The prostate is a reproductive system gland in men, about the size of a walnut. The function of the prostate is to help make semen.

Prostate gland: Overview

(Illustration courtesy of National Cancer Institute).  The prostate gland is situated between the bladder and the rectum.

After skin cancer, prostate cancer is the most common form of cancer in U.S. men. Relative to other cancers, prostate cancer often grows more slowly. Cell changes can take place over years, even decades. 

By age 50 most men show no symptoms of prostate cancer; however, it is very likely that some precancerous or cancer cells are present. Sometimes bladder and urination problems can be a signal of either prostate cancer or benign prostatic hyperplasia (also called BPH). BPH is non-cancerous.

Most of these cancers will not pose a problem. But waiting for symptoms to appear can be deadly, with the cancer then more advanced. That is why it is very important to monitor prostate health for men, especially after age 50. Eight percent of prostate cancer diagnoses of U.S. men will have serious symptoms, and three percent will die from the disease.

Prostate cancer can spread to other parts of the pelvis, to your bones, and throughout your body. Some of the symptoms of prostate cancer include:

• Chronic pain in the back, hips or pelvis
• Frequent urge to urinate (especially at night)
• Trouble urinating; weak or interrupted urine stream
• Blood in the urine or semen
• Painful ejaculation

Increased risk factors for prostate cancer include age (50+), those with a family history of prostate cancer (those whose fathers or brothers had the disease), and poor diets (high fat, few fruits and vegetables). In addition, prostate cancer tends to start younger and spread faster in African-Americans, thus increasing the importance of early screening.

Prostate cancer: Treatment options

A diagnosis of prostate cancer is not a death sentence. What is important after the diagnosis is knowing the grade and stage of cancer, as well as the specific treatment options (ranging from surgery to no intervention, often called "watchful waiting").

Stage and grade for prostate cancer

Grade. Most grading of prostate cancer uses one of two ratings/numbers to describe the grade of the tumor. The higher the rating, the higher the grade of tumor. One rating uses a scale G1to G4, and the other assigns a rating/score from 2 to 10. The tumor tissue in a low-grade cancer (G1 or 2, depending on the scale used) more closely resembles normal prostate tissue. High-grade tumors tend to grow more quickly and have an increased likelihood to spread (versus low-grade tumors).

Stage. There are four stages. The extent of prostate cancer in stages I and II is said to be localized; that is, still contained within the prostate gland itself and not spread outside of it. Stage III is sometimes called locally advanced cancer, and includes the seminal vesicles, another nearby gland. Stage IV describes a cancer which has spread further to other tissues, organs or the lymph nodes.

Treatment options for prostate cancer

Generally, there are three: surgery, radiation and watchful waiting (also called surveillance).

Surveillance, taking a wait-and-see approach, may be recommended for patients with early-stage prostate cancer, particularly those who are older or have other serious medical conditions. These patients have regular examinations. If there is evidence of cancer growth, active treatment may be recommended.

Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered by implanting radioactive seeds in the prostate using a needle.

Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection.

Because the specific treatment decision depends on a variety of factors (grade and stage, age, health, attitudes toward treatment, etc.), it is important to get as much information as possible and make an informed decision. The National Cancer Institute notes, for example, that "There is rarely a need to make a decision without taking time to discuss and understand the pros and cons of the various approaches."

Seek more than one opinion from a doctor if you can. There are usually several possible options for treatment, all reasonable. Gaining more than one perspective can be helpful in the process. Review the resource links for additional information and support groups.

Prostate screening

Detecting prostate cancer earlier rather than later

There are two tests utilized to detect prostate cancer before symptoms have developed: the digital rectum exam (DRE) and a blood test often called PSA. The test is called PSA because it attempts to detect a substance produced by the prostate called prostate specific antigen. In the the DRE, a doctor feels the prostate through the rectum to find any particularly hard or lumpy areas.

The PSA results are analyzed in a lab and reported back to your doctor. It is possible (and frequent) that men will show elevated PSA levels but do not have cancer. In addition, many men with prostate cancer can show relatively normal levels of PSA. The digital rectal exam (DRE) can also miss some cancers; both tests in combination are better in accurately detecting and assessing prostate cancer.

The only certain way to diagnose prostate cancer is through a biopsy, the removing of tissue samples (usually with a needle). Often, this procedure can be done in the doctor's office under local anesthesia. The cells removed are then examined for cancer cells.

Are there other conditions that can cause similar symptoms to prostate cancer?

Yes, definitely. Often as men age, the prostate will grow larger. Sometimes this growth will block or interfere with both urine or sexual function—some of the same symptoms for prostate cancer. It is a fairly common condition called benign prostatic hyperplasia or more commonly, BPH.

BPH is not prostate cancer, only an enlarged prostate. There are medications that can help treat BPH, and sometimes surgery is required to help relieve the symptoms.