Prostate cancer is one of the most common and deadly cancers among men in the United States. A prostate specific antigen (PSA) screening test can help lead to earlier detection and treatment, potentially before the cancer spreads.
Men should talk to their doctor about what prostate cancer screening entails, including risks and benefits. They should make an informed decision about whether screening is appropriate for them.
Learn the facts about prostate cancer, including its four stages, symptoms, and what to know about screening.
What Is Prostate Cancer?
The prostate is a walnut-sized organ that is part of the male reproductive system. Prostate cancer occurs when cells in the prostate grow uncontrollably, leading to a malignant tumor.
About 1 in 8 men will be diagnosed with prostate cancer in their lifetime. It is the second most common cancer among men, behind just skin cancer. It is the second-deadliest cancer among men, trailing only lung cancer.
The American Cancer Society (ACS) estimates that over 313,000 new cases of prostate cancer will be diagnosed in 2025, and over 35,000 people will die from prostate cancer.
Prostate cancer risk factors
All men are at risk for prostate cancer, but some people are at greater risk, according to the Centers for Disease Control and Prevention (CDC). Risk factors include:
- Age — Prostate cancer is most commonly diagnosed in men 65 and older. The risk of prostate cancer rises as you age.
- Family history — If you had a first-degree relative who had prostate cancer, you’re at higher risk of developing prostate cancer.
- Race — Black men have a higher risk of prostate cancer and are also over twice as likely to die from it than white men.
What Are the Stages of Prostate Cancer?
There are four stages of prostate cancer, which are based on the severity of the disease and whether it’s spread. Some of the stages are broken down into sub-stages (A, B, and C) based on their severity within the stage.
- Stage 1 — Stage 1 prostate cancer is small and confined to the prostate. It typically can’t be felt with a digital rectal exam or seen on imaging.
- Stage 2 — Stage 2 prostate cancer is larger, but it still has not spread outside the prostate. It may be able to be felt with a digital rectal exam or seen on imaging. It may be in both lobes of the prostate.
- Stage 3 — Stage 3 prostate cancer may have spread beyond the prostate into the seminal vesicles, which are the glands behind the bladder, or other nearby tissues.
- Stage 4 — Also known as metastatic or advanced prostate cancer, stage 4 is the most severe. It may have spread to nearby lymph nodes or other areas of the body, such as the bones, distant lymph nodes, or other organs.
The Gleason score
Clinicians also use something called the Gleason score to grade prostate cancer. It helps determine how aggressive the cancer is and how quickly it will spread.
To calculate the Gleason score, clinicians examine a patient’s tissue sample from a biopsy under a microscope. They grade the patient’s two most common cell patterns on a scale from 1 (resembles normal prostate tissue) to 5 (highly mutated). They add these two numbers together for the Gleason score.
Gleason scores range from 6 to 10. A Gleason score of 6 means the cancer is less aggressive and will likely spread slowly. A Gleason score of 9 or 10 means the cancer is highly aggressive and likelier to spread quickly.
The presence of any grade 5 cells is concerning, whether they’re among the most common cell types or not. Grade 5 cells raise the risk of the cancer recurring.
Prostate Cancer Symptoms
There may be different symptoms at different stages of prostate cancer.
If you’re in the early stages of prostate cancer, you may not have any symptoms at all. The most common early-stage symptoms are:
- Blood in your urine or semen.
- Difficulty urinating (frequent urination or a slow/weak urination stream).
Common symptoms of more advanced prostate cancer include:
- Blood in your urine or semen.
- Difficulty urinating (frequent urination or a slow/weak urination stream).
- Erectile disfunction.
- Loss of bladder or bowel control.
- Numbness in the feet or legs.
- Pain in other areas of the body, such as the hips, ribs, pelvis, or back.
- Pain when ejaculating.
- Pain when urinating.
- Unexplained weight loss.
You should talk to your doctor if you have any symptoms of prostate cancer. These symptoms don’t necessarily mean you have prostate cancer, as other conditions can cause similar symptoms.
Screening for Prostate Cancer
There are two major screening tests for prostate cancer: the prostate specific antigen (PSA) test and a digital rectal exam.
The PSA test is a blood test that measures the level of PSA (a substance that the prostate produces) in your blood. Elevated PSA levels in the blood can indicate prostate cancer or other prostate conditions. However, an elevated PSA level does not necessarily mean you have cancer — other factors can cause higher PSA levels.
According to the American Cancer Society:
- Most men who don’t have prostate cancer have a PSA level of below 4 nanograms per milliliter of blood. However, this doesn’t guarantee that you don’t have prostate cancer.
- Men with a PSA level of between 4 and 10 nanograms per milliliter have about a 25% chance of having prostate cancer.
- Men with a PSA level of over 10 have over a 50% chance of prostate cancer.
A digital rectal exam is a physical examination in which a clinician inserts a gloved, lubricated finger into the rectum to feel for abnormalities in the prostate. The U.S. Preventive Services Task Force (USPSTF) does not recommend digital rectal exams for prostate cancer screening.
Prostate screening guidelines
The USPSTF updated its prostate cancer screening guidelines in 2018.
- Men 55 to 69 years old should make informed, individual decisions about getting a PSA test for prostate cancer. They should discuss the benefits, risks, and uncertainties of screening and of prostate cancer treatment.
- Men 70 and older should not get routine screening for prostate cancer.
Other organizations, such as the ACS, have different recommendations. The ACS recommends discussing prostate cancer screening, including benefits and risks, with your doctor at the following ages:
- 50 years old — Discuss screening with your doctor if you’re expected to live at least 10 more years and have an average risk of prostate cancer.
- 45 years old — Discuss screening with your doctor if you’re at high risk for prostate cancer (such as if you’re Black or have one immediate relative who was diagnosed with prostate cancer before age 65).
- 40 years old — Discuss screening with your doctor if you have more than one immediate relative who was diagnosed with prostate cancer before age 65.
Talk to your doctor if you’re unsure about your prostate cancer risk, whether you should get screened, and how often.
Prostate Cancer Diagnosis
While elevated PSA levels can be a sign of prostate cancer, PSA tests alone can’t diagnose prostate cancer. That’s because your PSA level can be elevated for other reasons. The main way doctors diagnose prostate cancer is with a biopsy of the prostate.
Using imaging from a transrectal ultrasound or magnetic resonance imaging (MRI) as a guide, a urologist will insert a thin needle into the prostate to take a sample. They typically repeat this several times to get samples from different areas of the prostate.
The tissue samples then go to a lab, where a pathologist examines them under a microscope to see if cancer is present.
Imaging tests can also help to diagnose prostate cancer and/or whether it’s spread. These include:
- Transrectal ultrasound.
- MRI.
- Bone scan.
- Positron emission tomography (PET) scan.
- Computed tomography (CT) scan.
These tests can help diagnose prostate cancer and its stage.
How Is Prostate Cancer Treated?
Prostate cancer treatment options depend on factors like the stage of the disease and how likely it is to spread. Your care team can include specialists such as a urologist, medical oncologist, radiation oncologist, surgical oncologist, and more.
Early-stage prostate cancer treatment can cure the disease. Treatment options for advanced prostate cancer cannot cure the disease, but they can relieve symptoms, slow the cancer’s growth, and prolong your life.
Treatment options can include:
- Active surveillance or observation — These are options for cancer that isn’t likely to spread quickly. Active surveillance means monitoring the cancer by getting regular screenings such as PSA tests. If the cancer grows or starts causing symptoms, treatment can change. For observation, no tests are done, and symptoms are treated as they occur. This is typically an option for older patients or those with serious health problems.
- Chemotherapy — This uses specialized drugs to kill or shrink cancer cells. Chemotherapy is not a typical treatment for early-stage prostate cancer, but it can be used if the cancer has spread.
- Hormone therapy — Also known as androgen deprivation therapy, hormone therapy attempts to decrease levels of male hormones like testosterone and dihydrotestosterone to prevent prostate cancer from growing.
- Immunotherapy — In immunotherapy, you receive medications designed to boost your immune system. This can improve your immune system’s ability to recognize, attack, and kill cancer cells.
- Radiation therapy — Radiation therapy kills cancer cells with high-energy rays. The two main types of radiation therapy are external beam radiation therapy and internal radiation therapy (brachytherapy). In external therapy, a specialized machine outside the body delivers targeted beams directly at the cancer cells. In brachytherapy, small, radioactive seeds are placed inside the body to kill the cancer. People with prostate cancer may get external radiation, internal radiation, or both.
- Surgery — The standard of care procedure is a radical prostatectomy. It is usually performed using minimally invasive techniques that decrease the pain and make recovery a lot easier. This surgery removes the prostate and seminal vesicles.
- Targeted therapy — These are specialized drugs that target and attack cancer cells while limiting any effects on healthy cells. Targeted therapy may be an option if prostate cancer has spread and if chemotherapy and hormone therapy are ineffective.
Can Prostate Cancer Be Cured?
If caught and treated early, prostate cancer is very curable. According to the American Cancer Society, the five-year survival rate for localized and regionalized prostate cancer is over 99%.
Stage 4, or advanced, prostate cancer is not curable. However, advances in treatment have enabled people to live much longer after diagnosis — even several years.
UPMC Hillman Cancer Center is a leader in cancer treatment. We are the only Comprehensive Cancer Center in western Pennsylvania as designated by the National Cancer Institute and one of only 57 in the United States. For more about how we provide life-changing cancer care, visit our website.
Editor's Note: This article was originally published on , and was last reviewed on .