AUA Summit - What is Prostate Cancer?

Advertisement

Centro de recursos Patient Magazine Podcast Donate
  2. Urology A-Z

Prostate Cancer – Early-Stage

Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

What is Prostate Cancer?

What is the Prostate?

The prostate and seminal vesicles are part of the male reproductive system. The prostate is about the size of a walnut. The seminal vesicles are two smaller pairs of glands attached to the back of the prostate. The prostate sits below the bladder, in front of the rectum. It surrounds the urethra, a small tube that carries urine from the bladder out through the penis.

The main job of the prostate and seminal vesicles is to make fluid for semen. During ejaculation, sperm moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture— semen—goes through the urethra and out of the penis as ejaculates.

Diagram of the Male Reproductive System

Enlarge

What is Prostate Cancer?

Cancer is the result of abnormal cell growth, which takes over the body’s normal cell function, making it harder for the body to work the way it should. Prostate cancer develops when abnormal cells form and grow in the prostate gland. Not all abnormal growths, also called tumors, are cancerous (malignant). Some tumors are not cancerous (benign).

  • Benign growths, such as benign prostatic hyperplasia (BPH), are not life threatening. They do not spread to nearby tissue or other parts of the body. These growths can be removed and may grow back slowly (but often do not grow back).
  • Cancerous growths, such as prostate cancer, can spread (metastasize) to nearby organs and tissues such as the bladder or rectum, or to other parts of the body. If the abnormal growth is removed, it can still grow back. Prostate cancer can be life threatening if it spreads far beyond the prostate (metastatic disease).

What is Early-stage Prostate Cancer?

Prostate cancer stays “localized” when cancer cells are found only in the prostate or even a little bit beyond it (extra-prostatic extension), but do not move to other parts of the body. If the cancer moves to other parts of the body, it is called “advanced” prostate cancer.

Prostate cancer is often grouped into four stages.

  • Early-stage | Stages I & II: The tumor has not spread beyond the prostate. This is often called “early-stage” or “localized” prostate cancer.
  • Locally Advanced | Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called “locally advanced prostate cancer.”
  • Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called “advanced prostate cancer.”

Symptoms

In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Prostate cancer can also cause symptoms unrelated to BPH. If you have urinary problems, talk with your healthcare provider about them.

Symptoms of prostate cancer can be:

  • Dull pain in the lower pelvic area
  • Frequent urinating
  • Trouble urinating, pain, burning, or weak urine flow
  • Blood in the urine (Hematuria) 
  • Painful ejaculation
  • Pain in the lower back, hips or upper thighs
  • Loss of appetite
  • Loss of weight
  • Bone pain

Updated August 2018

Causes

The cause of prostate cancer is unknown, but researchers know many things can increase a man's risk for the disease.

  • Age: As men age, their risk of getting prostate cancer goes up. Harm to the DNA (or genetic material) of prostate cells is more likely for men over the age of 55.
  • Ethnicity: African American men have a higher rate of the disease. One in six African American men will be diagnosed with prostate cancer. Prostate cancer occurs less often in Asian American and Hispanic/Latino men than in non-Hispanic white men.
  • Family History: Men who have a grandfather, father or brother with prostate cancer face a higher risk of getting the disease. Having family members with breast and ovarian cancer also raises a man’s risk for prostate cancer.
  • Weight: Studies link being overweight in your 50s and later to a greater risk of advanced prostate cancer. Doctors advise keeping to a healthy weight to reduce risk.

What are the Signs of Prostate Cancer?

In its early stages, prostate cancer may have no symptoms. When symptoms do occur, they can be urinary symptoms like those of an enlarged prostate or Benign Prostatic Hyperplasia (BPH). Talk with your doctor if you have any of these symptoms:

  • Dull pain in the lower pelvic zone
  • Frequent need to pass urine
  • Trouble passing urine, pain, burning or weak urine flow
  • Blood in the urine (hematuria)
  • Painful ejaculation
  • Pain in the lower back, hips or upper thighs
  • Loss of hunger
  • Loss of weight
  • Bone pain

Stages

How is Prostate Cancer Graded and Staged?

Grading (with the Gleason Score) and staging defines the progress of cancer and whether it has spread:

Grading

When prostate cancer cells are found in tissue from the core biopsies, the pathologist "grades" it. The grade is a measure of how quickly the cells are likely to grow and spread (how aggressive it is).

The most common grading system is called the Gleason grading system. With this system, each tissue piece is given a grade between three (3) and five (5). In the past, we assigned scores of one (1) and two (2). A grade of less than three (3) means the tissue is close to normal. A grade of three (3) suggests a slow growing tumor. A high grade of five (5) indicates a highly aggressive, high-risk form of prostate cancer.

The Gleason system then develops a "score" by combing the two most common grades found in biopsy samples. For example, a score of grades 3 + 3 = 6 suggests a slow growing cancer. The highest score of grades 5 + 5 = 10 means that cancer is present and extremely aggressive.

The Gleason score will help your doctor understand if the cancer is as a low-, intermediate- or high-risk disease. Generally, Gleason scores of 6 are treated as low risk cancers. Gleason scores of around 7 are treated as intermediate/mid-level cancers. Gleason scores of 8 and above are treated as high-risk cancers.

If you are diagnosed with prostate cancer, ask about your Gleason score and how it impacts your treatment decisions.

Staging

Tumor stage is also measured. Staging describes where the cancer is within the prostate, how extensive it is, and if it has spread to other parts of the body. One can have low stage cancer that is very high risk. Staging the cancer is done by DRE and special imaging studies.

The system used for tumor staging is the TNM system. TNM stands for Tumor, Nodes and Metastasis. The "T" stage is found by DRE and other imaging tests such as an ultrasound, CT scan, MRI or bone scan. The imaging tests show if and where the cancer has spread, for example: to lymph nodes or bone.

These staging imaging tests are generally done for men with a Gleason grade of 7 or higher and a PSA higher than 10. Sometimes follow-up images are needed to evaluate changes seen on the bone scan.

Diagram of Prostate Cancer Staging

Enlarge

Imaging Tests

Not all men need imaging tests. Your doctor may recommend imaging exams based on results from other tests.

Prostate cancer may spread from the prostate into other tissues. It may spread to the nearby seminal vesicles, the bladder, or further to the lymph nodes and the bones. Rarely, it spreads to the lungs and or other organs.

Your healthcare provider may recommend a pelvic CT scan , an MRI scan or a bone scan to check if your cancer has spread.

What Are The Survival Rates For Prostate Cancer?

Many men with prostate cancer will not die from it; they will die from other causes. For men who are diagnosed, it is better if it is caught early.

Survival rates for men with prostate cancer have increased over the years, thanks to better screening and treatment options. Today, 99% of men with prostate cancer will live for at least 5 years after diagnosis. Many men having treatment are cured. Most prostate cancer is slow-growing and takes many years to progress. One out of three men will survive after five years, even if the cancer has spread to other parts of the body.

Updated August 2018

Clinical Trials

Clinical trials are research studies involving real patients to test if a new treatment or procedure is safe, effective and maybe better than established options. The goal is to learn which treatments work best for certain illnesses or groups of people.

Clinical trials follow strict scientific standards. These standards help protect patients and produce more reliable study results.

Are you interested in participating in a clinical trial for prostate cancer? Ask your doctor if you qualify for a specific prostate cancer trial. Learn as much as you can about the benefits and risks of the study. To search for information on current clinical trials for the treatment of bladder cancer visit the Clinical Trials Resource Center—you may also visit the National Institutes of Health website.  

Updated January 2020

After Treatment

Each year, more men are surviving prostate cancer and winning back their lives. Prostate cancer can be a manageable disease if caught early and treated appropriately.

Once you have finished treatment, it is time to manage your side effects. It is time to create a long-term schedule with your doctor for future tests. It's also time to go on with your life.

Talk to your healthcare provider about the side effects or problems you have after treatment. You and your healthcare provider can decide your best next steps.

If you haven't yet started treatment, consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects, like incontinence, is lower.

What are the Emotional Effects Following Treatment?

After treatment, you may feel very emotional. You may also worry about cancer returning. Many men still feel anxious and unsure, or upset about treatment side effects.

Whatever you're feeling, it's important to tell your healthcare provider about it. Work together. Build a plan with your provider or a counselor to deal with your emotional health and general wellbeing.

What are The Physical Effects Following Treatment?

Erectile dysfunction and urinary incontinence are the side effects reported most often by men following prostate cancer treatment.

Erectile Dysfunction (ED) Issues After Prostate Cancer Treatment

After prostate cancer, many men experience erectile dysfunction (ED). An erection happens when sexual arousal causes nerves near the prostate to send signals. The signals cause the blood vessels in the penis to fill with blood. The blood in the vessels makes the penis erect. ED happens when this process doesn't work well (or is damaged from surgery or radiation) and a man cannot keep an erection long enough for sexual satisfaction. Your doctor can help you understand the causes of ED and therapies that could help you recover.

What Causes ED After Prostate Cancer Treatment?

Nerves involved in the erection process surround the prostate gland. Surgery may damage the nerve bundles that control blood flow to the penis, causing ED. Or, these nerves may be removed with the cancer. Radiation therapy also can damage the erectile nerves causing ED. In addition, the amount of blood flowing to the penis can decrease after treatment.

While most surgeons try to perform a nerve sparing procedure, it is not always possible.

The chance of ED after treatment depends on many things:

  • Age
  • Health
  • Sexual function before treatment
  • Stage of the cancer
  • Whether the nerves that control erection were damaged after surgery or radiation.

How Long Can ED Last?

If treatment causes ED, there is still a chance for erectile function to come back over time (unless both nerves were destroyed). It may take up to 24 months or longer before you are able to have a full erection, but it is possible. Some men recover sooner. The average time for erections that allow intercourse is between 4 and 24 months. Men under age 60 have a better chance of regaining erections than older men. Even with nerve-sparing surgery, erections do not return right away or to full pre-surgery function. But, they may recover enough for sex. There are medicines and devices to treat ED.

Even with no erection, or a weak erection, men can orgasm.

Are There Treatments for ED After Prostate Cancer Treatment?

There are several treatments that can help ED. They include pills, vacuum pumps, urethral suppositories, penile injections and penile implants. Individual treatments don't work for every patient. They have their own set of side effects. A healthcare provider can talk with you about the pros and cons of each method. They can help you decide which individual or combination of treatments is right for you.

Urinary Incontinence After Prostate Cancer Treatment

Urinary incontinence can sometimes result from prostate cancer treatment . Urinary incontinence is urine leakage without your control. Men may have many types of incontinence after prostate surgery.

  • Stress incontinence - Coughing, laughing, sneezing, or exercising can strain the pelvic floor muscles, causing urine to leak. This is the most common type of urinary incontinence.
  • Urge incontinence - You feel a sudden, urgent need to go to the bathroom, even when the bladder is not full. This happens because the bladder is overly sensitive. Urge incontinence is also called overactive bladder.
  • Urinary frequency - You go to the bathroom very often. You may feel the need to go every 30 to 60 minutes.
  • Mixed incontinence - You have symptoms of more than 1 type of urinary incontinence.
  • Because incontinence may affect your physical and emotional recovery, it is of great value to understand how to manage this problem.

How Long Will Incontinence Last?

It is common to have incontinence for a time after prostate surgery. If you have stress incontinence, you may need to wear pads for a few weeks or months. In most cases, urinary control will return. Still, incontinence may last as long as 6 to 12 months. It's rare for it to last more than a year.

Are there Treatments for Incontinence After Prostate Cancer Treatment?

Treatment for incontinence depends on the type and severity of the problem. Ask your doctor about treatment choices, risks and benefits, and what you should expect.

  • Physical therapy can help you regain bladder control. Your doctor can write you a prescription for it. Most health plans will cover it.
    • Kegel exercises build up the pelvic floor muscles, training them to keep urine in the bladder. If you're going to have prostate cancer surgery, your doctor may suggest that you start doing these exercises before your surgery.
    • Biofeedback may be used with Kegel exercises to help you judge how well the pelvic floor muscles are working and let you know whether you are doing the exercises the right way.
    • Neuromuscular electrical stimulation uses a device that sends electrical impulses to nerves, which causes muscles to contract. It may be used with Kegel exercises to help train the pelvic floor muscles to contract properly.
  • Timed voiding, a way to reduce urinary frequency with planned bathroom visits. It's used to help your bladder spread out so that it can hold more urine. Your nurse or doctor can help you make a plan for timed voiding.
  • Avoiding bladder irritants during the healing period. These foods and drinks can bother the bladder: 
    • Caffeine in coffee, tea, and sodas
    • Acidic drinks such as juices
    • Alcohol
    • Artificial sweeteners
    • Spicy foods
  • Medication can calm bladder irritability and help reduce urine leaks.
  • Surgery is mainly offered if your bladder has tried to heal on its own, but healing is not complete after at least a year. Your doctor will talk with you about these choices if other treatments haven't helped with your urinary problems.
  • Products such as pads can help reduce pain from urine leakage. These products do not treat incontinence but do help keep up a higher quality of life.

What if Prostate Cancer Returns?

Prostate cancer may return. Durable (or long-term) remission depends on the specifics of your cancer. If you'd like to learn more about how to manage advanced prostate cancer, read our advanced prostate cancer article. 

Updated March 2019

More Information

Questions to Ask Your doctor

About Diagnosis:
  • What is my Gleason score, the grade and the stage of my cancer?
  • How aggressive is this cancer? Is it likely that my cancer will spread? (Has it spread?)
    • If the cancer has spread, where?
  • Do I need more tests now?;
  • What type of schedule should I be on to track changes with this cancer?
About Treatment:
  • What are my treatment choices (including surveillance, localized therapy or systemic therapy)?
    • What are the advantages and disadvantages of each?
    •  What are the time considerations and costs for each?;
    • What is your experience with each option?
    • Would I have to go somewhere special to get treatment?
  • Why do you recommend one type of therapy over another?
  • What are the chances for each treatment to manage my cancer and for how long?
  • What are the chances of complications from each treatment?
    • What kinds of complications are likely from each?
    • When are they likely to occur?
  • What if I choose no treatment (watchful waiting or active surveillance)?
    • How often will I need to take follow-up tests?
  • If I use hormone therapy, what type do you suggest and why?
    • How would we manage potential side effects from hormone therapy?
  • What are the chances that my cancer will return after treatment - and if it does, what options for treatment do I have then?
  • Can we develop a short and long-term plan for my care?
  • Is there someone you would recommend for another opinion?
About Side Effects & Recovery:
  • What are the potential side effects of the treatment you recommend: both immediately and in the long term?
  • How can I manage side effects?
    • How would we manage potential urinary dysfunction and for how long?
    • How would we manage potential erectile dysfunction and for how long?
    • What other side effects should I consider?
  • How much recovery time will be required after surgery?
  • Will I need to take time off from work or other activities to manage treatment and treatment side effects?

Updated August 2018

Explore Further

Urology Care Podcast
Urology Care Podcast

Listen to The Urology Care Podcast, the Urology Care Foundation’s official podcast.

UrologyHealth extra
UrologyHealth extra®

Read the latest issue of UrologyHealth extra®, the Urology Care Foundation's patient-focused magazine.