- How common
- About 1 in 8 men is diagnosed during his lifetime
- Symptoms
- Usually none in the early stages
- How it is found
- PSA blood test, exam, MRI and biopsy
- Treatment
- Ranges from close monitoring to surgery or radiation
What is prostate cancer?
The prostate is a walnut-sized gland that sits just below the bladder and wraps around the urethra, the tube that carries urine out of the body. It is part of the male reproductive system and makes some of the fluid in semen. Prostate cancer starts when cells in the gland begin to grow and multiply out of control.
Most prostate cancer causes no symptoms, especially early on. That is why men are screened for it. When symptoms do appear, they can include trouble urinating, or blood in the urine or semen. Pain in the hips, back or chest can be a sign that the cancer has spread to the bones. Trouble urinating is much more often caused by a benign enlarged prostate, but it is still worth having checked.
Who is at risk?
Prostate cancer is one of the most common cancers in men. About 1 in 8 men will be diagnosed with it during his lifetime. Your risk is higher with:
- Age. It is most often found in men over 50, and the risk keeps rising with age.
- Family history. A father or brother with prostate cancer raises your risk.
- Ethnicity. African American men are more likely to develop prostate cancer, and more likely to be diagnosed at a younger age and with more advanced disease.
- Weight. Some studies suggest that men who are overweight or obese may have a higher risk.
Many men who get prostate cancer have none of these risk factors. That is why every man should talk with his doctor about screening, whatever his risk. Finding prostate cancer early can improve both the outcome and quality of life.
When should I start screening? Many men begin talking with their doctor about a PSA test between ages 45 and 50. Men at higher risk, including African American men and men with a strong family history, may start earlier, around 40 to 45.
How is prostate cancer found?
Finding prostate cancer is usually a series of steps. Each one helps decide whether the next is needed.
PSA blood test
PSA (prostate-specific antigen) is a protein made by the prostate. A high or rising level can be an early sign of cancer. It can also go up with an enlarged or inflamed prostate, so a high PSA is a reason for a closer look, not a diagnosis.
Digital rectal exam (DRE)
Dr. Su gently feels the back of the prostate with a gloved finger to check for firm areas or lumps. It takes only a few moments.
Biomarker tests
Blood or urine tests such as the 4Kscore, SelectMDx, ExoDx and IsoPSA look for markers linked to prostate cancer. They help decide whether a biopsy is needed and help avoid biopsies that aren’t.
Prostate MRI
An MRI can show areas of concern inside the prostate. It is especially helpful when the PSA and exam don’t give a clear answer, or when an aggressive cancer is suspected. It can also show how far a cancer extends and whether it has spread beyond the gland.
Biopsy
The only way to confirm prostate cancer is to take small samples of tissue and look at them under a microscope. MRI-ultrasound fusion biopsy, which uses your MRI to aim at the suspicious areas, is one of Dr. Su’s areas of expertise. How fusion biopsy works.
Understanding your results
If a biopsy finds cancer, the pathology report describes how aggressive it looks. You will usually see a Gleason score (for example, 3 + 4 = 7) and a Grade Group from 1 to 5. Lower numbers mean a slower-growing cancer. Dr. Su puts this together with your PSA, exam and imaging to place the cancer in a risk group, from low to high. The risk group, your age, your overall health and your own priorities all guide which treatments make sense.
Treatment options
Treatment depends on the stage and aggressiveness of the cancer, and many men have more than one reasonable choice.
Active surveillance
For many slow-growing cancers, close monitoring is the recommended first step. You have regular PSA tests and exams, with repeat MRI or biopsy on a schedule. If the cancer shows signs of growing, you move on to treatment. This lets many men avoid or delay the side effects of treatment.
Robotic prostatectomy
The whole prostate is removed through a few small incisions using the da Vinci robotic system. When the cancer allows, Dr. Su spares the nerves that control erections. About robotic prostatectomy.
Radiation therapy
High-energy beams aimed from outside the body (external beam radiation), or tiny radioactive seeds placed in the prostate (brachytherapy), destroy cancer cells. Radiation is given by a radiation oncologist and is sometimes combined with hormone therapy.
HIFU and TULSA
Focal therapy treats only the part of the prostate that holds the cancer. HIFU (high-intensity focused ultrasound) uses sound waves from a probe in the rectum to heat and destroy the target. TULSA (transurethral ultrasound ablation) uses a device in the urethra, guided by MRI. It is an option for some men whose cancer is limited to one area. Dr. Su performs HIFU and TULSA for selected patients. Both are newer than surgery and radiation, and long-term results are still being studied.
Hormone therapy
Prostate cancer uses testosterone to grow. Hormone therapy (androgen deprivation therapy) lowers testosterone or blocks it. It is often paired with radiation for higher-risk cancer, and it is a main treatment when cancer has spread or come back. On its own, it controls the cancer rather than curing it.
How Dr. Su helps you decide
There is rarely one right answer for everyone. Your choice depends on your cancer’s risk group, your age and health, and how you weigh possible side effects such as leaking urine, erection problems or bowel changes. Dr. Su reviews your results and imaging with you, explains what each option involves and what recovery looks like, and builds a plan around your needs and circumstances. She works closely with medical and radiation oncologists, so your plan fits your cancer and your priorities.
Dr. Su is board-certified and completed a fellowship in robotic surgery and urologic oncology at the John Wayne Cancer Institute in Santa Monica. She sees patients in Long Beach, Koreatown and Beverly Grove.
Want to read more? The National Comprehensive Cancer Network (NCCN) publishes free, detailed guides for patients with prostate cancer, based on the same guidelines doctors use. NCCN Guidelines for Patients.
Questions patients ask
Does a high PSA mean I have prostate cancer?
Not necessarily. PSA can also rise with an enlarged prostate, inflammation or infection. A high PSA is a reason for a careful evaluation, which may include a repeat test, a biomarker test and an MRI before any decision about a biopsy.
Does prostate cancer always need to be treated right away?
No. Many low-risk prostate cancers grow so slowly that they may never cause harm. For these, active surveillance with regular tests is often the recommended approach, and treatment starts only if the cancer shows signs of change.
Will treatment affect my erections or bladder control?
It can. Surgery and radiation both carry a risk of erection problems and urine leakage, and the risk differs by treatment and from man to man. Dr. Su will explain the likely effects of each option for you, and how they are managed if they happen. See erectile dysfunction treatment.
Should my brothers or sons be screened?
It is worth telling them about your diagnosis. Having a father or brother with prostate cancer raises a man’s risk, so the men in your family should ask their own doctors when to start screening.
What should I bring to my first visit?
Your PSA results over time (the trend matters), any MRI or biopsy reports, and a list of your medications. If you have MRI images on a disc, bring that too.