Prostate cancer

Prostate cancer is cancer that occurs in the prostate — a small walnut-shaped gland in men that produces seminal fluid. It is one of the most common cancers in men. Many prostate cancers grow slowly and remain confined to the prostate, where they may not cause serious harm. Others are aggressive and can spread quickly.

Early prostate cancer usually causes no symptoms. Screening with PSA blood testing and digital rectal examination is a shared decision based on age, risk, and personal values, because screening can detect both clinically important and unimportant cancers. Treatment options range from active surveillance to surgery, radiation, and systemic therapies for advanced disease.

Early prostate cancer often has no symptoms. When symptoms occur, they may include:

• Difficulty starting urination or weak/interrupted urine flow
• Frequent urination, especially at night
• Difficulty emptying the bladder completely
• Pain or burning during urination
• Blood in the urine or semen
• Pain in the back, hips, or pelvis that does not go away
• Painful ejaculation
• Unexplained weight loss or fatigue in advanced disease

These symptoms can also be caused by non-cancerous conditions such as BPH or prostatitis. Sudden inability to urinate or bone pain warrants prompt evaluation.

Prostate cancer develops when genetic changes in prostate cells cause uncontrolled growth. Exact causes for any individual are often unclear. Risk is influenced by age, ancestry, family history, and inherited mutations (including BRCA2, HOXB13, and DNA mismatch-repair genes). Hormonal influences (androgens) support prostate tissue growth. Lifestyle factors such as diet and obesity may play a role in risk and progression, though relationships are complex.

Established risk factors include:

• Age — risk rises sharply after 50
• Family history of prostate cancer, especially in a brother or father diagnosed young
• African ancestry — higher incidence and often more aggressive disease
• Inherited genetic syndromes (BRCA1/2, Lynch syndrome, others)
• Obesity — associated with higher risk of aggressive disease
• Possibly certain dietary patterns and chemical exposures (research ongoing)

Complications can arise from the cancer or its treatment:

• Metastatic spread to lymph nodes and bone (pain, fractures, high calcium)
• Urinary obstruction and kidney problems
• Erectile dysfunction and urinary incontinence after surgery or radiation
• Bowel changes after radiation
• Hormone-therapy side effects (hot flashes, bone loss, metabolic changes, mood and sexual effects)
• Anxiety and quality-of-life impact from diagnosis and monitoring

There is no sure prevention. Risk-reduction strategies include:

• Maintaining a healthy weight and staying physically active
• Eating a balanced diet rich in fruits and vegetables
• Not smoking
• Discussing screening thoughtfully rather than pursuing unselected testing
• For men at very high genetic risk, specialized counseling about enhanced screening or risk-reducing options

5-alpha-reductase inhibitors reduce the chance of detecting some prostate cancers but are not routinely recommended solely for prevention because of side effects and complexity of risk–benefit balance.

Evaluation may include:

• PSA blood test and PSA trends / density
• Digital rectal examination
• Multiparametric MRI of the prostate when biopsy is considered
• Prostate biopsy (systematic ± MRI-targeted) for tissue diagnosis and Gleason/Grade Group
• Genomic or molecular tests on biopsy tissue in selected cases to refine risk
• Bone scan, CT, PSMA PET, or other imaging for staging when risk of spread is significant
• Genetic counseling/testing for selected men with family history or high-risk features

Discuss prostate cancer risk and screening with a clinician starting around age 50 for average-risk men, earlier (about 40–45) for higher-risk men (African ancestry, strong family history, or known genetic mutations). See a clinician for persistent urinary symptoms, blood in urine or semen, or ongoing pelvic or bone pain.

Treatment depends on grade, stage, PSA, life expectancy, and preferences:

• Active surveillance — for many low-risk cancers; monitoring with PSA, exam, MRI, and repeat biopsy as needed, with treatment if the cancer shows progression
• Surgery — radical prostatectomy (open, laparoscopic, or robotic)
• Radiation — external beam and/or brachytherapy; often combined with hormone therapy for intermediate- or high-risk disease
• Hormone therapy (ADT) — lowers androgen signaling; used with radiation and as backbone therapy for advanced disease
• Advanced disease — novel hormonal agents, chemotherapy, radioligand therapy (e.g., PSMA-targeted), immunotherapy in selected cases, bone-targeted agents, and clinical trials
• Focal therapies — in investigational or selected settings

Shared decision-making is essential because trade-offs involve cancer control versus urinary, sexual, and bowel side effects.

Supportive steps:

• Participate fully in shared decisions about screening and treatment
• Report urinary, sexual, and bowel side effects — many can be improved
• Stay active and maintain a healthy weight
• Attend all surveillance and follow-up visits
• Seek support for emotional impact of diagnosis
• For men on hormone therapy: resistance exercise, bone-health measures, and metabolic monitoring

Bring:

• Prior PSA results and prostate biopsy/MRI reports
• Family history of prostate, breast, ovarian, or related cancers
• List of medicines and urinary/sexual symptoms
• Personal priorities (cancer control vs side-effect avoidance)
• Questions about active surveillance eligibility, surgery vs radiation, and recovery