Prostate Cancer 101

Not including skin cancer, prostate cancer is the most common cancer in American men.  The prostate is a part of the male reproductive system, which includes the penis, prostate and testicles.  It is located just below the bladder and in front of the rectum.  It is about the size of a walnut and surrounds the urethra. 

Who is at Risk?

All men are at risk for prostate cancer.  Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 or 3 men will die from prostate cancer.  The most common risk factor is age – the older a man is, the greater the chance of getting prostate cancer. 

Some men are, however, at in increased risk for prostate cancer.  African Americans and those who have a family history of prostate cancer are at a greater risk of getting or dying from prostate cancer.

What are the symptoms?

Different people have different symptoms for prostate cancer, some men have no symptoms at all.  Typical symptoms are:

  • Difficulty starting urination.
  • Weak or interrupted flow of urine.
  • Frequent urination, especially at night.
  • Difficulty emptying the bladder completely.
  • Pain or burning during urination.
  • Blood in the urine or semen.
  • Pain in the back, hips, or pelvis that doesn’t go away.
  • Painful ejaculation.

What is the screening for prostate cancer?

Screening for prostate cancer begins with a blood test called a prostate specific antigen (PSA) test. This test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by—

  • Certain medical procedures.
  • Certain medications.
  • An enlarged prostate.
  • A prostate infection.

Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results. If the PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer.

Who should get screened?

Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer.

In 2018, the U.S. Preventive Services Task Force (USPSTF) made the following recommendations about prostate cancer screening—

  • Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.
  • Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
  • Men who are 70 years old and older should not be screened for prostate cancer routinely.

The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread. However, most prostate cancers grow slowly or not at all.

Possible Benefits of Screening

The benefits of screening for prostate cancer may include—

  • Finding prostate cancers that may be at high risk of spreading, so that they can be treated before they spread. This may lower the chance of death from prostate cancer in some men.
  • Some men prefer to know if they have prostate cancer.

Possible Harms

  • Screening men age 55 to 69 years of age may prevent about 1 death for every 1,000 men screened.
  • Screening may prevent 3 men from developing prostate cancer that spreads to other places in the body for every 1,000 men screened.
  • The possible harms of screening for prostate cancer include harms from screening, diagnosis, and treatment.

How is prostate cancer treated?

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are—

  • Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
  • Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
  • Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer. There are two types of radiation therapy—
  • External radiation therapy. A machine outside the body directs radiation at the cancer cells.
  • Internal radiation therapy (brachytherapy). Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.

For more information or to see if you should be screened for prostate cancer talk to your physician.  

Prostate Cancer