Top questions about prostate cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on June 14, 2022.

What you should know about prostate cancer

Prostate cancer is the second-most common type of cancer found in American men, after skin cancer. If you or a loved one is diagnosed with prostate cancer, one of the first things you can do is educate yourself about the disease and available treatment options.

What is prostate cancer?

Prostate cancer is cancer that occurs in a man’s prostate—the walnut-size gland in the male reproductive system. It is located below the bladder in front of the rectum and surrounds the upper part of the urethra, the tube that empties urine from the bladder. The prostate helps regulate bladder control and produces the seminal fluid that nourishes and transports sperm.

How common is prostate cancer?

Thirteen out of every 100 men in America will get prostate cancer at some point in their lives, according to the Centers for Disease Control and Prevention (CDC). Out of those thirteen, two to three will die from prostate cancer. Age is the most common risk factor. As you age, the risk of developing prostate cancer continually increases.

What causes prostate cancer?

It isn't yet known what specifically causes prostate cancer, but there are several risk factors for the disease, including age and ethnicity.

Is prostate cancer genetic?

Most men who develop prostate cancer have no family history. At the same time, prostate cancer seems to run in some families which suggests a genetic component. A man’s risk of prostate cancer more than doubles when his father, son, or brother has it, too, according to the American Cancer Society. Prostate cancer may run in families not only because of shared genes but also because they may be exposed to the same environmental factors that may be cancer-causing and have similar lifestyle habits.

What are symptoms or signs of prostate cancer?

Early prostate cancer usually causes no symptoms. Typically, it's found by a PSA test or digital rectal exam.

When should I start testing for prostate cancer?

There are benefits and risks to being tested. Four key groups—the U.S. Preventative Services Task Force, the American Cancer Society, the National Comprehensive Cancer Network and the American Urological Association—have urged family physicians to discuss the value and risks of routine testing with all male patients, taking into consideration their unique medical history. However, it’s worth noting that the majority of studies of prostate cancer prevention, screening, treatment and outcomes dramatically underestimate the risk to African-American men, who are 60 percent more likely to get prostate cancer.

Which doctors are involved in diagnosing prostate cancer?

The main types of doctors who treat prostate cancer include:

  • Urologists and urologic oncologists: surgeons who treat diseases of the urinary system and male reproductive system, including the prostate, and who treat prostate cancer by removing tumors and surrounding tissue during an operation
  • Radiation oncologists: doctors who treat cancer with radiation therapy
  • Medical oncologists: doctors who treat cancer with medicines such as chemotherapy or hormone therapy

What are the potential side effects of prostate cancer treatment?

There are possible risks and potential side effects with any type of treatment for prostate cancer, including active surveillance. They include incontinence, urinary issues, sexual dysfunction, hot flashes, nausea and fatigue. Other side effects, such as bowel changes, are also possible, depending on the type of treatment. Some of these may be temporary, while others are long term.

Questions about prostate cancer treatment

Treatment for prostate cancer depends on many factors, including the type and location of the disease. Here are the answers to some common questions about prostate cancer treatment:

Should I consider surgery?

A radical prostatectomy is a surgical procedure in which the prostate is removed, along with any nearby tissue that contains prostate cancer cells. This is a common treatment for localized prostate cancer. The da Vinci® Surgical System allows the surgeon to offer this procedure using a minimally invasive approach.

There are two options, open or laparoscopic surgery:

  • In an open radical prostatectomy, a surgeon makes a single long incision to remove the prostate.
  • In a laparoscopic prostatectomy, which may be performed using robotic assistance, the surgeon uses a mechanical device to remove the prostate via several small incisions. This may sometimes result in a quicker recovery time.

Is radiation therapy an option for me?

Radiation therapy uses high-powered X-rays to kill cancer cells, shrink tumors and provide relief of certain cancer-related symptoms. Radiation therapy may be used in men with both early- and advanced-stage prostate cancer. It may also be used in combination with surgery to kill remaining cancer cells.

Radiation oncologists use a variety of therapies and tools to deliver maximum radiation doses, with less damage to healthy tissues and organs. Focusing the radiation directly on the prostate may lower the risk of side effects. Our range of radiation therapy options includes external beam radiation therapy, stereotactic body radiation therapy, high-dose rate brachytherapy and increasingly less common, low-dose rate brachytherapy.

Can I treat my prostate cancer with chemotherapy?

Chemotherapy is the use of strong drugs to kill cancer cells. It is not a common treatment for prostate cancer, but it may be used if cancer has spread outside the prostate gland and hormone therapy has been unsuccessful. Typically, chemotherapy drugs for prostate cancer are usually given intravenously (injected into a vein). Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.

What is active surveillance?

When you receive a prostate cancer diagnosis, your natural inclination may be to remove the cancer immediately. But not all prostate cancers are aggressive and many do not spread at the same rate. For some patients, the recommended treatment may just be to keep a close eye on the disease, through a strategy known as active surveillance. Active surveillance may be recommended for patients with:

  • A small tumor that is confined to the prostate
  • A slow-growing cancer
  • A cancer that is at low risk of growing locally or spreading

Active surveillance is not the recommended treatment for every patient with localized prostate cancer. A number of men, given the possibility that the cancer could become more aggressive, prefer to eliminate even the smallest tumor and accept the risk of side effects from treatment. It’s a very personal decision, and we’re here to explain all of your options and answer your questions or concerns.

How does hormone therapy work?

Hormone therapy for prostate cancer is treatment that decreases the body’s levels of androgens (called androgen deprivation therapy, or ADT) with the intent of shrinking the size of the cancer in the prostate as well as other areas (metastases).

Am I a candidate for immunotherapy?

In patients with metastatic prostate cancer, immune therapies may be recommended as a second-line treatment for patients who have not been successful with hormone therapy.

Where does prostate cancer spread?

It’s possible for prostate cancer cells to break away from the tumor and spread anywhere in the body. However, in most men, prostate cancer cells that spread tend to metastasize to nearby lymph nodes first, then to bones. Even if the cancer has spread to other areas of the body, it’s still referred to as prostate cancer because that is where it originated.

Questions to ask your doctor

Asking questions of your doctor may help you make more informed decisions about your care. Open communication between a patient and his doctor is extremely important. Here are answers to some common questions prostate cancer patients should ask their doctors:

What is a prostate-specific antigen (PSA) level?

PSA is a substance produced by both the healthy prostate and prostate cancer. A PSA test is used primarily to screen for prostate cancer. The levels of PSA in the blood may be higher in men who have prostate cancer or other conditions. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. The PSA test may detect high levels of PSA that could indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, may also increase PSA levels.

What is a Gleason score?

The Gleason scale, developed by physician Donald Gleason in the 1960s, provides a score that helps predict the aggressiveness of prostate cancer. Following a needle prostate biopsy, pathologists assign two numbers to prostate cells ranging from 1 to 5 based on how they look under a microscope, though grades of 1 and 2 are rarely given. The higher the grade, the more abnormal the prostate cells appear. Since most prostate cancers contain cells of different grades, the two most common types are used to determine the Gleason score. The grades of the two most common cell types are added together to find the Gleason Sum, typically resulting in a number between 6 and 10. A higher sum means the cancer is more likely to behave aggressively.

A Gleason Sum of six often means the cancer is likely to grow and spread very slowly. Many years may pass before these cancers become a problem.

A Gleason Sum of seven may mean the cancer is likely to grow and spread at a modest pace. Some of these patients are candidates for active surveillance, while others should be treated immediately.

A Gleason Sum between eight and 10 may mean the cancer is likely to grow and spread aggressively. These patients are high risk and require immediate treatment. 

How likely is my cancer to progress without treatment?

Oncologists who treat prostate cancer take a number of factors into consideration that predict how fast the cancer will grow. These factors include the clinical stage of the cancer, the PSA level and the appearance of the prostate cancer cells under the microscope (the Gleason Sum). Together, these factors may be used to predict an individual’s risk of prostate cancer progression.

How much experience do you have treating my type and stage of prostate cancer?

Prostate cancer experts are trained and experienced in knowing both when and how the cancer should be treated. Oncologists who are not only experienced in treating cancer but in treating your type of cancer are better equipped to explain the comprehensive treatment options available.

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