This information is intended to provide a general overview of prostate cancer. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.
Prostate cancer begins in the prostate, a small, walnut-sized gland that is part of the male reproductive system and is responsible for producing semen and nourishing sperm. The cancer develops when cells within the prostate become abnormal and begin to multiply uncontrollably.
The prostate is situated directly below the bladder and in front of the rectum, wrapping around a section of the urethra, the tube that drains urine from the bladder. The vast majority of prostate cancers are classified as adenocarcinomas, which are cancers that originate in the gland cells that line many organs, including the prostate.
Though it only affects males, prostate cancer is one of the most common cancers diagnosed, and it is also one of the most treatable, boasting a high five-year survival rate. This high success rate is typically attributed to several factors: the disease often grows slowly, effective and established treatments are available, and most cases are identified before the cancer has spread outside the prostate gland.
A risk factor is anything that increases your chance of developing prostate cancer. Key risk factors include:
This is the most significant risk factor. Over 90% of cases are diagnosed in men aged 55 or older.
The risk increases if a close relative (father, brother, or son) has or had prostate cancer, especially if they were diagnosed at a younger age.
Certain genetic mutations, such as those associated with Lynch syndrome and the BRCA1 and BRCA2 genes, can elevate a man's risk.
A diet high in fat, particularly animal fats, may increase risk, while a diet rich in fruits and vegetables may help decrease it.
Prostate cancer is more common in North America and northwestern Europe than in other regions globally.
Some research suggests a role for prostate inflammation (prostatitis), and sexually transmitted diseases are also being investigated as possible risk factors.
While no action guarantees prevention, certain lifestyle choices can help lower your risk:
Additionally, certain substances like lycopenes (found in tomatoes, pink grapefruit, and watermelon) are being studied for their potential to help prevent cell damage. Medications such as Proscar® (finasteride) or Avodart® (dutasteride) may also reduce the risk of low-grade prostate cancer. If you are at a high risk, consult with your urologist or healthcare provider about these options.
Prostate cancer often produces no symptoms in its early stages. In more advanced cases, symptoms may appear, although they vary significantly from person to person. Because the prostate is close to the bladder and surrounds the urethra, most symptoms are related to urination.
It is important to remember that these symptoms are not always an indicator of prostate cancer. They may also be caused by non-cancerous conditions like benign prostatic hyperplasia (BPH), a common condition in which the prostate gland enlarges. If you experience any of these symptoms, it is vital to consult with your doctor for proper evaluation.
Early and accurate diagnosis is crucial for increasing the chances of successful treatment and recovery.
If prostate cancer symptoms are present, your doctor will discuss your health, lifestyle, and family medical history with you. One or more of the following tests may be used to determine if cancer is present and if it has spread:
A simple screening test where a healthcare provider gently inserts a gloved finger into the rectum to feel the prostate gland for enlargement or abnormal areas, such as a lump. Although not a definitive test, regular DREs help detect changes over time and can find cancer even if the PSA level is normal.
This blood test measures the amount of PSA protein, which is produced by prostate gland cells, circulating in the blood. A PSA level of 4 nanograms per millilitre (ng/mL) or lower is typically considered normal; a higher level suggests an increased chance of prostate cancer. High PSA levels can also be caused by non-cancerous factors like an enlarged prostate (BPH), infection (prostatitis), or age. Certain conditions like obesity or taking some medications/supplements can also lower the PSA level. Despite its limitations, PSA testing has dramatically improved the detection of early-stage prostate cancer. It is also used to help plan treatment, monitor for cancer spread or recurrence, and aid in active surveillance. Doctors usually do not recommend the PSA test for men over 75 or those with other significant health issues.
These tests provide a better view of the prostate. They help identify areas for biopsy sampling and determine if the cancer has spread outside the gland. Imaging tests may include:
This is the only way to confirm a prostate cancer diagnosis. A small sample of suspected cancerous tissue is removed and examined under a microscope. Prostate biopsies are usually outpatient procedures performed using a TRUS guide, though SSCHRC also conducts biopsies through the perineum (the skin between the scrotum and anus) and Fusion Biopsies, which use special software to target abnormalities seen on an MRI. If a biopsy does not show cancer but reveals abnormal changes in cell size and shape, called prostatic intraepithelial neoplasia (PIN), regular screenings are recommended, especially for high-grade PIN.
If cancer is found, it is graded to help doctors choose the best treatment and predict the rate of growth. A specialist compares the cancer cells to normal prostate cells, assigning a grade from 1 (nearly normal) to 5 (highly irregular). The Gleason score is the sum of the two most common cell grades in the sample. The most common lowest grade is 3.
Gleason Scores:
Once diagnosed, your doctor will assess the risk of the disease becoming harmful using the Gleason score, PSA level, and the clinical stage (based on DRE/imaging findings). This assessment places the cancer into three main risk groups to guide treatment:
For intermediate or high-risk cancer, further imaging, such as bone scans or CAT/MRI scans, may be used to confirm if the cancer has spread.
Your treatment plan is highly individualised, depending on your overall health, age, the cancer's grade and associated risk, and your personal goals for treatment outcomes. It is important to discuss all available options and their potential effects with your doctor.
One or more of the following therapies may be used:
Recommended for older patients or those with a very low-risk form of the disease due to its slow growth. It involves closely monitoring the cancer with repeat PSA tests and biopsies at set intervals. Treatment is initiated only if tests indicate the disease is progressing.
The surgical removal of the entire prostate gland. Lymph nodes near the prostate may also be removed to check for spread. Surgeons at SSCHRC are highly experienced and often use minimally invasive, robotic surgical procedures, which result in smaller incisions, less blood loss and pain, and shorter hospital stays. Patients typically wear a catheter for about one week post-procedure.
Uses high-energy beams to destroy cancer cells and is one of the two most common primary treatments (along with surgery). It generally offers better urinary control than surgery but may cause more bowel and bladder irritation; both can lead to erectile dysfunction. SSCHRC offers advanced types of radiation therapy, including:
A treatment where a thin probe is inserted into the tumour to freeze and kill cancer cells with heat generated by focused ultrasound waves. It is rarely used but can be the best option for small, localised tumours when surgery is not suitable.
Uses focused heat waves to kill cancer tissue. Typically offered to patients with early-stage, low- to intermediate-risk tumours that are confined to the prostate and visible on MRI.
Since most prostate cancers are hormone-sensitive (male hormones like testosterone fuel their growth), this therapy aims to reduce or block these hormones. It can slow growth and reduce tumour size but does not cure the disease. The two main types are:
Hormone therapy is often used for late-stage, high-grade, recurrent, or metastatic tumours, or to shrink the cancer before surgery or radiation. Side effects can include impotence, hot flashes, depression, loss of muscle and bone mass, and fatigue. Many side effects are successfully treatable, and you should always report them to your doctor.
Drugs designed to kill fast-growing cells, including cancer cells. It is most often used for patients with high-risk disease or those whose cancer has recurred or spread.
A treatment that harnesses a patient's own immune system to fight the cancer, sometimes involving engineering immune cells in a lab. This approach is particularly useful for advanced prostate cancer that is unresponsive to hormone therapy.
Active surveillance is often recommended. Treatment (surgery or radiation) may be chosen by younger patients or those with a large volume of cancer tissue.
Treatment is generally advised, typically with surgery or radiation therapy, sometimes combined with hormone therapy.
Usually involves a combination of therapies (surgery, radiation, hormone therapy, and chemotherapy). It may be curable, or it may be managed as a chronic disease.
If cancer returns after initial treatment (surgery or radiation), the other primary option may be used, along with systemic therapies like hormone therapy and possibly chemotherapy. Elevated PSA levels without visible cancer (biochemical recurrence) are often managed with intermittent hormone therapy and close monitoring.
If cancer has spread beyond the prostate, systemic therapies like hormone therapy and chemotherapy are used. Cancer that responds is castrate-sensitive; if it becomes less responsive, it is called castrate-resistant disease, which requires additional therapies, including new drug combinations and immunotherapy, often accessed through clinical trials.
As a world-leading cancer centre, SSCHRC is home to numerous clinical trials for prostate cancer. Your care team may discuss a clinical trial with you if they believe it offers the best chance for a positive outcome, improved survival, minimal side effects, and a higher quality of life.