Understanding Prostate Cancer: Risk Factors and Symptoms

Prostate cancer is the most common cancer type in men, except for skin cancer. The American Cancer Society estimates that nearly 270,000 men in the US will be diagnosed with the disease in 2022. According to the Centers for Disease Control and Prevention (CDC), about 13 in every 100 men will have prostate cancer at some point in their lives, and two to three of them will die of the disease. However, nearly 100 percent of men diagnosed with prostate cancer live at least five years with the disease.

The prostate gland is beneath the bladder and in front of the rectum. It is about the size of a walnut and helps produce semen. Prostate cancer occurs when cells in the prostate gland begin to grow out of control and form tumors.

Causes and risk factors of prostate cancer

It’s not clear what causes prostate cancer, but there are risk factors that will boost your chances of developing it. Let’s take a look.

• Age. This is the number one risk factor. Most cases of prostate cancer are diagnosed in men 65 and over. An estimated one in 12 men over 70 will get prostate cancer. Younger men also can develop the disease, but it’s rare in men under 50.
• Race/Ethnicity. Though it’s not clear why, African American men are more likely to get prostate cancer than white men, and they are twice as likely to die from it. They also have a higher risk of being diagnosed at a younger age. African American men are often diagnosed with more advanced prostate cancer and have higher odds of developing a more aggressive and difficult to treat form of prostate cancer.
• Genetics. Men with a family history of prostate cancer are also at higher risk. If your father or a brother had prostate cancer, your risk doubles. It goes up even higher if you have two or more relatives with the disease, especially if those relatives developed the disease when they were younger.
• Inherited gene mutations that play a role in some types of other cancer, such as BRCA1 and BRCA2 which cause breast and ovarian cancer, also contribute to prostate cancer. Overall, gene mutations can be a factor in about 10 percent of prostate cancer cases.

Symptoms of prostate cancer

Prostate cancer, especially in its early stages, rarely causes any symptoms. If the disease has progressed, however, some symptoms may occur. They include:

• Difficulty urinating. Your stream may be slow or weak and you may have to go more frequently, particularly during the night.
• Blood in your urine or semen.
• Erectile dysfunction (ED).
• Bone pain, including in the hips, spine, and other areas when cancer has spread beyond your prostate to your bones.
• Bowel and/or bladder incontinence.
• Weakness or tingling in your legs and feet.

If you have any of these symptoms, see your doctor. They are likely caused by something other than prostate cancer, such as non-cancerous growth of your prostate that’s normal with age. However, you should be examined.

Prostate cancer screening and diagnosing

Most prostate cancer is caught early, thanks to screening. Two tests are common.

• PSA. This blood test measures a protein called prostate-specific antigen (PSA). If it’s above 4 nanograms per milliliter, your likelihood of cancer goes up.
• Digital Rectal Exam (DRE). A doctor feels your prostate with a gloved finger, examining it for lumps or other abnormalities that may indicate a tumor.

Neither test is definitive, and you should talk to your doctor about whether screening is right for you. This conversation should take place starting at age 50 for most men. Because of their higher risk of prostate cancer, African American men should talk to their doctor at age 45. Men with a family history of the disease should start the discussion at age 45 if only their father or a brother had it. If more first-degree relatives have had prostate cancer, talk to your doctor when you’re 40.

If you are over 70 or not expected to live ten more years due to your current health, screening is not recommended.

If screening suggests you have cancer, you can then undergo a biopsy to confirm. During this procedure, a small amount of tissue from your prostate will be removed and examined in a laboratory. Your doctor may use imaging tests, such as magnetic resonance imaging (MRI) or ultrasound, to help find the most suspicious spots for testing.

If the biopsy results are positive, you have cancer. You now need to know the stage, or how advanced your cancer is. This is based on something called a Gleason score. Each of your prostate tissue samples is evaluated. The more abnormal your cells, the higher your Gleason score, which can range from 6 to 10. A score of 6 likely means slow-moving cancer that may not require treatment. As the Gleason score rises, so does the likelihood that you have an aggressive, potentially deadly cancer. Your Gleason score will help your doctor determine the best treatment for you.

Prostate cancer treatment

Active surveillance or watchful waiting. For older men with other health issues, prostate cancer may require no treatment. As cancer can move slowly, these men are more likely to die of other causes, such as old age. But it’s not possible to predict what your cancer will do. For that reason, doctors often recommend something called active surveillance or watchful waiting for men who don’t have fast-moving cancer.

• Active Surveillance. This means that you will have regular tests to determine if your cancer has started to get worse. A doctor typically won't consider treatment until active surveillance shows it's getting worse
• Watchful Waiting. This involves fewer tests than active surveillance, and treatment, if it becomes necessary, will be done to ease the symptoms of your cancer rather than attempt to cure it.

If your cancer is more advanced or if you don’t feel comfortable remaining untreated, you have options.

Surgery. This is often recommended if your cancer has not spread beyond your prostate. During surgery, your entire prostate and nearby tissue will be removed. This is called a radical prostatectomy. It may cure your cancer. However, it can have significant side effects, including:

• Urinary incontinence, which is often temporary
• Erectile dysfunction, which may or may not be temporary

Radiation Therapy. This type of treatment has the same success rate as surgery for prostate cancer that has not spread beyond the prostate. The most commonly used type is called external beam radiation therapy (EBRT). Depending on the type of EBRT your doctor recommends, you will undergo as few as five or as many as 45 sessions of radiation. Side effects may include:

• Frequent urination or bowel movements during treatment and for a few weeks after.
• Erectile dysfunction usually develops slowly after treatment.

Hormone Therapy. This treatment keeps your testicles from producing testosterone, a male sex hormone that fuels the growth of prostate cancer. Hormone therapy is typically used if your cancer has spread elsewhere in your body, though in some cases, it may be used alongside radiation therapy. There are two types of hormone therapy:

• Surgical castration (orchiectomy), in which your testicles are removed.
• Chemical castration, in which medications are used to halt the production of testosterone or to keep it from interacting with cancer cells.

While hormone therapy slows prostate cancer, it does not cure it. Eventually, it will become ineffective and your cancer will grow again. Side effects of hormone therapy include:

• Erectile dysfunction.
• Low sex drive.
• Weight gain.
• Osteoporosis.
• Shrinkage of testicles and penis.
• Fatigue.
• Anemia.

Chemotherapy. This type of treatment is used for cancers that have spread beyond the prostate. It can help you live longer and reduce the pain caused by the disease, but it does not cure prostate cancer.

Everyone’s experience with prostate cancer is individual, so be sure to actively communicate with your doctor about your concerns and needs as you discuss treatment options.