Prostate cancer basics

If you are in the dark about prostate cancer, here are some things to know:

• Prostate cancer is a common cancer of men that causes about one in 20 cancer-related deaths.
• Black men are more likely to get prostate cancer and have a higher chance of dying from the disease than men of other races.
• Prostate cancer can run in families and be linked to a family history of seemingly unrelated cancers.
• Prostate cancer does not always need treatment, but when it does, the outcome is excellent if the cancer is caught and treated at an early stage.

Not sure what a prostate is? That's OK. Keep reading to get the facts on this common cancer.

What is a prostate?

A prostate—or more accurately, a prostate gland—is a male sex organ. The gland sits below the bladder and produces the fluid (semen) men release during orgasm, which contains sperm. People born with male sex organs (penis) have a prostate, whereas people born with female sex organs (vagina) do not. Since about half the people in the world are born male, a lot of people have a prostate.

Who is most likely to get prostate cancer?

Anyone with a prostate can develop prostate cancer. In fact, many men who live into old age will develop prostate cancer but never know they have it. It's the second most common cancer in men. Only skin cancer is more common.

About one in 8 men will be diagnosed with prostate cancer during his lifetime and about one in 41 men will die of the disease. However, most men with prostate cancer do not die from prostate cancer.

Is it possible to predict who will get prostate cancer?

Not really, but research shows certain things increase a man's chances. These are called risk factors. Some risk factors for prostate cancer cannot be changed, such as:

Growing older

As a man ages past 50 to 55 years old, the risk of prostate cancer increases each year. The disease most often is diagnosed in men aged 65 to 74. Most deaths from prostate cancer are in men aged 75 to 84.

Being Black

Researchers aren't sure why, but Black men have a higher risk of developing prostate cancer than men of other races. The cancer also tends to develop earlier and to be more aggressive—meaning it grows and spreads faster—in Black men.

Having a close relative with prostate cancer

Men whose father, paternal uncle or brother had prostate cancer have a higher risk of also developing the cancer. The risk is even greater if more than one family member had prostate cancer or if a family member developed the disease at a younger age or died from it.

Having close relatives with other cancers

A less common risk factor is a family history of other cancers—including breast, ovarian, pancreatic, colorectal or endometrial cancer—that are associated with prostate cancer by way of gene defects (mutations) passed from parents to their children. For example, BRCA1 and BRCA2 gene mutations, which are known for increasing the risk of breast and ovarian cancer in women, also are risk factors for aggressive prostate cancer in men. The Main Line Health Genetics and Risk Assessment Program offers a wealth of information and services for people who may be at risk for inherited cancers.

Smoking and being overweight/obese also are risk factors. Men who smoke or are an unhealthy weight and develop prostate cancer tend to have more serious disease.

What can a man do if he's concerned about prostate cancer?

A few things. To start, men should understand their personal risk for prostate cancer. This is an important topic to cover at a doctor visit. If it's been a while since a man has seen a doctor, this is a great reason to make an appointment. During the discussion, if it turns out close family members have had prostate or other cancers, the doctor may recommend cancer risk assessment and genetic counseling.

Once a man understands his risk for prostate cancer, he may want to consider being screened for prostate cancer. Prostate cancer screening is a way to look for early signs of the cancer before any hint of a problem, such as changes in a man's normal urinating (peeing) habits. Screening is the only way to tell if the prostate is healthy.

But I've heard prostate cancer screening may not be a good idea. Why is that?

"It's true prostate cancer screening may not be right for all men," says David McGinnis, MD, a urologist at Bryn Mawr Hospital, part of Main Line Health. "Some men will not benefit from finding prostate cancer, even if it's treatable," he explains. "This may be because the cancer is growing so slowly it's unlikely to cause problems throughout the rest of the man's life. But there are other reasons a man may not benefit from prostate cancer screening."

The decision to be screened for prostate cancer is highly personal. Every man's risk factors, overall health, goals and values will be different. This is a complex topic to discuss with a doctor. Doctors should be up to date on current prostate cancer screening recommendations, one of which is for men to make an informed decision after learning about the uncertainties, risks and potential benefits of prostate cancer screening.

When should men have this discussion with a doctor?

Men of any age who are concerned about prostate cancer should talk to a doctor about whether screening is right for them. As for when to start these conversations, experts agree that it should be based on a man's personal risk for prostate cancer. Most recommend starting at:

• Age 50 if a man is at average risk for prostate cancer and expected to live at least 10 more years
• Age 40 to 45 if a man is Black or has a family history of prostate cancer, particularly in a first-degree relative (father, brother) who was diagnosed before age 65
• As early as age 40 if a man is known or likely to carry a gene mutation such as BRCA1 or BRCA2

Are there different types of prostate cancer?

Yes, but by far the most common type is adenocarcinoma. These cancers develop from the gland cells that make the fluid in semen. Nearly 100% of prostate cancers are this type.

More important to know is how quickly a prostate cancer is growing. The faster it grows, the more it can spread and cause serious health problems. Doctors refer to fast-growing prostate cancer as aggressive or high-risk prostate cancer. They also use a grading system, called the Gleason score, to describe how fast or slow prostate cancer grows. Generally, prostate cancers scored at 7 or above are considered higher risk.

The Gleason score is one of many factors weighed when determining whether and how to treat prostate cancer. A score of 7 or above also should prompt consideration of genetic testing.

"Any man with prostate cancer and a Gleason score of 7 or greater is a candidate for genetic evaluation, as is any man with metastatic prostate cancer," says Rachael Brandt, PhD, MS, LCGC, a licensed genetic counselor and manager of the Genetics and Risk Assessment Program at Main Line Health. "Confirming a genetic link to the cancer can help determine if a certain treatment would be most effective for him while providing vital information for his family members."

If screening leads to a diagnosis of prostate cancer, is treatment always the next step?

No. Prostate cancer treatment is not one size fits all. Like decisions about screening, decisions about treatment are highly personal. Key considerations are how advanced the cancer is and how fast it's growing and the man's age, overall health and understanding of the risks and potential benefits of his treatment options, which may include doing nothing.

It's important to note that prostate cancer found through screening is most likely to be early-stage cancer that has not spread beyond the prostate (called localized prostate cancer). Standard options for treating localized prostate cancer are surgery to remove the prostate, radiation therapy to destroy the tumor inside the prostate and frequent monitoring with tests (called active surveillance) but no treatment unless the tumor becomes more aggressive.

Men with low-risk (slow-growing) tumors and a longer life expectancy may wish to start with active surveillance and only have surgery or radiation therapy if their cancer becomes more aggressive. Men who are older or have other serious illnesses might opt to only treat symptoms of prostate cancer if they develop.

Overall, what's most important to know about prostate cancer?

Men should realize that if they live long enough—into their 80s or beyond—they will probably get prostate cancer. That doesn't mean they will die from prostate cancer. Only a small percentage of men who get prostate cancer die from the disease. However, men should understand their risk for prostate cancer and consider screening early. Then, if aggressive prostate cancer is found, it can be treated before it spreads, and a man can get back to living his life.

If you're unsure about your risk for prostate cancer or whether screening is right for you, make an appointment to discuss these questions with your primary care physician.

Next steps:

Learn more about urologist David McGinnis, MD
Learn more about genetic counselor Rachael Brandt, PhD, MS, LCGC
If you don't have a primary care physician, let us help you find one
Learn more about urology care at Main Line Health