Prostate Cancer—Beyond the Basics

Updated August 21, 2024

Prostate cancer is the most common cancer in American men, other than skin cancer. It’s estimated that there will be 299,000 new cases of prostate cancer in the United States in 2024, and approximately 35,250 deaths from the disease.¹

About 1 in every 8 men will be diagnosed with prostate cancer in their lifetime.¹ It's a complex disease, but understanding the risk factors, signs and symptoms, and screening recommendations can help you take steps to protect your prostate health. It’s time to make your health a priority—and this article will help you get started.

What is prostate cancer?

The prostate is a walnut-shaped gland that plays an important role in male reproductive health. Its primary function is to produce and secrete prostate fluid, a key component of semen. The prostate also helps regulate urine flow by squeezing the urethra (the tube that carries urine from the bladder to outside the body) and preventing urine leakage. While typically considered a small gland, the prostate can become enlarged or even develop cancer.

Normally, cells grow and divide to fulfill the body's needs. But when cells grow out of control, they can form a mass of tissue called a tumor. Prostate cancer is a type of cancer that starts in the prostate gland. Prostate cancer can also spread (or metastasize, pronounced muh-ta-stuh-size), which means that cancer cells have broken away from the original tumor and traveled to other parts of the body through the blood or lymphatic system.  

Are there types of prostate cancer?

Most types of prostate cancers are adenocarcinomas, but there are other, extremely rare forms of prostate cancer.²

An adenocarcinoma (pronounced adeno-car-suh-no-muh) is a type of cancer that starts in the glands that line the organs. Even though adenocarcinomas start to grow in the glands, they can eventually spread to other parts of the body, like the lymph nodes, bone, liver, lungs, and brain.³

Less common types of prostate cancer include²:

• Neuroendocrine tumors (NETs)
• Sarcomas
• Small cell carcinomas
• Transitional cell carcinomas

What is metastatic prostate cancer?

Metastatic (pronounced meh-tuh-stat-ik) prostate cancer is when the cancer has spread beyond the prostate. It’s the most advanced state of prostate cancer and has spread to other parts of the body, like the lymph nodes, bones, lungs, or liver. Metastatic prostate cancer is often called stage IV prostate cancer.⁴ 

What is castration-resistant prostate cancer? 

Castration-resistant prostate cancer (CRPC) is an advanced prostate cancer that no longer responds to treatment with hormones that lower testosterone. This means that the cancer continues to grow, even though testosterone levels are low. CRPC can also show signs of growth, such as a rising PSA (prostate-specific antigen) level.⁵

What is metastatic castration-resistant prostate cancer? 

Metastatic castration-resistant prostate cancer (mCRPC) is a more advanced form of CRPC that has spread beyond the prostate to other parts of the body. The cancer continues to grow, even after treatment to lower testosterone levels.⁵

Can women get prostate cancer?

Anyone who has a prostate gland can get prostate cancer. 

Who’s at risk for prostate cancer?

Anyone with a prostate is at risk of getting prostate cancer. The risk of prostate cancer increases with age.⁶ Prostate cancer is uncommon in men under 40, but the risk increases rapidly after age 50. Most cases (60%) are diagnosed in men over 65.⁷ Other factors that can raise the risk of prostate cancer include⁶:

• Race/ethnicity | African American men and Caribbean men of African ancestry are at a higher risk of developing prostate cancer.
• Family and personal health history | Men who have a first-degree relative (father, son, or brother) or relatives within 3 generations (on either side of the family) who had prostate cancer, or who were diagnosed with prostate cancer when they were 55 years old or younger, are at a higher risk of developing the disease. There’s also a higher risk for men who have been diagnosed with prostate cancer and have other family members who have had breast, ovarian, or pancreatic cancer.

What causes prostate cancer?

Researchers are still trying to figure out exactly what causes prostate cancer. But they’ve found some risk factors and are looking into how they might cause the disease. What we do know (in basic terms) is that changes in the DNA of a normal prostate cell can lead to prostate cancer. 

DNA is the material in our cells that makes up our genes. Genes control how our cells work, including how they grow and divide. There are 2 main types of genes that are involved in cancer¹⁰:

1. Oncogenes (pronounced onco-genes) are genes that help cells live, grow, and divide.
2. Tumor suppressor genes are genes that stop cells from growing too fast, fix mistakes in the DNA, or cause cells to die when they should.

Cancer can happen when there are changes (mutations) in the DNA that keep the oncogenes turned on or the tumor suppressor genes turned off. When these kinds of changes happen to these genes, cells can grow out of control—and it can lead to cancer. 

In prostate cancer, it’s thought that changes in oncogenes or tumor suppressor genes can cause prostate cells to grow out of control. These changes can be passed down from a parent (inherited) or can happen during a person's lifetime.¹⁰

Is prostate cancer linked to inherited gene mutations?

Inherited gene mutations are changes in genes that are passed down from parents to children. These mutations can increase the risk of developing certain diseases, including prostate cancer. Several inherited gene mutations have been linked to hereditary prostate cancer, including¹⁰:

• BRCA1 and BRCA2 are tumor suppressor genes that help fix damaged DNA, keep cells healthy, and protect a person from getting cancer. Mutations in these genes (especially BRCA2) can increase a person’s risk of developing prostate cancer.
• HOXB13 is a gene that’s involved in the development of the prostate gland. Mutations in this gene can increase a person’s risk of developing prostate cancer at a younger age.

Other gene mutations that can increase a person’s risk of prostate cancer, include¹⁰:

• ATM
• CHEK2
• MLH1
• MSH2
• MSH6
• PALB2
• PMS2
• RAD51D
• RNASEL

Just because a person inherits a gene mutation doesn’t mean they will get cancer. But these mutations are important to identify because they can help people (and their doctors) better understand their risk of developing prostate cancer.

What are the signs and symptoms of prostate cancer?

Not everyone has the same symptoms of prostate cancer. Some people don't have any signs at all.¹¹ But some of the signs to look for are:

• Difficulty starting urination
• Weak flow of urine (or urine flow that starts and stops)
• Frequent urge to urinate
• Dribbling of urine
• Getting up many times during the night to urinate
• Trouble completely emptying the bladder
• Blood in the urine or semen
• Pain or burning during urination
• Painful ejaculation
• Trouble getting an erection
• Pain in the back, hips, pelvis, or rectum that doesn’t go away
• Pain caused by touching the prostate
• Change in size, firmness, or texture of the prostate
• Lumps or hard areas spreading beyond the prostate

How is prostate cancer diagnosed?

Prostate cancer is found through a combination of tests and procedures, like:

• Physical exams, including a digital rectal exam (DRE)
• Lab tests, including PSA blood tests
• Biopsies
• Transrectal ultrasound (TRUS)
• Magnetic resonance imaging (MRI)

A biopsy is the only way to know for sure if a person has prostate cancer.¹³ But other tests and procedures can be very helpful in identifying prostate cancer. A prostate biopsy is a procedure when a needle is used to remove small samples of the prostate. The samples are then sent to a lab to be examined under a microscope to see if they are cancerous. It can take a few days (or longer) to get the results of a biopsy, which might be reported as¹³:

• Negative for cancer (cancer cells weren’t found in the biopsy samples)
• Positive for cancer (cancer cells were found in the biopsy samples)
• Suspicious (the cells look abnormal, but it might not be cancer)

When is the right time to start prostate cancer screening? What is a PSA blood test?

The right age, tests, and screening intervals depend on your risk of developing prostate cancer. 

PSA is a protein produced in the prostate by both cancerous and noncancerous cells. The PSA test measures the levels of PSA in the blood. It’s often used to screen for prostate cancer in men without symptoms. The PSA screening alone cannot tell you if you have prostate cancer, but if can tell your provider if more testing is needed. PSA levels can be high in cancerous and noncancerous conditions (like an enlarged prostate or inflammation of the prostate). 

The American Cancer Society (ACS) encourages men to discuss the pros and cons of prostate cancer screening with a healthcare provider and decide what’s best for them based on their values and preferences.¹⁴

For those who choose to have prostate cancer screening, the ACS recommends the PSA blood test for people in the following risk categories¹⁴:

• Men 50 years of age with an average risk of developing prostate cancer and no underlying health conditions that may reduce life expectancy
• Men 45 years of age with a high risk of developing prostate cancer, including African American men and those with an immediate family member who was diagnosed with prostate cancer before the age of 65
• Men 40 years of age with a higher risk of developing prostate cancer, such as those with multiple immediate family members with prostate cancer who were diagnosed at an early age

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