Prostate Cancer

Provides info on an initial diagnosis. Discusses diagnostic tests, including PSA test and digital rectal exam. Covers symptoms common to prostate cancer and other conditions. Discusses treatment with active surveillance, surgery, or radiation.

Prostate Cancer

Topic Overview

Is this topic for you?

For information on cancer
that has come back or spread to other parts of the body, see the topic
Prostate Cancer, Advanced or Metastatic.

What is prostate cancer?

Prostate cancer is the
abnormal growth of cells in a man's
prostate gland. The prostate sits just below the bladder. It makes part of the
fluid for
semen. In young men, the prostate is about the size of
a walnut. As men age, the prostate usually grows larger.

is common in men older than 65. It usually grows slowly and can take
years to grow large enough to cause any problems. As with other cancers, treatment for prostate cancer works best when the cancer is found early. Often, prostate cancer that has spread responds to treatment. Older men who have prostate cancer usually die from other causes.

Experts don't know what causes
prostate cancer, but they believe that your age, family history (genetics), and
race affect your chances of getting it.

What are the symptoms?

Prostate cancer usually
doesn't cause symptoms in its early stages. Most men don't know they have it
until it is found during a regular medical exam.

When problems are
noticed, they are most often problems with urinating. But these same symptoms
can also be caused by an enlarged prostate (benign prostatic hyperplasia). An enlarged prostate is common in older men.

See your doctor for a checkup if:

  • You have urinary problems, such as:
    • Not being able to urinate at all.
    • Having a hard time starting or stopping the flow of urine.
    • Having to urinate often, especially at night.
    • Having pain or burning during urination.
  • You have difficulty having an erection.
  • You
    have blood in your urine or semen.
  • You have deep and frequent pain in your lower back, belly, hip, or

How is prostate cancer diagnosed?

The most common
way to check for prostate cancer is to have a
prostate-specific antigen (PSA) blood test. A higher
level of PSA may mean that you have prostate cancer. But it could also mean
that you have an enlargement or infection of the prostate.

If your
PSA is high,
you may need a
prostate biopsy to figure out the cause. A biopsy means that your
doctor takes tissue samples from your prostate gland and sends them to a lab
for testing.

How is prostate cancer treated?

Your treatment
will depend on what kind of cancer cells you have, how far they have spread,
your age and general health, and your preferences.

You and your
doctor may decide to manage your cancer with active surveillance or to treat it with surgery or radiation.

If you are over age 80 or have other serious health problems, like heart disease, you may choose not to have treatments to cure your cancer. Instead, you can just have treatments to manage your symptoms. This is called watchful waiting.

Choosing treatment for prostate cancer can be
confusing. Talk with your doctor to choose the treatment that's best for you.

How can treatment affect your quality of life?

Your age and overall health will make a difference in how treatment may
affect your quality of life. Any health problems you have before you are
treated, especially urinary, bowel, or sexual function problems, will affect
how you recover.

Both surgery and radiation can cause
urinary incontinence (leaking urine) or impotence (not being able to have an erection). The level of
urinary incontinence and how long it lasts and the quality of the erections a
man has after treatment will depend on whether the cancer has spread. These
also depend on what treatment is used.

Nerves that help a man
have an erection are right next to the prostate. Surgery to remove the cancer
may damage these nerves. Many times a special form of surgery, called
nerve-sparing surgery, can preserve the nerves. But if the cancer has spread to
the nerves, they may have to be removed during surgery.

same nerves can also be damaged by the X-rays that are used in radiation

Medicines and mechanical aids may help men who are
impotent because of treatment. Some men recover part or most of their ability
to have an erection several months or even years after surgery.

Frequently Asked Questions

Learning about prostate cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with prostate cancer:

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The exact cause of
prostate cancer isn't known. But experts believe that
your age and family history (genetics) may have something to do with your
chances of getting the disease.

The prostate usually gets larger as
you age. Having an enlarged prostate (benign prostatic hyperplasia, or BPH) is very common among older men and doesn't
increase your chances of getting prostate cancer. But an enlarged prostate
is sometimes caused by prostate cancer instead of BPH.


Prostate cancer usually doesn't cause
symptoms in its early stages. When there are symptoms, they may include:

  • Urinary problems, such as:
    • Not being able to urinate at all.
    • Having a hard time starting or stopping the flow of urine.
    • Having to urinate often, especially at night.
    • Having pain or burning during urination.
  • Difficulty having an erection.
  • Blood in your urine or semen.
  • Deep and frequent pain in your lower back, belly, hip, or

Symptoms that may show that the cancer has spread, or
metastasized, to other parts of the body include:

  • Weight loss.
  • Bone pain, especially
    in the lower abdomen, hip, pelvis, or lower back.
  • Swelling in the
    legs and feet.

For more information about prostate cancer that has come
back or spread, see the topic
Prostate Cancer, Advanced or Metastatic.

What Happens

Prostate cancer is a common cancer affecting older men. It usually takes years to become large enough to cause any problems. Sometimes, though, it grows quickly.

Many prostate cancers are found early, when the cancer cells are only in the prostate. When prostate cancer spreads beyond the prostate, it goes first to the lymph nodes in the pelvis, and then on to the bones, lungs, or other organs. For more information, see the topic
Prostate Cancer, Advanced or Metastatic.

About 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime during their lifetime.footnote 1 But most men who are diagnosed with prostate cancer don't die from prostate cancer.

What Increases Your Risk

Some things can increase your chances of getting prostate cancer. These things are called risk factors. But many people who get prostate cancer don't have any of these risk factors. And some people who have risk factors don't get this cancer.


Being older than 50 is the
main risk factor for
prostate cancer. About 6 out of 10 new prostate cancers are found in men who are 65 or older.footnote 2

Family history

Your chances of getting the disease
are higher if other men in your family have had it.

  • Your risk is doubled if
    your father or brother had prostate cancer. Your risk also depends on the
    age at which your relative was diagnosed.
  • Men whose families carry the gene changes that cause breast cancer,
    BRCA1 or BRCA2, are thought to be at increased risk for prostate


  • Prostate cancer is more common among African-American men than men of other races. African-American men also have a greater chance of getting the kind of prostate cancer that grows and spreads.
  • In men of other races, non-Hispanic white men are more likely to get prostate cancer than Hispanic or Asian-American men.

When to Call a Doctor

Call your doctor right away if:

  • You cannot urinate.
  • You have symptoms of a urinary infection. For example:
    • You have blood or pus in your urine.
    • You have pain in your back just below your rib cage.
    • You have a fever, chills, or body aches.
    • It hurts to urinate.
    • You have groin or belly pain.
  • You have pain in your back or hips.
  • Your pain isn't controlled.
  • You are vomiting or nauseated.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You have pain when you ejaculate.
  • You have trouble starting or controlling your urine.

Who to see

The following health professionals can evaluate
urinary symptoms:

The following doctors treat prostate cancer:

You may want to get a second opinion from a different
specialist before making your treatment decision. For example, if your doctor
is a family medicine physician, you may want to talk to a radiation oncologist,
a urologist, or a urologic or medical oncologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Tests before diagnosis

Tests include:

  • A
    digital rectal exam, in which the doctor inserts a
    gloved finger into your rectum to feel your prostate gland. Some prostate
    tumors can be found this way.
  • A
    PSA test to measure the levels of prostate-specific
    antigen (PSA) in your blood. A higher level of PSA may be a sign of an
    enlargement, infection, or cancer of the prostate. If it's possible that an
    infection is raising your PSA, you may first have 4 to 6 weeks of
    antibiotics. Your doctor may suggest a second PSA test
    before thinking about doing a biopsy.
  • An MRI called a multiparametric
    MRI (mpMRI). It shows a picture of the prostate along with other important information, such as the size of the prostate,
    blood flow, and what the prostate tissue looks like.
  • A transrectal ultrasound, in which the doctor inserts a probe into your rectum to check your prostate. The probe uses sound waves (ultrasound) to create a picture of the prostate.
  • A tumor marker (biomarker) test, such as 4Kscore, the Mi-Prostate Score (MiPS), or the Prostate Health Index (PHI). These tests look for signs of cancer in a
    sample of blood or urine.
  • A
    prostate biopsy, in which tissue is taken from the
    prostate and examined under a microscope. A biopsy is the only way to confirm
    whether you have prostate cancer.

Tests after diagnosis

If you have low-risk localized prostate cancer and decide on active surveillance, you will have regular checkups and tests, including PSA tests and prostate biopsies. You may also have other tests, such as an mpMRI. If there
is no change in your condition, you may continue active surveillance. If tests show that your
cancer is growing, you will need to consider having other treatment. Of course, you can also decide at any time to have treatment even if your cancer isn't growing.

If your cancer appears to be a faster-growing type, more tests will be done to see if the cancer has spread. Tests may include:

Tests after treatment

After treatment for prostate cancer, you have regular checkups to check for any signs
that the cancer has come back or spread. Tests include:

  • Blood tests. Different types of blood tests are
    used to see whether cancer has spread to your bones or liver.
  • A
    bone scan to check for bone damage caused by the cancer spreading.
  • A
    CT scan or MRI to look for a new tumor.

Screening tests

Screening for prostate cancer involves checking for signs
of the disease when there are no symptoms. It may be done with the PSA test. And while it's important to have regular health checkups, experts disagree on whether PSA testing should be used to routinely screen men for prostate cancer. Testing could lead you to have cancer treatments that you don't need.

So talk with your doctor. Ask about your risk for
prostate cancer, and discuss the pros and cons of PSA testing.


Your treatment decision will
depend on:

  • Your age.
  • Any serious health problems.
  • Your
    PSA level.
  • What kind of cancer cells you
    have. This is called the
    grade or Gleason score of your cancer. Most prostate
    cells grow very slowly. But some types of cells grow quickly and spread
    to other areas of the body.
  • How far your cancer has spread. This
    is called the
    stage of your cancer.
  • The side effects of
  • Your personal feelings and concerns.

Treatment may be more successful if prostate cancer is found and treated early. But not all prostate cancers may need to be treated, at least not right away. Treating low-risk prostate cancer may be unnecessary, as some of these cancers grow so slowly that they will never cause problems during a man's lifetime. Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can
before deciding whether to have treatment or which treatment to have.

Types of treatment

The main treatments for prostate cancer include:

  • Surgery to remove the cancer by removing the prostate gland. This operation is called a
  • Radiation treatments,
    which include external and internal radiation. These treatments have been improved with newer
    technologies that reduce side effects and other problems caused by radiation.
    To learn more, see Other Treatment.

Cancer that hasn't spread outside the prostate is called localized prostate cancer. Men with localized prostate cancer have options for their care. Tests show if a localized prostate cancer is likely to grow.

  • Low-risk means that the cancer isn't likely to grow right away. Men have the option to choose active surveillance. This means their cancer will be watched closely by their doctors with regular checkups and tests to see if the cancer grows. This choice allows them to delay having surgery or radiation, often for many years. If the cancer grows very slowly, they may never need treatment.
  • Medium-risk means that the cancer is more likely to grow. Some men may have the option to choose active surveillance. Most men will likely need treatment with surgery or radiation.
  • High-risk means that the cancer will most likely grow right away. Men will likely need treatment with surgery or radiation.

Men who have prostate cancer that has come back or has already spread throughout the body may have other treatments, including hormone therapy.

A diagnosis of prostate cancer usually means that you
will be seeing your doctor regularly for years to come. So it's a good idea to
build a relationship that is based on full and honest information. Ask your
questions about your cancer so that you can make the
best decision about treatment. Your doctor also may give you some advice on
changes to make in your life to help your treatment succeed.

Additional information about prostate cancer is provided by the National Cancer Institute at

Side effects of treatment

Treatments such as surgery or radiation can cause serious side effects. Some are short-term problems. But a side effect can become a long-term problem.

  • Surgery can cause leaking urine (urinary incontinence) and erection problems.
  • Radiation can cause bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage. It can also cause bladder problems, such as a burning feeling when you urinate.

For men with high-risk prostate cancer, radiation treatment is given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.

In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.footnote 3

Coping with cancer

A cancer diagnosis can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit the website at

Follow-up care

After surgery or radiation

If you choose surgery or
radiation to treat your
prostate cancer, it will be important to have regular
checkups. If your cancer comes back, this will help your doctor find it early.

Treatment decisions

To make the decision that is best for you, take the time to understand your options and the medical facts about your cancer. Sometimes the medical facts will guide your decision. But a good decision also reflects what matters most to you. This includes how you feel about radiation or surgery and the likely side effects. It also includes deciding if you want any treatment if you are an older man or have other health problems.

  • Age isn't a reason to avoid surgery. But if you are 70 or
    older, other medical conditions, such as
    heart disease, may affect your decision. Men who are
    older also have a higher rate of incontinence and impotence after surgery. Age
    is especially important to think about if you have early-stage cancer, which
    generally grows slowly.
  • Get a second or even a third opinion
    before making your treatment decisions. You may hear differing advice or
    opinions, which may seem confusing. But talking with other doctors can help you
    make your decision. If your doctor is a medical oncologist, you may want to
    talk with other prostate cancer specialists, such as a urologist, a radiation
    or urologic oncologist, or a surgeon.
  • Studies show that fewer side effects are
    reported at large medical centers, where the surgeons do prostatectomies more
    often and so are more experienced and skilled.footnote 4

Home Treatment

Managing symptoms and side effects

During any stage of
prostate cancer, there are things you can do at home
to help manage the symptoms of cancer or the side effects of treatment or both. If your doctor has given you instructions or medicines to treat symptoms or side effects, be sure to use them. Healthy habits such as eating right and getting enough
sleep and exercise can help control your symptoms and side effects.

Try the following tips to manage:

  • Nausea or vomiting. Watch for and treat early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
  • Pain. Not all forms of cancer or cancer treatment cause pain. But if you do have pain, there are many home treatments that can help.
  • Diarrhea. Rest your stomach, and be alert for signs of dehydration. Check with your
    doctor before using any nonprescription medicines for your diarrhea. Be sure to
    drink enough fluids.
  • Constipation. Make sure you drink enough fluids and eat fruits, vegetables, and
    fiber in your diet each day. Do not use a laxative without first talking to
    your doctor.
  • Sleep problems. Often, simple measures such as having a regular bedtime, getting some exercise during the
    day, and having no caffeine late in the day can help with sleep problems.
  • Urinary problems. Home treatment for urinary incontinence includes eliminating
    caffeinated drinks from your diet and setting a schedule of urinating every 3
    to 4 hours, regardless of whether you feel the need. Try doing
    pelvic floor (Kegel) exercises to strengthen your
    pelvic muscles.

Managing stress

  • Learning that you have prostate cancer and being treated for it can be very stressful. Find ways to reduce your stress.
  • You may want to talk with family or friends. Some people find that spending time alone is what they need.

    Consider meeting with a counselor or joining a support group of others who have prostate cancer.

  • Your doctor may also be able to help you find other sources of support and information. Learning relaxation techniques, such as yoga or visualization exercises, may also help you reduce your stress.

    Your feelings about your body may change after treatment. Dealing with your body image may involve talking openly about your worries with your partner and discussing your feelings with a doctor.

For more information, see the topic Getting Support When You Have Cancer.


Hormones are medicines that can affect the growth of
prostate cancer cells.
Hormone therapy is sometimes used with radiation
treatment or surgery to help make sure that all cancer cells are

can't cure prostate cancer. But it will usually shrink the tumor and
slow the rate of cancer growth, sometimes for years. Taking a hormone-therapy
medicine lowers your level of testosterone and other male hormones. Another way
to lower male hormones is by having surgery to remove the testicles, called an


Surgery for prostate cancer may
be done to:

  • Remove the prostate and its cancer (prostatectomy). Nearby lymph nodes also may be removed to check for cancer (lymphadenectomy) during a prostatectomy.
  • Fix urinary problems that are caused by a tumor pressing on the
    urethra (transurethral resection of the prostate, or TURP).

Radical prostatectomy

Radical prostatectomy is an operation
to remove the entire prostate and any nearby tissue that may contain cancer. It
can be done as open surgery through an incision (cut) in the belly, or as
laparoscopic surgery through several very small
incisions in the belly. Laparoscopic surgery to remove the prostate is done with a tiny camera and
special tools. Sometimes lymph nodes in the area
also are removed so that they can be checked for signs of cancer. This is
called a
lymph node biopsy.

  • Nerve-sparing surgery helps preserve the nerves that are along
    the side of the prostate and that are needed for an erection. This is only done
    when there is little chance of leaving cancer cells behind. If you already have
    sexual function issues, nerve-sparing surgery may not be the best choice for
  • Robotic-assisted laparoscopic radical prostatectomy is surgery
    done through small incisions in the belly with robotic arms that translate the
    surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.

Surgery may completely remove your prostate
. But it isn't possible to know for sure before surgery whether the
cancer has spread beyond the prostate. When cancer has spread, it can't always
be cured with surgery alone.

Other Medical Treatment

Active surveillance or watchful waiting

Active surveillance means that you will be watched closely by your doctor. If the cancer starts to grow more quickly, you will need to have other treatment, such as surgery. Your regular
checkups may include digital rectal exams,
PSA tests, and biopsies.

Watchful waiting also means that you will be
closely watched by your doctor. But the goal of watchful waiting is to treat symptoms that cause
problems rather than to cure the cancer. Men who are older and men who have other serious health problems, like heart disease, and aren't well enough to have surgery or radiation often choose watchful waiting.

Radiation therapy

Radiation therapy may be used alone or combined with
hormone treatment when the cancer has high-risk features (based on Gleason score and stage). Radiation may also be used when the cancer has spread after surgery.

Radiation treatment for prostate cancer includes:

  • External radiation. Also called external beam radiotherapy, or EBRT, radiation
    uses high-energy rays, such as X-rays, to destroy the cancer. It is
    usually given in multiple doses over 4 to 9 weeks. Radiation destroys tissue,
    so it may damage the nerves along the side of the prostate that affect your
    ability to have an erection. If you already have bowel problems, external
    radiation may make your symptoms worse. The most common forms of external
    radiation are:

    • Conformal radiotherapy (3D-CRT). It
      uses a three-dimensional planning system to target a strong dose of radiation
      to the prostate cancer. This helps to protect healthy tissue from
    • Intensity-modulated radiation therapy (IMRT). It uses newer 3D-CRT technology to target the cancer.
    • Proton beam therapy. This is radiation therapy that uses a different type of energy (protons)
      rather than X-rays. This allows a higher amount of specifically directed
      radiation, which protects nearby healthy tissues (especially the
      rectum). Sometimes proton beam therapy is combined with
      X-ray therapy. (It is available only at big medical centers.)
  • Internal radiation (brachytherapy). Brachytherapy is a one-time radiation treatment that
    uses tiny radioactive seeds. After you are given anesthesia, the doctor uses a
    needle to inject the seeds into your prostate, where they slowly release
    radiation directly into the cancer. Sometimes external radiation or hormone
    is added to brachytherapy. If you already have urinary problems,
    brachytherapy may make your symptoms worse.

    • High-dose-rate (HDR) brachytherapy. For this form of brachytherapy, radioactive material is
      placed into the prostate for a very brief period of time (seconds to minutes)
      and then removed. The radiation is delivered this way several times.

Less common or newer treatments

Some less common or newer treatments still being studied for prostate cancer include:

  • Cryosurgery. This treatment freezes the
    prostate gland to kill the cancer.
  • High-intensity focused ultrasound (HIFU). This treatment uses sound waves to destroy prostate tissue.
  • MRI-guided focal laser ablation. This treatment uses heat from a laser to destroy prostate tissue.

Clinical trials

Your doctor may talk to you about joining a research study called a clinical trial if one is available in your area. Clinical trials are research studies to look for ways to improve treatments for prostate cancer.

Complementary therapy

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side
effects of cancer treatments. Some of the complementary therapies that may be helpful include:

Mind-body treatments like those mentioned above may help
you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain,
headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about
the possible value and potential side effects. Let your doctor know if you are already
using any such therapies. Complementary therapies aren't meant to take the
place of standard medical treatment. But they may improve your quality of life
and help you deal with the stress and side effects of cancer treatment.

Other Places To Get Help


American Cancer Society (ACS)
250 Williams Street NWAtlanta, GA 30303

National Cancer Institute (U.S.) (or :// for live help online)



  1. National Cancer Institute (2017). SEER cancer stat facts: Prostate cancer. National Cancer Institute. :// Accessed July 10, 2017.
  2. American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: ://
  3. Resnick MJ, et al. (2013). Long-term functional outcomes after treatment for localized prostate cancer. The New England Journal of Medicine, 368(5): 436–445.
  4. Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.

Other Works Consulted

  • Keating NL, et al. (2010). Diabetes and cardiovascular disease during androgen deprivation therapy: Observational study of veterans with prostate cancer. Journal of the National Cancer Institute, 102(1): 39–46.
  • Malcolm JB, et al. (2010). Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. Journal of Urology, 183(5): 1822–1828.
  • National Cancer Institute (2011). Prostate Cancer Treatment (PDQ)—Patient Version. Available online: ://
  • National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: ://
  • Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
  • Schaeffer EM, et al. (2012). Radical retropubic and perineal prostatectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2801–2829. Philadelphia: Saunders.
  • Scher HI, et al. (2015). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 932–980. Philadelphia: Walters Kluwer.
  • Su L, Smith JA (2012). Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2830–2849. Philadelphia: Saunders.


ByHealthwise StaffPrimary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology Richard M. Hoffman, MD, MPH - Internal Medicine

Current as ofFebruary 26, 2018