The prostate is a small gland found in a man’s lower abdomen. It’s located under the bladder and surrounding the urethra. The prostate is regulated by the hormone testosterone and produces seminal fluid, also known as semen. Semen is the substance containing sperm that exits the urethra during ejaculation.

When an abnormal, malignant growth of cells — which is called a tumor — forms in the prostate, it’s called prostate cancer. This cancer can spread to other areas of the body.

Types of prostate cancer

Most cases of prostate cancer are a type of cancer called an adenocarcinoma. This is a cancer that grows in the tissue of a gland, such as the prostate gland.

Prostate cancer is also categorized by how fast it grows. It has two types of growths:

• aggressive, or fast growing
• nonaggressive, or slow growing

With nonaggressive prostate cancer, the tumor either doesn’t grow or grows very little over time. With aggressive prostate cancer, the tumor can grow quickly and may spread to other areas of the body, such as the bones.

CAUSES

There’s no known cause for prostate cancer. Like all cancers, it could be caused by many things, including a family history or exposure to certain chemicals. Whatever the instigating factor is, it leads to cell mutations and uncontrolled cell growth in the prostate.

Risk factors

Doctors do not know exactly why prostate cancer occurs, but the following risk factors may make it more likely:

• Age: The risk increases after the age of 50, but it is rare before the age of 45.
• Race or ethnicity: It is more common in black males than white ,ales. Asian and Hispanic males have a lower risk than black males or white males.
• Family history: If a male has a close relative with a history of prostate cancer, they have a higher chance of developing it themselves.
• Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes increase the chance of breast cancer in females, too. Men born with Lynch syndrome also have a higher risk of prostate and other cancers.

Other possible factors

There is some evidence to suggest that other factors may play a role, but scientists need more evidence to confirm their involvement:

• diet
• obesity
• smoking
• exposure to chemicals, such as the herbicide Agent Orange
• inflammation of the prostate
• sexually transmitted infections
• vasectomy

SYMPTOMS

There are often no symptoms during the early stages of prostate cancer, but screening can detect changes that can indicate cancer.

Screening involves a test that measures levels of PSA in the blood. High levels suggest that cancer may be present.

Males who do experience symptoms may notice the following:

• difficulty starting and maintaining urination
• a frequent urge to urinate, especially at night
• blood in the urine or semen
• blood in the urine or semen
• painful urination
• in some cases, pain on ejaculation
• difficulty getting or maintaining an erection
• pain or discomfort when sitting, if the prostate is enlarged

Advanced symptoms

Advanced prostate cancer can involve the following symptoms:

• bone fracture or bone pain, especially in the hips, thighs, or shoulders
• edema, or swelling in the legs or feet
• weight loss
• tiredness
• changes in bowel habits
• back pain

Diagnosis

Screening for prostate cancer

Digital rectal exam

Whether to test healthy men with no symptoms for prostate cancer is controversial. Medical organizations don’t agree on the issue of screening and whether it delivers benefits.

Some medical organizations recommend men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer.

Prostate screening tests might include:

Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may indicate prostate infection, inflammation, enlargement or cancer.

PSA testing combined with DRE helps identify prostate cancers at their earliest stages. Hence, debate continues surrounding prostate cancer screening.

Diagnosing prostate cancer

If a DRE or PSA test detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as:

• Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.
• Prostate biopsy is often done using a thin needle that’s inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.
• MRI fusion. While still being developed worldwide, MRI fusion to assist in prostate biopsy and diagnosis is being used more and more.

Treatment

Treatment will depend on the stage of the cancer, among other factors. Treatment for prostate is very effective in the early stages.

• Early stage prostate cancer

A prostatectomy is one possible treatment for early stage prostate cancer.

If the cancer is small and localized, a doctor may recommend: Watchful waiting or monitoring

The doctor may check PSA blood levels regularly but take no immediate action.

Prostate cancer grows slowly, and the risk of side effects may outweigh the need for immediate treatment.

• Surgery

A surgeon may carry out a prostatectomy. They can remove the prostate gland using either laparoscopic or open surgery.

• Radiation therapy. Also, radiation therapy can affect prostate tissue, damaging sperm and reducing the amount of semen for transporting it.

Options include:

• Brachytherapy: A doctor will implant radioactive seeds into the prostate to deliver targeted radiation treatment.
• Conformal radiation therapy: This targets a specific area, minimizing the risk to healthy tissue. Another type, called intensity modulated radiation therapy, uses beams with variable intensity.

Advanced prostate cancer

As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, the treatment options will change.

Options include:

• Chemotherapy: This can kill cancer cells around the body, but it can cause adverse effects.
• Hormonal therapy: Androgens are male hormones. The main androgens are testosterone and dihydrotestosterone. Blocking or reducing these hormones appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most of the body’s hormones. Various drugs can also help. Lupron is a kind of hormone therapy that doctors use to treat prostate cancer.
• Most doctors do not recommend surgery in the later stages, as it does not treat cancer that has spread to other parts of the body. However, some experts have suggested that it may help in some cases.

New treatments

Some newer approaches aim to treat prostate cancer without the side effects that other treatment options can bring.

These include:

• cryotherapy
• high intensity focused ultrasound

After surgery, a doctor will continue to monitor PSA levels.

Effects on fertility

The prostate gland plays a role in sexual reproduction. Prostate cancer and many of its treatments affect fertility in several ways.

For example, if a male has surgery to remove either the prostate gland or the testicles, it will affect semen production and fertility.

Complications

Complications of prostate cancer and its treatments include:

Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as the, or travel through the bloodstream or lymphatic system to the bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it’s unlikely to be cured.

Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type, and  severity.  It is and the likelihood that It will improve over time. Treatment options may include medications, catheters and surgery.

Erectile dysfunction. Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.

Prevention

Risk of having prostrate cancer can be achieved through the following measures:

• Choose a healthy diet full of fruits and vegetables. Avoid high-fat foods and instead focus on choosing a variety of fruits, vegetables and whole grains. Fruits and vegetables contain many vitamins and nutrients that can contribute to your health.
• Whether you can prevent prostate cancer through diet has yet to be conclusively proved. But eating a healthy diet with a variety of fruits and vegetables can improve your overall health.
• Choose healthy foods over supplements. No studies have shown that supplements play a role in reducing your risk of prostate cancer. Instead, choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of vitamins in your body.
• Exercise most days of the week. Exercise improves your overall health, helps you maintain your weight and improves your mood. There is some evidence that men who don’t exercise have higher PSA levels, while men who exercise may have a lower risk of prostate cancer.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it by exercising most days of the week. If you need to lose weight, add more exercise and reduce the number of calories you eat each day. Ask your doctor for help creating a plan for healthy weight loss.

Talk to your doctor about increased risk of prostate cancer. Men with a high risk of prostate cancer may consider medications or other treatments to reduce their risk. Some studies suggest that taking 5-alpha reductase inhibitors, including finasteride (Propecia, Proscar) and dutasteride (Avodart), may reduce the overall risk of developing prostate cancer. These drugs are used to control prostate gland enlargement and hair loss in men.

However, some evidence indicates that men taking these medications may have an increased risk of getting a more serious form of prostate cancer (high-grade prostate cancer). If you’re concerned about your risk of developing prostate cancer, talk with your doctor.