Understand prostate cancer

About 1 in 8 men will be diagnosed with prostate cancer in the United States. It is most common in older men.

The information on this page may help you gain a better understanding of a prostate cancer diagnosis and prepare you to make important decisions with your doctor.

What is prostate cancer?

The prostate gland is found only in males. It sits below the bladder (where urine is stored) and in front of the rectum (the last part of the lower intestine). The prostate makes some of the fluid found in semen. In younger men, the prostate is about the size of a walnut. But as men age, the prostate may get larger.

Prostate cancer starts when cells begin to grow out of control in the prostate gland. This type of cancer is one that may spread slowly to other areas of the body. In fact, most prostate cancers grow slowly. People with prostate cancer may not have symptoms or problems for years, or during their lifetime.

More than half of those diagnosed with prostate cancer are over 65 years old. According to the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) Program, the rate of prostate cancer incidence from 2016 to 2020 was 65% higher in non-Hispanic Black men compared to non-Hispanic White men. However, over 80% of cases are found before the cancer spreads from the prostate to organs far away from the prostate.

Risk factors for prostate cancer

Scientists have identified certain risk factors for prostate cancer. Anything that increases the chance of getting a disease is called a risk factor.

Having a risk factor, or even several risk factors, for a disease does not mean you will get that disease.

Risk factors for prostate cancer can include:

Age: The chance of being diagnosed with prostate cancer goes up after age 50, with about 6 out of 10 cases found in men older than 65 years

Race and/or ethnicity: Prostate cancer affects Black men and Caribbean men of African ancestry more often than other races. It also usually develops in these men at a younger age

Geography: Unlike other parts of the world, prostate cancer is very common in North America, northwestern Europe, Australia, and the Caribbean

Family history: Having a father or brother with prostate cancer more than doubles the risk of developing this cancer. This risk is higher for men with several affected relatives, especially if their relatives were young when diagnosed

Gene changes: Inherited gene changes may raise the risk of prostate cancer, though researchers think it’s a small percentage of cases. These changes include inherited mutations of BRCA1 or BRCA2 genes (also linked to breast and ovarian cancer in women) and Lynch syndrome, which is also known as hereditary non-polyposis colorectal cancer, or HNPCC

Talk to your doctor if you think you may be at increased risk.

Prostate cancer screening and diagnosis

It is important to talk with your doctor about the risks, benefits, and uncertainties of testing for prostate cancer. It is still unclear whether the benefits of prostate cancer screening outweigh the risk for most men. The American Cancer Society (ACS) recommendation for prostate cancer screening includes:

Age 45 for men at high risk: High risk includes Black men and men who have a first-degree relative (such as a father or brother) diagnosed with prostate cancer younger than age 65
Age 40 for men at higher risk: Higher risk includes those men with more than one first-degree relative (such as a father or brother) who had prostate cancer younger than age 65
Age 50 and older for men at average risk: Get screened for prostate cancer if they are expected to live at least 10 more years

There may be 2 parts of prostate screening:

Digital rectal exam: Your doctor will insert a finger into your butt (rectum) to check the size and texture of your prostate. Not every doctor will require a digital rectal exam
PSA test: This blood test shows how much prostate-specific antigen, or PSA, is in your blood. Although PSA is always in your blood, a cancerous prostate makes unusually high amounts of this substance

High levels of PSA can also mean other conditions, not just cancer, so your doctor cannot diagnose prostate cancer without additional tests. If prostate cancer is suspected, your doctor may perform some or all of the following diagnostic approaches.

Medical history/physical exam

Your health care provider may begin by taking your medical and family history. Bring in a list of old and new medicines, including over-the-counter medications and supplements. Inform your doctor if any family members have had prostate cancer

Blood and urine tests

Additional blood and urine tests may also be referred to as biomarker tests. Information from these tests helps your doctor decide whether a biopsy is necessary

Imaging

Your doctor may want to see pictures of your prostate. This may reveal the size of the prostate and if there is a mass present. If there is cancer, the scan can show if it has spread. Information from imaging also contributes to the decision to perform a biopsy or not. However, imaging may not be needed if other tests show a lower risk that the cancer will spread

Common imaging tests include:

CT scan: A computed tomography (CT or CAT) scan uses x-rays to take pictures of the inside of the body. This test may include contrast, sometimes called contrast dye, which is injected into the bloodstream and makes vessels, organs, and other tissues stand out in images

MRI scan: A magnetic resonance imaging (MRI) scan uses radio waves and magnets to take pictures inside the body. Like a CT scan, MRI scans may also be done with contrast. In a multiparametric MRI (mpMRI), multiple scans without contrast are done, followed by an MRI scan with contrast

PET scan: A positron emission tomography (PET) scan uses a radioactive drug called a tracer, which is injected into a vein and shows where cancer cells are in the body

PSMA-PET: PSMA-PET imaging uses a tracer that targets prostate-specific membrane antigen (PSMA), which is produced by prostate cancer cells

Bone scan: Because prostate cancer may spread to the bones, it may be necessary to have a bone scan. After a radioactive tracer is injected into your bloodstream, a special camera takes photos of the tracer in your bones. Bone damage shows up as bright spots on the image

A combination of imaging techniques: Your doctor may order one or more of these tests

Biopsy

Core needle biopsy: This is the most common biopsy for prostate cancer. A urologist will perform the procedure. A typical approach uses an ultrasound probe inserted into the rectum (butt) so the urologist can view the prostate. The urologist, using a hollow needle, may take multiple biopsies from different areas of the prostate. The samples are sent to a lab for analysis

Biomarkers and genetic tests may be used in prostate cancer

If you’ve been diagnosed with prostate cancer, your doctor may order biomarker testing. A biomarker is a biological molecule, which can be measured, and is found in prostate or lymph node tissues removed during a biopsy.

The presence and type of biomarkers found in your sample may help your doctor determine the treatment plan that is right for you. Keep in mind that these tests can identify lower-risk prostate cancer, which does not require aggressive treatment.

Tests for biomarkers may also be called molecular tumor tests, molecular assays, or analysis. Listed below are common molecular tests for the biomarkers associated with prostate cancer:

Decipher

Oncotype DX

Prolaris

Genetic tests

Genetic (germline) testing: Performed by using a sample of blood, urine, or saliva, genetic testing looks for inherited mutations (abnormal changes) that occur in every cell in your body. For prostate cancer, genetic testing looks for mutations in the following genes: BRCA1, BRCA2, ATM, CHEK2, MLH1, MSH2, PCM2, MSH6, PALB2, PMS2, and others.

Stages of prostate cancer

From the National Cancer Institute (NCI)

The information below is based on information originally published by the National Cancer Institute (NCI), the US government’s main agency for cancer research. Use this information to talk to your doctor about your specific stage of prostate cancer.

The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Grade Group.

PSA levels and Grade groups of prostate cancer

The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.

The Grade Group depends on the Gleason score:

Grade Group 1 is a Gleason score of 6 or less.
Grade Group 2 or 3 is a Gleason score of 7.
Grade Group 4 is a Gleason score of 8.
Grade Group 5 is a Gleason score of 9 or 10.

Stage 1 prostate cancer

In stage 1, the cancer is found in the prostate only.

The cancer is not felt during a digital rectal exam and is found by needle biopsy (done for a high PSA level) or in a sample of tissue removed during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Grade Group is 1.

Or stage 1 can be

The cancer is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is lower than 10 and the Grade Group is 1.

Stage 2 prostate cancer

In stage 2, cancer is more advanced than in stage 1, but has not spread outside the prostate. Stage 2 is divided into stages 2A, 2B, and 2C.

Stage 2A

Cancer is found in one-half or less of one side of the prostate. The PSA level is at least 10 but lower than 20 and the Grade Group is 1.

Or stage 2A can be

Cancer is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 1.

Stage 2B

Cancer is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 2.

Stage 2C

Cancer is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 3 or 4.

Stage 3 prostate cancer

Stage 3 is divided into stages 3A, 3B, and 3C.

Stage 3A

Cancer is found in one or both sides of the prostate. The PSA level is at least 20 and the Grade Group is 1, 2, 3, or 4.

Stage 3B

Cancer has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 1, 2, 3, or 4.

Stage 3C

Cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 5.

Stage 4 prostate cancer

Stage 4 is divided into stages 4A and 4B.

Stage 4A

The cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The PSA can be any level and the Grade Group is 1, 2, 3, 4, or 5.

Stage 4B

Cancer has spread to other parts of the body, such as the bones or distant lymph nodes. Prostate cancer often spreads to the bones.

Common types of treatment

Once your doctor has performed the necessary tests to confirm your cancer diagnosis, its stage of cancer, and its biomarkers, they will work with you to determine which treatment plan is right for you.

Your doctor may recommend one or more of the following treatments:

Active surveillance or watchful waiting: Used with older men who aren’t showing symptoms or have other medical conditions, active surveillance/watchful waiting is monitoring the condition without giving cancer treatment
Bisphosphonate therapy: Bisphosphonate drugs are prescribed to lessen the risk of bone fracture in men with prostate cancer that has spread to the bone
Chemotherapy: The use of drugs to stop cancer cell growth
Immunotherapy: A treatment using the patient’s immune system to attack cancer cells
Hormone therapy: The use of drugs, surgery, or other hormones to remove hormones or block their action. This stops cancer cells from growing
Radiation therapy and radiopharmaceutical therapy:
- Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells or keep them from growing
- Radiopharmaceutical therapy is given as an injection of radium-223 into a vein, after which it travels through the bloodstream and then collects in parts of the bone that have cancer so that it can kill the cancer cells
Surgery: Removing the affected tissue is done when the patient is in good health. This can mean removing part or all of the prostate, as well as other affected areas
Targeted therapy: The use of drugs or other substances to identify and attack specific cancer cells

Visit Common cancer treatments for more information.

Example questions to ask your doctor about prostate cancer

What stage is my cancer?
Has the cancer spread beyond my prostate?
What is the Gleason score of my cancer? What does that mean?
Was my cancer tested for biomarkers?
What do the results of my biomarker tests mean?
Do I need any other tests before we decide on treatment?
Is watchful waiting/active surveillance an option for me?
Based on what you’ve learned about my cancer, what is my prognosis (outlook)?
What treatment choices do I have?
What is the goal of treatment (to remove or treat the cancer, slow its growth, ease symptoms, etc)?
Should I get a second opinion?
If surgery is recommended, is there anything else I need to do or take before or after surgery?
How quickly do we need to decide on treatment?
Once we decide on a treatment plan, what kind of side effects do you think I might have?

        
What stage is my cancer?
Has the cancer spread beyond my prostate?
What is the Gleason score of my cancer? What does that mean?
Was my cancer tested for biomarkers?
What do the results of my biomarker tests mean?
Do I need any other tests before we decide on treatment?
Is watchful waiting/active surveillance an option for me?
Based on what you’ve learned about my cancer, what is my prognosis (outlook)?
What treatment choices do I have?
What is the goal of treatment (to remove or treat the cancer, slow its growth, ease symptoms, etc)?
Should I get a second opinion?
If surgery is recommended, is there anything else I need to do or take before or after surgery?
How quickly do we need to decide on treatment?
Once we decide on a treatment plan, what kind of side effects do you think I might have?

What’s next

Common cancer treatments

Be involved in treatment decisions

Who is on your care team

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