About Prostate Cancer

Nearly all types of prostate cancer start in the gland cells that make the prostate fluid. These cancers are called adenocarcinomas. Other types of cancer can also start in the prostate. These include small cell carcinoma, transitional cell carcinoma, and sarcoma. But these types of cancer are rare. Most men with prostate cancer have adenocarcinoma.

Prostate cancer often causes no symptoms in its early stages. By the time symptoms start, the cancer may have spread outside the prostate. When that happens, more extensive treatment may be needed.

These are the symptoms that can occur:

• A need to urinate often, especially at night

• Weak or interrupted urine flow

• Trouble starting to urinate

• Trouble emptying the bladder

• Being unable to urinate

• Accidental urination

• Painful or burning when you urinate

• Blood in your urine or semen

• Pain or stiffness in your lower back, hips, ribs, or upper thighs

• Loss of ability to have an erection

• Weakness or numbness in legs or feet

Many of these symptoms may be caused by other health problems so it's important to see your healthcare provider if you have any of these symptoms. Only a healthcare provider can tell if you have cancer.

Screening means checking for a health problem before a person has symptoms. It's still not clear exactly how helpful screening is for prostate cancer. Learning more about prostate cancer screening and the risks and benefits of it can help you decide if it's right for you.

Two screening tests can be used to check for prostate cancer:

• PSA blood test. This test looks at the level of prostate-specific antigen (PSA) in the blood. PSA is a protein made by prostate cells. A high level means it's more likely that a man has prostate cancer.

• Digital rectal exam (DRE). In this exam, the healthcare provider puts a lubricated, gloved finger into the rectum to check the size of the prostate and feel for lumps or abnormal areas.

Abnormal results on these screening tests can mean that a man might have prostate cancer, but these tests can’t diagnose prostate cancer. A prostate biopsy is needed to be sure.

Not all healthcare providers agree that prostate cancer screening is useful. This is because:

• PSA test results aren't always right. In some cases, the PSA test can have false-positive or false-negative results. A false positive means that test results show that a man may have cancer when he doesn’t. This can lead to more tests, which can lead to stress and possible harm from the tests. A false negative means that test results don’t show cancer when a man has it. This can mean you don't get the extra tests or treatment you need.

• Finding prostate cancer early may not be helpful. Even if screening does help find cancer early, prostate cancer often grows slowly and mostly affects older men. This means that finding it early may not lead to a longer life. Many men with prostate cancer die years later of other causes without having symptoms or being treated for their prostate cancer.

But healthcare providers can’t always tell which cancers are likely to grow fast and need to be treated. And even if a cancer is slow-growing, a man may not be OK with living with cancer and want it treated. Treatment for prostate cancer can have very serious side effects, such as erection problems and lack of urine control (incontinence). Men are advised to talk with their healthcare providers to make an informed decision about screening.

If you're thinking about being screened, talk with your healthcare provider about:

• Your personal risk of prostate cancer based on your age, race, and family history

• What the screening test results can and can’t tell you

• What the next steps would be if the test results show you might have prostate cancer

• What your options would be for treating or not treating right away

• What the treatment options are if you were to have treatment, including the benefits and possible harms of different treatments

You and your doctor will decide how to approach your prostate cancer care.

The treatment options include:

• Active surveillance
• Surgery, including robotic-assisted prostate removal
• Radiation
• Hormone therapy
• Chemotherapy
• Cryotherapy