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Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. In fact, more than 65% of all prostate cancers are diagnosed in men over the age of 65.
But the roles of race and family history are important as well. African American men are 61% more likely to develop prostate cancer compared with Caucasian men and are nearly 2.5 times as likely to die from the disease. Men with a single first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed at a young age, with the highest risk seen in men whose family members were diagnosed before age 60. (When weighing risk factors for prostate cancer, it’s also important to recognize that there are non-risk factors, or factors that have not been linked to an increase in risk.)
Although genetics might play a role in deciding why one man might be at higher risk than another, social and environmental factors, particularly diet and lifestyle, likely have an effect as well.
In fact, research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease.
More information about how dietary and lifestyle changes can affect the risk of prostate cancer development and progression can be found in the Nutrition, Exercise and Prostate Cancer guide.
Non-Risk Factors
Equally important to knowing what has been linked to an increase in the risk of developing prostate cancer is knowing what has not been linked to an increase in risk.
The most common misperception about the risk of prostate cancer is that the presence of non-cancerous conditions of the prostate increase the risk of prostate cancer.
Although these conditions can cause symptoms similar to those of prostate cancer and should be evaluated by a physician, there is no evidence that having BPH (benign prostatic hyperplasia) or prostatitis increases the risk for developing prostate cancer.
BPH
BPH is a non-cancerous enlargement of the prostate. Because the urethra, the tube that carries urine from the bladder out of the body, runs directly through the prostate, enlargement of the prostate in BPH squeezes the urethra, making it difficult, and often painful, for men to urinate.
The growth of the prostate in men with BPH is unrelated to prostate cancer, and a number of research studies have shown that the presence of BPH does not make a man any more or less likely to develop prostate cancer.
Learn more about BPH
Prostatitis
Prostatitis is an infection in the prostate, and is the most common cause of urinary tract infection in men. Most treatment strategies are designed to relieve the symptoms of prostatitis, which include fever, chills, burning during urination, or difficulty urinating.
Research has shown that the presence of prostatitis does not make a man any more or less likely to develop prostate cancer.
Learn more about prostatitis
Sexual Activity
High levels of sexual activity or frequent ejaculation have been rumored to increase prostate cancer risk. This is untrue. In fact, studies show that men who reported more frequent ejaculations had a lower risk of developing prostate cancer.
Prevention
The ultimate goal of prostate cancer prevention strategies is to prevent men from developing the disease. Unfortunately, despite significant progress in research over the past 16 years, this goal has not yet been achieved. Both genetic and environmental risk factors for prostate cancer have been identified, but the evidence is not yet strong enough to be helpful to men currently at risk for developing prostate cancer.
By contrast, some success has been seen with strategies that can delay the development and progression of prostate cancer. Studies with finasteride and dutasteride, which are typically used for men with the noncancerous condition BPH, have shown that they might play a role in slowing the development of prostate cancer; ongoing studies will help to define the optimal role of these agents.
In the meantime, diet and lifestyle modifications have been shown to reduce the risk of prostate cancer development and progression, and can help men with prostate cancer live longer and better lives.
Read Dr. Patrick Walsh's Top 10 Considerations for Preventing Prostate Cancer.
More information about how dietary and lifestyle changes can be incorporated into everyday life can be found in the Nutrition and Prostate Cancer guide.
PSA & DRE Screening
The purpose of screening for cancer is to detect the cancer at its earliest stages, before any symptoms have developed.
Some men, however, will experience symptoms that might indicate the presence of prostate cancer. Because these symptoms can also indicate the presence of other diseases or disorders (such as BPH or prostatitis), these men will undergo a more thorough work-up. Typically, men whose prostate cancer is detected through screening are found to have very early-stage disease that can be treated most effectively.
Screening for prostate cancer can be performed quickly and easily in a physician’s office using two tests: the PSA (prostate-specific antigen) blood test, and the digital rectal exam (DRE).
The PSA Blood Test
PSA is a protein produced by the prostate and released in very small amounts into the bloodstream. When there’s a problem with the prostate, such as when prostate cancer develops and grows, more and more PSA is released, until it reaches a level where it can be easily detected in the blood.
During a PSA test, a small amount of blood is drawn from the arm, and the level of PSA is measured. PSA levels under 4 ng/mL are usually considered "normal," results over 10 ng/mL are usually considered "high," and results between 4 and 10 ng/mL are usually considered "intermediate."
However, PSA can also be elevated if other prostate problems are present, such as BPH or prostatitis, and some men with prostate cancer have "low" levels of PSA. This is why both the PSA and DRE are used to detect the presence of disease.
The Digital Rectal Exam
During a DRE, the physician inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture. Often, the DRE can be used by urologists to help distinguish between prostate cancer and non-cancerous conditions such as BPH.
Should I Be Screened?
The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk, such as African American men and men with a strong family history of one or more first-degree relatives diagnosed at an early age, should begin testing at age 45. However, all men over 40 should speak with their doctors at the the time of their annual physicals and develop a proactive prostate health plan that is right for them based on their lifestyles and family history.
There is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening note that because most prostate cancers grow very slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems.
Because a decision of whether to be screened for prostate cancer is a personal decision, it's important that each man talk with his doctor about whether prostate cancer screening is right for him.
Diagnosis (Gleason Scores and Staging the Disease)
Although the DRE and PSA tests cannot diagnose prostate cancer, they can signal the need for a biopsy to examine the prostate cells and determine whether they are cancerous. In some men, changes in urinary or sexual function lead to a full evaluation by the doctor, and, if prostate cancer is suspected, a biopsy will be performed.
The Biopsy
During a biopsy, needles are inserted into the prostate to take small samples of tissue, often under the guidance of ultrasound imaging. The biopsy procedure may cause some discomfort or pain, but the procedure is short, and can usually be performed without an overnight hospital stay.
Gleason Grading and Gleason Scores
Under normal conditions, prostate cells, just like all other cells in the body, are constantly reproducing and dying, and each new prostate cell has the same shape and appearance as all of the other prostate cells. But cancer cells look different, and the degree to which they look different from normal cells is what determines the cancer grade. "Low-grade" tumor cells tend to look very similar to normal cells, whereas "high-grade" tumor cells have mutated so much that they often barely resemble the normal cells.
The Gleason grading system accounts for the five distinct patterns that prostate tumor cells tend to go through as they change from normal cells. The scale runs from 1 to 5, where 1 represents cells that are very nearly normal, and 5 represents cells that don’t look much like prostate cells at all.
After examining the cells under a microscope, the pathologist looking at the biopsy sample assigns one Gleason grade to the most common pattern, and a second Gleason grade to the next most common pattern. The two grades are added, and the Gleason score, or sum, is determined.
Generally speaking, the Gleason score tends to predict the aggressiveness of the disease and how it will behave. The higher the Gleason score, the less the cells behave like normal cells, and the more aggressive the tumor tends to be.
Staging the Disease
Staging determines the extent of prostate cancer. Localized prostate cancer means that the cancer is confined within the prostate. Locally advanced prostate cancer means that most of the cancer is confined within the prostate, but some has started to escape to the immediate surrounding tissues. In metastatic disease, the prostate cancer is growing outside the prostate and its immediate environs, possibly to more distant organs.
A number of tests can be used to help determine the stage of disease. For example, cancers growing outside of the prostate can often be detected through traditional imaging studies, such as CT scans, MRIs, or x-rays, or through more specialized imaging tests such as bone scans. Note that because these tests cannot detect very small groups of cancer cells, results of these tests cannot be used alone to determine the stage of the disease, to guide treatment options, or to predict outcomes.
Metastatic disease can also be detected through imaging studies, and often can be detected in the lymph nodes. Cancers that spread to more distant organs tend to travel through the lymph system, a circulatory system similar to the blood stream that carries cells important in fighting infection and disease. During a biopsy, or, more often, during surgery, lymph nodes will be removed and examined for the presence of cancer cells.
Knowing the stage of disease can help to determine how aggressively the disease needs to be treated, and how likely it is to be eradicated by the available treatment options.
The National Cancer Institute has additional information about cancer staging.
Prostate Cancer Treatment
There is no "one size fits all" treatment for prostate cancer, so each man must learn as much as he can about various treatment options and, in conjunction with his physicians, make his own decision about what is best for him.
For most men, the decision will rest on a combination of clinical and psychological factors. Men diagnosed with localized prostate cancer today will likely live for many years, so any decision that is made now will likely reverberate for a long time. Careful consideration of the different options is an important first step in deciding on the best treatment course.
Consultation with all three types of prostate cancer specialists—a urologist, a radiation oncologist and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes.
Click on the following for more information about particular treatment options for prostate cancer:
Active Surveillance
Prostatectomy (Surgery)
Other Surgical Procedures
Radiation Therapy
Radiation Therapy for Advanced or Recurrent Prostate Cancer
Hormone Therapy
Chemotherapy
Other Treatment Options
Emerging Therapies
Side Effects
Improvements in treatment delivery over the years have significantly reduced the severity of side effects of prostate cancer treatments. Nevertheless, it is important to understand how and why these effects occur, and to understand how best to minimize how these side effects, if they occur, will affect daily life.
There are six broad categories of side effects from that are typically associated with prostate cancer treatments: urinary dysfunction, bowel dysfunction, erectile dysfunction, loss of fertility, effects due to the loss of testosterone, and side effects of chemotherapy. Depending on the treatment strategy used, some or all of these effects might be present. It’s also important to realize that not all symptoms are normal, and that some require immediate care. See When to Seek Help for more information.
A review of the roles of the prostate and its surrounding organs in the About the Prostate section can help in understanding how and why some of these effects occur.
Managing Bone Metastases and Pain
Prostate cancer cells that spread to the bone are known as prostate cancer bone metastases (not bone cancer). Once they settle in the bone, the cancer cells begin to interfere with the normal health and strength of the bones, often leading to bone pain, fracture, or other complications that can significantly impair one’s health.
Early detection of bone metastases can help to determine the best treatment strategy, and can help to ward off complications caused by the metastases.
In addition, because men with prostate cancer bone metastases often experience painful episodes, pain management and improving quality of life is an important part of all treatment strategies for men with bone metastases.
Nutrition & Prostate Cancer
Day after day, the effects of dietary and lifestyle changes on the development and progression of prostate cancer are being discussed and explored by leading researchers in the field.
Which foods and nutrients have been shown to be beneficial for patients with prostate cancer? How reliable are the data for nutritional strategies in prostate cancer? Are there foods or nutrients that might prevent prostate cancer or even prevent or delay a recurrence of the disease?
Here are some resources to help you answer these questions:
Nutrition, Exercise and Prostate Cancer Guide
By culling the data from the published literature, the Nutrition, Exercise and Prostate Cancer guide offers a comprehensive, yet concise overview of where we are today in the search for nutritional approaches to prostate cancer—and reminds us how much more we have yet to learn about how key nutritional strategies can affect the development and progression of prostate cancer. Click on the links below to read sections of the guide.
Understanding the Links Between Nutrition, Exercise, and Prostate Cancer
Obesity and Metabolism — Where We Went Wrong
Nutrition at the Molecular Level
The Delicate Balancing Act of Supplement Use
Implementing a Plan for Success
Incorporating Good Nutrition and Exercise Into Your Everyday Routine
A Commitment to Change
The Four S’s of Success
Prostate Cancer News: Lifestyle and Nutrition
Read the latest news about nutrition and lifestyle research.
The Taste for Living Cookbooks
The Taste for Living Cookbook and The Taste for Living WORLD Cookbook contain recipes that chef Beth Ginsberg created for prostate cancer survivor Mike Milken, who also serves as Chairman of the Prostate Cancer Foundation.
Issues to Consider
Most men with prostate cancer will live with their disease for many years. It’s therefore important to focus on the key issues to consider at each stage of disease.
The lists provided in this section are by no means exhaustive, and there might be other points to think about as well. The goal is to focus on what to know about each stage of disease, to be able to hold meaningful, regular dialogues with all members of the health care team.
The lists of issues to consider are divided into three parts:
What to consider when you’ve been diagnosed with early-stage disease
What to consider when your PSA starts to rise after initial treatment
What to consider when your PSA starts to rise during hormone therapy
Questions to Ask Your Doctor
The wide variety of approaches to prostate cancer makes it difficult to find the best treatment path. Obtaining answers to key questions is an important step in learning about prostate cancer, and can help guide the decision-making process.
The lists of questions to ask your doctor are divided into three parts:
What to ask when you’ve been diagnosed with early-stage disease
You’re Considering Surgery for Early-Stage Disease
You’re Considering Radiation Therapy for Early-Stage Disease
What to ask when your PSA starts to rise after initial treatment
What to ask when your PSA starts to rise during hormone therapy
