Prostate Cancer: Causes, Symptoms, Diagnosis, and Treatment
Also known as: Prostate carcinoma, Prostate adenocarcinoma
Prostate Cancer: A Common Cancer in Men
Prostate cancer is the most common cancer in American men aside from skin cancer, with the American Cancer Society estimating over 300,000 new cases diagnosed each year. It mostly affects men over 50 and is the second leading cause of cancer death in men, behind only lung cancer. The prostate, a gland in the male reproductive system, can develop malignant cells that often grow slowly. When the cancer is caught before it spreads beyond the prostate, the outlook is excellent: the 5-year relative survival rate is nearly 100%.
Causes and Risk Factors
Several factors increase the risk of developing prostate cancer. Age is the main factor: the disease is rare before age 40, and the risk rises rapidly after 50. A family history (father or brother affected) more than doubles the risk. Race also plays a role: prostate cancer is diagnosed more often in Black men, who are also more than twice as likely to die from it. Inherited mutations in the BRCA1 and BRCA2 genes (especially BRCA2) can also raise the risk. Environmental factors like a diet high in saturated fat and obesity may also contribute.
Symptoms
Prostate cancer is often symptom-free in its early stages, which is why screening matters. When symptoms do appear, they resemble those of benign prostate enlargement:
- Difficulty urinating (weak stream, hesitancy)
- Frequent urination, especially at night (nocturia)
- A feeling that the bladder isn’t fully empty
- Blood in the urine or blood in the semen
- Bone or lower back pain (advanced stages, with metastases)
Diagnosis
Diagnosis starts with a PSA (prostate-specific antigen) blood test, sometimes combined with a digital rectal exam. Many other conditions can also raise PSA, so an abnormal result is not a diagnosis on its own. If results are abnormal, a multiparametric prostate MRI is performed, followed if needed by prostate biopsies guided by ultrasound or MRI. A biopsy is the only way to confirm prostate cancer; it also determines the Gleason score, which measures how aggressive the tumor is.
Treatments
Treatment depends on the stage, aggressiveness, and the patient’s overall health:
- Active surveillance: for low-risk localized cancers, with regular PSA checks and follow-up biopsies
- Radical prostatectomy: surgical removal of the prostate, open or robot-assisted (the standard approach for localized cancer)
- External radiation or brachytherapy: an effective alternative to surgery
- Hormone therapy (androgen deprivation): blocks testosterone to slow tumor growth, used alone or in combination
- Chemotherapy and immunotherapy: reserved for metastatic disease resistant to hormone therapy
Prevention
There’s no guaranteed way to prevent prostate cancer, but certain habits may lower the risk. A balanced diet low in animal fat, with plenty of fruits and vegetables, is sensible for overall health, though no food (including lycopene-rich tomatoes) has been proven to lower prostate cancer risk. Regular physical activity and maintaining a healthy weight also help. Starting at age 50, men at average risk should talk with their doctor about PSA screening after being informed of its benefits and limitations. Men at higher risk (Black men or those with a father or brother who had prostate cancer) should start that conversation earlier, around age 40 to 45, per American Cancer Society guidance.
When Should You See a Doctor?
See a doctor promptly if you have persistent urinary difficulties, blood in the urine or semen, or unexplained pelvic or bone pain. Starting at age 50, discuss screening with your doctor even without symptoms. Men with a family history of prostate cancer should start this conversation earlier, around age 40 to 45.
Sources
- American Cancer Society: Key Statistics, U.S. prostate cancer case counts, ranking, and age at diagnosis
- American Cancer Society: Risk Factors, age, family history doubling the risk, and BRCA1/BRCA2
- American Cancer Society: Survival Rates, 5-year relative survival by stage (localized >99%)
- American Cancer Society: Screening Recommendations, ages 50, 45, and 40 for the informed screening discussion
- American Cancer Society: Cancer Facts & Figures for African American/Black People, higher prostate cancer incidence and death rate in Black men
- National Cancer Institute, official U.S. government cancer information
- National Cancer Institute: Prostate Cancer Prevention (PDQ), evidence on diet, fruits and vegetables, and lycopene
- U.S. Preventive Services Task Force, PSA-based prostate cancer screening recommendation
- MedlinePlus, U.S. National Library of Medicine health information