Prostate Cancer: Symptoms, Diagnosis & Treatment Options

What Is Prostate Cancer?

Prostate cancer occurs when abnormal cells in the prostate gland grow uncontrollably, forming a tumor. The prostate is a walnut-sized gland located below the bladder that produces seminal fluid. Prostate cancer is the most common cancer in men, with approximately 1.4 million new cases diagnosed globally each year.

The prostate gland is an essential part of the male reproductive system, surrounding the urethra (the tube that carries urine from the bladder). Its primary function is to produce prostatic fluid, which mixes with sperm from the testicles and fluid from other glands to create semen. Because of its location near the urethra, prostate problems—whether cancerous or benign—often affect urination.

Prostate cancer typically develops in the outer portion of the prostate gland, which is why early-stage cancers often cause no symptoms. The cancer usually grows slowly, and it can take 10 to 15 years before it spreads or causes noticeable problems. However, some forms of prostate cancer are more aggressive and can spread quickly to other parts of the body, particularly the bones, lymph nodes, and in advanced cases, organs like the liver and lungs.

Understanding the nature of prostate cancer is crucial because not all cases require immediate treatment. Many men live with slow-growing prostate cancer for years without it significantly impacting their health. This has led to the development of "active surveillance" as a management strategy, where doctors closely monitor the cancer rather than treating it immediately. This approach helps avoid unnecessary treatment side effects while still allowing for intervention if the cancer begins to progress.

Who can get prostate cancer?

Prostate cancer can affect anyone born with a prostate gland. This includes cisgender men and transgender women who have not had the prostate removed. Even individuals who have undergone gender-affirming surgery may retain their prostate and remain at risk.

Age is the most significant risk factor—half of all prostate cancer diagnoses occur in men over 70 years old, and the disease is extremely rare before age 50. However, certain groups face higher risks. Men of African descent have significantly higher incidence rates and are more likely to be diagnosed at younger ages. Having a father or brother with prostate cancer doubles your risk, and this risk increases further if multiple family members are affected or if they were diagnosed before age 55.

Approximately 5% of prostate cancers are linked to inherited genetic mutations, particularly in the BRCA1 and BRCA2 genes (the same genes associated with breast and ovarian cancer). Men with these mutations may develop prostate cancer at younger ages and may have more aggressive forms of the disease.

What Are the Symptoms of Prostate Cancer?

Early prostate cancer typically causes no symptoms. When symptoms occur, they commonly include frequent urination (especially at night), weak urine stream, difficulty starting urination, blood in urine or semen, and pain in the hips, back, or pelvis. Many of these symptoms overlap with benign prostate conditions.

One of the challenges with prostate cancer is that early-stage disease usually produces no symptoms at all. This is because most prostate cancers develop in the outer portion of the gland, away from the urethra. By the time symptoms appear, the cancer may have grown significantly or begun to spread. This is why screening programs using PSA blood tests were developed—to detect cancer before symptoms emerge.

When prostate cancer does cause symptoms, they often relate to urinary function because the growing tumor can press against the urethra or bladder. These urinary symptoms can include needing to urinate more frequently than usual, particularly during the night (nocturia), and experiencing a weak or interrupted urine stream. Some men notice difficulty starting urination or a sensation that the bladder hasn't completely emptied. Blood in the urine (hematuria) or semen can also occur, though this is less common.

Advanced prostate cancer that has spread to the bones can cause significant bone pain, particularly in the hips, spine, ribs, and pelvis. This pain may be persistent and worsen over time. Some men also experience unexplained weight loss, fatigue, or loss of appetite as the disease progresses. Erectile dysfunction can occur if the cancer affects nerves near the prostate.

Symptoms that are NOT always cancer

It's important to understand that many of these urinary symptoms are more commonly caused by benign (non-cancerous) conditions. Benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects most men as they age, causes very similar urinary symptoms. Prostatitis (inflammation of the prostate), urinary tract infections, and other conditions can also produce overlapping symptoms.

This is precisely why any persistent urinary changes should be evaluated by a healthcare provider. While symptoms alone cannot distinguish between cancer and benign conditions, proper medical evaluation—including PSA testing, physical examination, and potentially imaging or biopsy—can provide answers.

How Is Prostate Cancer Diagnosed?

Prostate cancer diagnosis involves PSA blood testing, digital rectal examination (DRE), MRI imaging, and prostate biopsy. The PSA test measures prostate-specific antigen levels in blood, while MRI helps identify suspicious areas. A biopsy, where tissue samples are taken from the prostate, provides definitive diagnosis and Gleason score grading.

The diagnostic process for prostate cancer typically begins with two simple tests: a PSA (prostate-specific antigen) blood test and a digital rectal examination (DRE). PSA is a protein produced by both normal and cancerous prostate cells, but cancer cells typically produce more of it. Elevated PSA levels can indicate prostate cancer, though they can also be raised by benign conditions like BPH, prostatitis, or even recent ejaculation or vigorous exercise.

During a digital rectal examination, a doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland through the rectal wall. The doctor checks for any hard lumps, irregular areas, or asymmetry that might suggest cancer. While this exam may feel uncomfortable, it's quick and provides valuable information that complements PSA testing.

If PSA levels are elevated or the DRE reveals abnormalities, the next step is usually an MRI scan of the prostate. Multiparametric MRI (mpMRI) has revolutionized prostate cancer diagnosis by allowing doctors to visualize suspicious areas within the prostate before performing a biopsy. This technology helps target biopsies more accurately and may help some men avoid unnecessary biopsies altogether.

Prostate biopsy

A prostate biopsy is the only way to definitively diagnose prostate cancer. During this procedure, a doctor uses a thin needle to collect small tissue samples from the prostate. Modern biopsies are often guided by MRI fusion technology, which combines MRI images with real-time ultrasound to precisely target suspicious areas identified on the MRI.

The tissue samples are examined under a microscope by a pathologist who determines whether cancer is present and, if so, assigns a Gleason score. The Gleason score (ranging from 6 to 10) indicates how aggressive the cancer appears. Lower scores (6) suggest slow-growing cancer, while higher scores (8-10) indicate more aggressive disease that may require more immediate treatment.

Additional tests for staging

If prostate cancer is confirmed, additional tests may be needed to determine whether it has spread beyond the prostate. These staging tests may include:

• Bone scan (skeletal scintigraphy): Uses a small amount of radioactive tracer to detect cancer spread to bones
• CT scan or PET scan: Creates detailed images to check lymph nodes and other organs
• PSMA PET scan: A newer, more sensitive imaging technique that detects prostate cancer cells throughout the body

What Are the Treatment Options for Prostate Cancer?

Prostate cancer treatment options include active surveillance (monitoring without immediate treatment), radical prostatectomy (surgical removal of the prostate), radiation therapy (external beam or brachytherapy), hormone therapy (androgen deprivation), chemotherapy, and newer targeted therapies. The best treatment depends on cancer stage, Gleason score, PSA level, age, and overall health.

Treatment decisions for prostate cancer are highly individualized because the disease behaves very differently from person to person. A slow-growing, low-grade cancer in an older man may never require treatment, while an aggressive cancer in a younger man may need immediate, intensive therapy. The treatment decision involves careful consideration of the cancer's characteristics, the patient's overall health, life expectancy, and personal preferences regarding potential side effects.

Modern prostate cancer care emphasizes shared decision-making, where doctors present all options and help patients choose based on their values and priorities. Some men prioritize avoiding treatment side effects like erectile dysfunction or incontinence, while others want the most aggressive treatment possible. Neither approach is inherently right—the best choice depends on individual circumstances.

Active Surveillance

Active surveillance is a management approach for low-risk prostate cancer where treatment is deferred while the cancer is closely monitored. This strategy recognizes that many prostate cancers grow so slowly they will never cause harm during a man's lifetime. By avoiding or delaying treatment, men can avoid side effects like incontinence and erectile dysfunction that often accompany surgery or radiation.

During active surveillance, men typically have PSA tests every 3-6 months, periodic digital rectal exams, and repeat biopsies (usually every 1-2 years) to ensure the cancer isn't becoming more aggressive. If monitoring shows signs of progression—rising PSA, higher Gleason score on repeat biopsy, or tumor growth—curative treatment can then be started.

Active surveillance is most appropriate for men with low-risk prostate cancer (Gleason score 6, low PSA, small tumor volume) and is supported by strong evidence showing that outcomes are excellent when used appropriately. It's important to distinguish active surveillance from "watchful waiting," which is a less intensive monitoring approach typically used for older men or those with limited life expectancy.

Surgery (Radical Prostatectomy)

Radical prostatectomy involves surgical removal of the entire prostate gland, seminal vesicles, and sometimes nearby lymph nodes. This procedure offers the best chance of cure for localized prostate cancer, with 10-year cancer-specific survival rates exceeding 95% for appropriate candidates.

Modern prostatectomy is most commonly performed using robotic-assisted laparoscopic techniques, which use small incisions and provide surgeons with magnified, 3D visualization and enhanced precision. Recovery time is typically shorter than with traditional open surgery, and experienced surgeons can often preserve the nerves responsible for erections and urinary control.

The main risks of prostatectomy include urinary incontinence and erectile dysfunction. Most men experience some degree of incontinence immediately after surgery, but the majority regain good urinary control within 3-12 months. Erectile function recovery depends heavily on age, baseline function, and whether nerve-sparing techniques were possible. Approximately 40-70% of men who had normal erections before surgery will recover sufficient function for intercourse, though this may take 1-2 years and often requires medication assistance.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells and offers an alternative to surgery with similar cure rates for localized disease. There are two main approaches:

External beam radiation therapy (EBRT) delivers radiation from a machine outside the body, precisely targeting the prostate while minimizing exposure to surrounding tissues. Modern techniques like intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) have improved precision and reduced side effects. Treatment typically involves daily sessions over 4-8 weeks, though newer SBRT protocols can complete treatment in just 5 sessions.

Brachytherapy involves placing radioactive seeds directly into the prostate, delivering high doses of radiation to the cancer while limiting exposure to nearby organs. Low-dose-rate (LDR) brachytherapy uses permanent seeds that slowly release radiation over months, while high-dose-rate (HDR) brachytherapy delivers radiation through temporarily placed catheters in more intensive sessions.

Radiation therapy's side effects differ from surgery. There's no immediate incontinence risk, but men may experience urinary urgency and frequency, bowel irritation, and gradual erectile dysfunction that develops over months to years. Radiation also poses a small long-term risk of secondary cancers in the treatment area.

Hormone Therapy (Androgen Deprivation Therapy)

Prostate cancer cells typically depend on testosterone and other male hormones (androgens) to grow. Hormone therapy, also called androgen deprivation therapy (ADT), works by reducing testosterone levels or blocking its effects on cancer cells. This doesn't cure the cancer but can significantly slow its growth, sometimes for many years.

Hormone therapy is used in several situations: combined with radiation therapy to improve cure rates for higher-risk localized cancers, as primary treatment for men who can't have surgery or radiation, and as the main treatment for metastatic prostate cancer. It's remarkably effective at controlling even advanced disease, though cancer eventually develops resistance (called castration-resistant prostate cancer).

Side effects of hormone therapy include hot flashes, loss of sex drive, erectile dysfunction, fatigue, weight gain, loss of muscle mass, bone density loss, and mood changes. Because of these significant effects, hormone therapy is typically used when the benefits clearly outweigh the side effects—usually in higher-risk or advanced disease.

Chemotherapy

Chemotherapy is generally reserved for prostate cancer that has spread and no longer responds to hormone therapy (castration-resistant prostate cancer). The most commonly used drug is docetaxel, which has been shown to extend survival and improve quality of life in men with metastatic castration-resistant prostate cancer. Cabazitaxel is another option for men whose cancer progresses after docetaxel treatment.

Newer research has shown benefits from using chemotherapy earlier in the disease course—specifically combining it with hormone therapy when metastatic prostate cancer is first diagnosed. This approach can significantly extend survival in appropriate patients.

Newer and Emerging Treatments

Several newer treatments have expanded options for advanced prostate cancer:

• Novel hormone agents: Drugs like abiraterone and enzalutamide work through different mechanisms than traditional hormone therapy and are effective in castration-resistant disease
• PARP inhibitors: For men with BRCA gene mutations, drugs like olaparib and rucaparib target DNA repair mechanisms in cancer cells
• Immunotherapy: Sipuleucel-T is a vaccine-like treatment that helps the immune system attack prostate cancer cells
• Radiopharmaceuticals: Drugs like radium-223 and lutetium-177 PSMA deliver radiation directly to cancer cells that have spread to bones or other sites

What Happens After Prostate Cancer Treatment?

After prostate cancer treatment, regular follow-up includes PSA testing every 3-6 months initially, then annually. PSA should become undetectable after prostatectomy or reach a very low level after radiation. Rising PSA may indicate cancer recurrence. Management of side effects like incontinence and erectile dysfunction is an important part of survivorship care.

Follow-up care after prostate cancer treatment serves two main purposes: detecting any recurrence of cancer early when it may still be treatable, and managing treatment-related side effects that impact quality of life. The cornerstone of follow-up is regular PSA testing, typically every 3-6 months for the first few years, then annually if levels remain stable.

After radical prostatectomy, PSA should become undetectable (below 0.1 ng/mL) since the prostate—the source of PSA—has been removed. Any detectable and rising PSA after surgery indicates cancer cells remain, either locally or as microscopic metastatic disease. After radiation therapy, PSA typically drops to a low level (called the nadir) over 1-2 years but doesn't become undetectable since the prostate remains. A PSA rise of 2.0 ng/mL or more above the nadir suggests recurrence.

Managing side effects after treatment

Quality of life after prostate cancer treatment has improved dramatically with modern techniques, but side effects remain a reality for many men. Urinary incontinence is most common immediately after prostatectomy, but most men see significant improvement within the first year. Pelvic floor muscle exercises (Kegel exercises) accelerate recovery, and physical therapists specializing in pelvic rehabilitation can provide guidance. For persistent incontinence, treatments ranging from bulking injections to artificial urinary sphincters are available.

Erectile dysfunction affects most men after prostate cancer treatment to some degree. Recovery after surgery depends on nerve preservation and may take 1-2 years. Oral medications (like sildenafil or tadalafil) help many men, and other options include vacuum devices, penile injections, and surgical implants. Open communication with healthcare providers and partners is essential—sexual rehabilitation is a normal and important part of recovery.

Men who received hormone therapy face additional challenges including hot flashes, fatigue, bone loss, and metabolic changes. Regular exercise, calcium and vitamin D supplementation, and bone density monitoring help manage these effects. Resistance training is particularly valuable for maintaining muscle mass and bone strength.

If the cancer returns

Cancer recurrence—detected by rising PSA—doesn't necessarily mean the cancer will become life-threatening. Many biochemical recurrences (rising PSA without visible disease) can be managed effectively for years or even decades. Treatment options depend on the original treatment and where the recurrence is located.

For recurrence after surgery, radiation therapy to the prostate bed (where the prostate was located) can be curative in many cases. For recurrence after radiation, options include salvage surgery, focal therapies, or hormone therapy. For metastatic recurrence, hormone therapy combined with newer agents can often control the disease for extended periods.

How Does Prostate Cancer Affect Daily Life?

Living with prostate cancer or its aftermath varies greatly depending on disease stage and treatment. Many men lead normal lives on active surveillance. Those who've undergone treatment may face changes in urinary function, sexual health, and emotional well-being. Support from healthcare teams, patient groups, and loved ones is vital for adaptation and quality of life.

The impact of prostate cancer on daily life varies enormously. Some men on active surveillance experience minimal disruption beyond regular monitoring appointments and the psychological challenge of knowing they have cancer. Others undergoing treatment for advanced disease face significant physical and emotional challenges. Understanding what to expect and having support systems in place makes a tremendous difference.

Physical activity is one of the most important things men can do throughout their prostate cancer journey. Regular exercise improves treatment outcomes, reduces treatment side effects like fatigue, helps maintain bone and muscle mass (especially important during hormone therapy), and improves overall quality of life. Both aerobic exercise and resistance training are beneficial, and many cancer centers now offer exercise programs specifically designed for cancer patients.

Nutrition also plays a supporting role. While no specific diet has been proven to cure or prevent prostate cancer recurrence, a healthy diet rich in vegetables, fruits, whole grains, and lean proteins supports overall health and may help maintain a healthy weight. Men on hormone therapy should pay particular attention to calcium and vitamin D intake for bone health.

Emotional and psychological support

A prostate cancer diagnosis brings emotional challenges regardless of the stage or prognosis. Anxiety about the future, changes in self-image, relationship stress, and depression are all common. These feelings are normal and deserve attention and support.

Many men find peer support invaluable. Prostate cancer support groups—whether in-person or online—connect men with others who understand their experiences. Partners and family members also benefit from support, as prostate cancer affects the whole family. Professional counseling can help when emotional challenges become overwhelming.

Sexual intimacy often changes after prostate cancer treatment, but satisfying intimacy is still possible. Open communication between partners is essential. Many couples find that working through these challenges together actually strengthens their relationship. Sex therapists and counselors with experience in cancer-related sexual issues can provide valuable guidance.

Can Prostate Cancer Be Prevented?

While prostate cancer cannot be completely prevented, certain factors may reduce risk or help detect it early. Regular screening starting at age 50 (or 40-45 for high-risk men) enables early detection. A healthy diet, regular exercise, maintaining a healthy weight, and not smoking may lower risk. Genetic testing can identify men at highest inherited risk.

There is currently no guaranteed way to prevent prostate cancer, but research suggests certain lifestyle factors may influence risk. Maintaining a healthy weight through diet and exercise appears protective—obesity is associated with more aggressive prostate cancer and worse outcomes. Regular physical activity has been linked to lower prostate cancer risk in some studies.

Dietary factors have been extensively studied, though results are mixed. Diets high in processed foods, red meat, and dairy have been associated with slightly increased risk in some studies, while diets rich in tomatoes (which contain lycopene), cruciferous vegetables, and plant-based foods may offer some protection. However, no specific food or supplement has been proven to prevent prostate cancer.

For men at particularly high risk due to family history or genetic mutations, more intensive screening starting at younger ages is recommended. Men with known BRCA mutations should begin discussions about screening at age 40. Some researchers are investigating whether medications like 5-alpha reductase inhibitors (finasteride and dutasteride) might have preventive effects, though these aren't currently recommended routinely for prevention.

The importance of screening

While screening doesn't prevent prostate cancer, it enables early detection when the disease is most treatable. The decision to screen should be individualized based on risk factors, life expectancy, and personal preferences after understanding both the benefits and potential harms of screening.

Major medical organizations recommend that men discuss prostate cancer screening with their doctors starting at:

• Age 50 for men at average risk who are expected to live at least 10 more years
• Age 45 for men at high risk, including African Americans and those with a first-degree relative diagnosed with prostate cancer before age 65
• Age 40 for men at very high risk, including those with multiple first-degree relatives diagnosed at young ages or known BRCA mutations