotherapy. Uses your own immune system to fight cancer. Substances made by the body or in a laboratory—such as Provenge®—are used to boost, direct or restore the body’s natural defenses against cancer.

  • Immunotherapy treatment with Provenge. This therapy trains your body’s immune system to attack prostate cancer cells. The treatment involves removing your white blood cells, mixing these cells with a drug designed to target cancer cells and infusing you with the treated blood. Provenge is an FDA-approved therapy for men who have advanced prostate cancer that isn’t responding to hormonal therapies.

Clinical trials. Your medical team may also recommend participation in a clinical trial. UCHealth conducts hundreds of these “trials” of new treatments or drugs. Participation in a clinical trial may provide those who qualify with access to drugs and vaccines years before they are widely available.

A multidisciplinary team approach

Specialists from many disciplines will work with you to personalize a treatment plan. Whether you need minimal treatment or a radical prostatectomy, your expert medical team will include the specialists you need:

Five-year prostate cancer survival rates

UCHealth Cancer Survival Rates - Prostate Cancer

Data source: Surveillance, Epidemiology, and End Results (SEER) 17 registries, National Cancer Institute, 2022. AJCC All Stages, 5 Year Relative Survival. Date of diagnosis from 2012 – 2018.

References

Center for Disease Control and Prevention (CDC). Basic Information About Prostate Cancer (https://www.cdc.gov/cancer/prostate/basic_info/index.htm)

National Cancer Institute (NCI). Prostate Cancer (https://www.cancer.gov/types/prostate)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Prostate Cancer (https://www.ncbi.nlm.nih.gov/books/NBK470550/)