You might know that prostate cancer is one of the most common cancers for U.S. men, ranking second behind skin cancer, according to the American Cancer Society. It occurs when cells in the prostate grow uncontrollably, resulting in cancer. But the fact is that most men don't have any symptoms of prostate cancer until it is in advanced stages. And some men may have prostate-related symptoms even though they never develop cancer.
Learn more about the prostate gland, its role in male reproductive health, the signs and symptoms of prostate cancer, testing, diagnosis, and the newest breakthroughs in non-invasive prostate cancer screenings.
What Is the Prostate Gland?
The prostate is part of the male reproductive system and is situated deep inside the pelvis, just below the bladder. The gland resembles a small donut-shaped organ surrounding the tubes that carry urine from the bladder and semen produced by the seminal vesicles.
The prostate gland secretes a fluid that blends with semen in the ejaculatory duct. Prostatic fluid is a thin, milky liquid that contains proteins, minerals, and enzymes that nourish and protect sperm.
The prostate gland secretes a fluid through the ducts and into the urethra (tube carrying urine), where it mixes with sperm and other fluids to form semen. The prostate fluid also contains the hormone-like substance spermine, which helps sperm move, and another component called prostate-specific antigen (PSA).
What Are the Symptoms of Prostate Cancer?
When prostate cells begin to grow uncontrollably, cancerous tumors may form. Many types of prostate cancer grow slowly and initially stay localized within the prostate gland. Early diagnosis of prostate cancer, when lesions are still confined to the prostate gland, offers a higher chance of successful treatment. Once cancer spreads outside the prostate gland, treatment becomes more difficult, and it can significantly affect a person's life expectancy.
According to Johns Hopkins Medicine, currently, the 5-year survival rate for early-stage prostate cancer, which includes stages I, II, and III, is almost 100%. Many men identified and treated at these localized or regional stages will be free of the disease after five years.
Prostate cancer metastasis (spreading) occurs when cancer cells break away from the primary tumor of origin and travel through the lymphatic system to another location. In many cases, symptoms of prostate cancer only manifest after it reaches advanced stages, making prostate screening even more important.
When warning signs of prostate cancer do occur, the following are the most common:
- Unintentional weight loss
- Detection of blood in urine
- Presence of blood in semen
- Difficulty controlling urination, including leaking
- Decreased flow of urine
- Sexual problems (e.g., erectile dysfunction)
- Lower back pain
- Pain in hips, pelvis, or rectum
- Bone pain
- Enlarged prostate
What Tests Evaluate Prostate Symptoms?
If you have prostate symptoms, a family history of prostate cancer, or have had previous prostate gland cancer, your doctor will likely order a blood test that measures the PSA circulating in your bloodstream. However, you need to know that an elevated PSA doesn’t automatically mean you have prostate cancer.
As you age, the prostate can increase in size and cause the urethra to narrow and diminish urine flow. You may have benign prostatic hyperplasia or hypertrophy, which is not the same as prostate cancer. In fact, you could have an elevated PSA level based on your age or other factors that aren’t cancer.
Some potential prostate conditions that are not cancer include:
- Prostate enlargement or benign prostatic hyperplasia or hypertrophy (BPH)
- Prostate inflammation, also called prostatitis
- Urinary tract infection
- Urinary catheter placement
- Medications like nonsteroidal anti-inflammatory drugs (NSAIDs), cholesterol-lowering statins, and meds for hypertension (high blood pressure)
- Ejaculation that can temporarily increase PSA levels
- Recent exercise like cycling
Another test your urologist may perform to examine your prostate is a digital rectal exam (DRE). As the name suggests, this is a manual exploration of the prostate using digits (fingers) through the rectum. A normal prostate is the size of a walnut or a ping-pong ball and feels smooth and slightly spongy when palpated (felt) through the rectum. If this is not the case, the doctor may suggest a biopsy.
What Tests Are Used for Diagnosing Prostate Cancer?
If prostate cancer is suspected, a urologist (a doctor specializing in the urinary system) will conduct further testing and discuss treatment options if needed. If your PSA or DRE suggests a possibility of prostate cancer, your doctor may discuss plans for a biopsy. This procedure involves taking small tissue samples from the prostate to microscopically examine them for cancer cells.
During a prostate biopsy, the doctor locates the prostate using imaging guidance like transrectal ultrasound (TRUS) or MRI. They then insert a hollow needle through the rectum or skin between the scrotum and anus to extract cylindrical cores of prostate tissue. Antibiotics are prescribed to reduce infection risk.
Typically, 12 to 20 cores are collected from different prostate areas. While the biopsy can cause brief discomfort, the area is numbed with a local anesthetic beforehand. The entire procedure takes around 10 minutes in the doctor's office. Taking multiple cores from different regions aims to improve accuracy.
One limitation of prostate biopsies is the risk of inaccurate results where either the biopsy misses an existing tumor due to sampling errors or the cancer being in an inaccessible location. Additionally, pathologists examining the biopsy samples can have variability in interpreting the microscopic findings, leading to over or underdiagnosis in some cases.
To enhance prostate cancer detection, newer biopsy techniques leverage imaging technology. MRI-guided biopsies use multi-parametric MRI (mpMRI) scans to visualize suspicious lesions, allowing precise targeting during biopsy. This approach has demonstrated greater accuracy than traditional TRUS-guided biopsies alone.
Other emerging tests, such as biomarker assays that test urine samples after a digital rectal exam, are also being explored as potential screening methods to complement PSA tests and guided biopsies.
Who Should Get Prostate Screening Tests?
Screening means looking for abnormalities before they cause prostate cancer symptoms. The goal of screening is to find cancers that might be at high risk for spreading before they actually have a chance to spread.
For most types of cancer, your personal risk of prostate cancer and family risk factors determine who should get screened. According to the American Urological Association, men should follow this age and risk-based guideline:
- 45-50 years of age: Consider discussing screening options with your doctor, balancing risks and their circumstances
- 40-45 years of age (high risk): Black (African descent) race/ethnicity, family history of prostate cancer (brother, father, multiple relatives), and/or known genetic mutations (like BRCA1 or BRCA2)
- 50-69 years of age: Regular screening every 2-4 years
- After age 70: Screening should be on a case-by-case basis balancing risks and circumstances
Currently, no standard imaging recommendations for prostate cancer screening exist, although research is ongoing. That said, Ezra is committed to using advanced technology to improve cancer detection and outcomes.
What Are Prostate Cancer Treatment Options?
The treatment for prostate cancer depends on factors like the stage (extent) of the cancer, its aggressiveness (determined by the Gleason score), and your overall health.
Some common treatments an oncology specialist might recommend include:
- Active surveillance, which entails close monitoring of slow-growing, early-stage cancers
- Surgery, also called a prostatectomy, removes the entire prostate gland and other areas of advanced prostate cancer (metastatic prostate cancer) that has spread
- Radiation therapy that uses radioactive beams to destroy cancer cells
- Hormone therapy, which works by lowering testosterone levels to slow down growth
- Immunotherapy to stimulate the body’s immune system so it’s better able to fight off cancer
Remember That Early Detection Is Key
Prostate cancer is the second most common cancer in men, especially those over the age of 50. Prostate cancer risk factors include age, race, family history, and certain genetic mutations. Symptoms of early-stage prostate cancer may be impossible to recognize as it often has no outward symptoms, but advanced stages can create urinary symptoms and other problems.
Men need to be aware of the signs of prostate cancer and understand their risk factors. Prostate cancer screening, which may include a PSA blood test and a digital rectal exam, can help with early detection when the cancer is more treatable.
Ezra offers a unique MRI to screen for prostate cancer, using the latest cutting-edge science to detect prostate cancer before symptoms are noticeable. When you book an Ezra Full Body MRI, you can scan up to 13 organs, including the prostate, in just an hour.
Learn more about the Ezra Scan and get answers to your FAQs to see if it’s right for you.
