Men’s Health A-Z

Prostate Cancer


Frequently asked questions about prostate cancer, including what is prostate cancer, what are the symptoms, how do you prevent it, and what causes it?

Prostate Cancer

What is Prostate Cancer?

The prostate is a gland that is part of a man’s urinary and reproductive system. It is located just below the urinary bladder. The prostate gland is responsible for making and releasing fluids that provide nutrients and lubrication for sperm. These fluids come from cells that line the glands and ducts of the prostate, and each one of these cells has the potential to become cancerous. Women do not have a prostate gland. 

Once a cell becomes cancerous, it loses the normal control processes that regular cells in the body have. A cell starts to grow faster and becomes more aggressive. The aggressive, fast-growing cell can find its way outside of the glands into the support structures of the prostate, where it then continues to grow. It can turn into small lumps, which can become larger over time. These larger lumps can become dangerous as they pass on to other parts of the body. This is when it becomes a life-threatening situation. However, it is curable if prostate cancer is caught when it’s just a small clump of cells.

The severity of prostate cancer depends on several issues. Severity can range from mild to very aggressive and a threat to a man’s life. The average age of diagnosis for prostate cancer is 65. However, men in their 30s or men in their 80s can also be diagnosed.

What Causes Prostate Cancer?

5% to 10% of prostate cancers may be genetic or hereditary. For example, black men and those with a family history have an increased risk for prostate cancer.  All other occurrences of prostate cancer are sporadic and are likely due to exposure to testosterone, environmental factors, diet, or race. 

Prostate cancer is known as a silent killer because the prostate sits deep in the pelvis under the urinary bladder, and cancer can grow silently there for months to years. Eventually, it can cause trouble with urination or blood in the urine. But these are signs of later disease. If it spreads outside of the prostate, it can cause pain, such as if it settles into a bone.

Prostate cancer can run in the family, especially in families that have germline mutations such as BRCA one and BRCA two and other genetic mutations or hereditary syndromes. 

A number of years ago, it was thought that a vasectomy may increase the risk of prostate cancer. However, subsequent studies have disproven this. Today we know that it is highly unlikely that getting a vasectomy increases the risk of prostate cancer. 

The consumption of excessive amounts of red meat has been associated with an increased risk of prostate cancer. 

Alcohol is causally related to several cancers. However, prostate cancer is not one of them. There is some evidence that hard liquor may increase the risk of prostate cancer, but in general, light to moderate alcohol intake may be protective of your prostate as well as your heart. 

Riding a bike may put pressure on the prostate gland and slightly raise the PSA blood test. But there is no evidence that it actually causes damage to the prostate or leads to prostate cancer.

Yes, there is some evidence that long-term smokers have an increased risk for prostate cancer amongst other cancers as well.

Stress can compromise a person’s immune system and lead to many physical issues, including cancers. However, it is not considered a strong risk factor for prostate cancer.

How can you prevent Prostate Cancer?

Eat Healthier

Dietary measures can be used to help prevent prostate cancer, such as decreasing the amount of saturated fat in your diet, eating more leafy green vegetables, tomatoes, soy protein products, cruciferous vegetables, green tea or pomegranate, coffee, dark chocolate, red wine, and beer. Also, multivitamins may be helpful. 

Get Active

Physical activity with moderate exercise can be very effective in lowering cancer growth rates and recurrence rates.

There has been an interesting study that shows that the more a man ejaculates, the less likely he is to develop advanced prostate cancer. This was a single study and is not being confirmed. However, it is important for a man to ejaculate at least two or three times a week if he is in his younger, very virile age period. The older a man gets, the less he is able to orgasm.

Commonly Asked Questions

The severity of prostate cancer depends on a number of issues. The severity of prostate cancer can range from almost benign acting to very aggressive and a threat to a man’s life

Prostate cancer begins inside the prostate gland. If it is an aggressive type, it can spread outside of the gland either to lymph channels or through the bloodstream to bones and other organs. Once the cancer spreads, known as metastasis, it can be fatal.  

Prostate cancer develops because of lifetime exposure to testosterone, which comes from a man’s testes. In addition, environmental and genetic factors can lead to mutations in cells that become cancerous and are then fed by testosterone.

Different organizations or healthcare organizations have varying answers, but, on average, screening should begin at age 50. If a man has increased risk factors such as strong family history, is Afro-American, or consumes a lot of red meat, he should be screened in his mid-40s. There is evidence that if the PSA is very low in the mid-40s, it does not have to be checked again for a number of years. If, however, the PSA is elevated, it should result in more careful screening in the subsequent years. 

If the baseline PSA or the first PSA measurement is below 1 in a man in his 40s or 50s, a rectal exam does not reveal any abnormalities, and he has no risk factors, then the PSA can be checked every two to three years. If any of the above happens, then he should be checked once a year. 

The average age of diagnosis for prostate cancer is 65, however, men in their 30s or men in their 80s can also be diagnosed.  

The majority of prostate cancers are curable. It is only when cancer has spread to other parts of the body that it becomes incurable. But with today’s treatments, men can live quite a few years with advanced prostate cancer. 

Before cancer is treated, a man’s potency and ability to ejaculate are not affected. However, if the cancer grows significantly in the prostate, and after treatment with surgery or radiation, sexual function can become an issue. A man may lose his ability to achieve an erection and ejaculate. However, this is not always the case.  

Surgery and radiation do not impact libido or sexual desires, or the ability to love one’s partner. Hormone therapy, however, does decrease libido and sexual desires as well as lead to erectile problems.

Symptoms 

Prostate cancer in its earliest stages does not cause any symptoms. That’s why it’s important to have your prostate checked and to also encourage your family members and friends to get checked as well. Prostate cancer, when diagnosed at an early stage, is very curable. 

Prostate cancer in later stages, when it’s far advanced or when it’s spread to other parts of the body, can cause different symptoms.

  • Difficulty urinating
  • Urgent need to urinate
  • Frequent urination, especially at night
  • Burning or pain when urinating
  • Inability to urinate or difficulty starting or stopping urine flow
  • Blood in the urine or semen

Symptoms in the prostate itself are uncommon. Once cancer starts growing outside of the prostate, such as if it is in bones or other organs it can then cause pain.  

If you have prostate cancer, will it cause any of the following: 

  • Hip pain 
  • Headaches – Late in the disease
  • Blood in stools – Only after a biopsy
  • Impotence – After surgery or radiation treatment
  • Painful urination – Only if the cancer is extensive and invading into the urinary canal or causing a blockage that could lead to a urinary tract infection which is painful. 
  • Tiredness – Prostate cancer treatment can lead to fatigue
  • Weight loss – When the cancer is advanced and spread to other parts of the body, it can cause weight loss. 
  • Lower back pain – If the cancer has spread to the spine, it can cause pain.
  • Shoulder pain – Only if the cancer has spread to the shoulder bones.
  • Swollen feet – Prostate cancer can cause swelling in the legs if the lymph channels in the pelvis are compromised. If cancer is growing in the lymph channels, they become plugged up, and this leads to swelling in the lower limbs.
  • Diarrhea
  • Itching
  • Fainting
  • High blood pressure
  • Groin pain – Unusual
  • Testicular pain – Unusual

Diagnosis

The key is a blood test called PSA or prostate-specific antigen combined with a good history and a digital rectal examination. The PSA is a simple blood test that detects excessive amounts of protein being made by the prostate gland and released into the bloodstream. This can occur with any prostate disease, including benign growth, infection, or cancer. The ultimate diagnosis is based on a biopsy wherein samples are taken of the prostate using a special needle, and these are examined under the microscope. 

Once the PSA is elevated, further testing needs to be done, including a feel of the prostate with a digital rectal examination. Depending on the results of the digital rectal exam, other tests may then follow.

Once a man has prostate cancer, a CT scan can look for enlarged lymph nodes or even bone changes.

You can detect prostate cancer early by taking a blood test called prostate-specific antigen or PSA. 

There is evidence that early detection can save lives. It can also decrease the severity of the disease because treatments can be more focused, including active surveillance. 

PSA stands for prostate-specific antigen and not prostate cancer-specific antigen. Therefore, the number needs to be taken in combination with other variables such as the size and feel of the prostate, the age of the man, and other risk factors. Very high PSA numbers, such as greater than 20, are an increased indication of prostate cancer. 

The Gleason score and/or scale are based on the appearance of cancer cells and how they are growing. When a pathologist looks at the cancer cells under the microscope, they will assign an evaluation or grade to the most common appearance and a second grade to the second most common appearance. 

These two grades from one to five are then added together to create a score. For example, Gleason grade three plus four equals Gleason score of seven. The higher the score, the more aggressive the cancer’s behaviour will be, and the prediction of the outcome becomes more accurate. 

There is no evidence that a biopsy can cause cancer or cause it to spread.

It is not possible to check for cancer yourself, but it is essential to know your family history. If possible, ask your father and grandfather, while they are still alive, whether anyone on the male side of the family has had prostate issues.

Treatment

When the cancer is caught early on, if it has a very low Gleason score and a low or very low risk, it can be monitored without any treatment other than modifying diet and lifestyle. 

Surgery to remove the prostate and radiation treatments are common treatments for more aggressive cancers that are inside the prostate. One type of surgery that is becoming more common is robot assisted prostatectomy due to it being minimally invasive. 

When cancer has spread beyond the prostate, hormone therapy may be recommended. Hormone therapy uses special medication to stop the testicles from making testosterone and is very effective. Radiation treatments work by altering the DNA in cells as they divide, causing those cells to die.

If prostate cancer is caught at an early stage when it is still confined to the prostate, it can be cured in the majority of cases.

Coping

Coping with prostate cancer can be very challenging, depending on the severity of prostate cancer and life circumstances. For detailed information and resources about coping with prostate cancer, please visit the Canadian Cancer Society

Coping with any cancer can be very difficult emotionally as well as physically. Being present and helping a man talk about his challenges as well as helping him attend his healthcare appointment, encouraging exercise, and dietary modifications can all help someone with the disease. 

Other Prostate Conditions

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Medically reviewed by

Dr. Larry Goldenberg

Dr. Larry Goldenberg, CM, OBC, MD, FRCSC, FACS, FCAHS

Dr. Goldenberg is a urologic surgeon and clinical scientist, who specializes in prostate cancer research and treatment.

More about Dr. Larry