Prostate Cancer - Types, Stages, Causes, Symptoms, Screening, Treatment and Prevention

Introduction

Prostate cancer is a significant health concern for men worldwide, with increasing incidence in both developing and developed countries. While it most commonly affects men over the age of 50, cases are now being reported in younger age groups as well, especially those between 35 and 55 years. Early detection plays a critical role in improving treatment outcomes and preserving quality of life.

Many men may have heard of the prostate gland, PSA (Prostate-Specific Antigen) tests, or cancer screenings, but may not fully understand their importance until symptoms appear. By recognizing the early signs of prostate cancer and understanding the risk factors, men can take proactive steps to safeguard their health.

What is Prostate Cancer?

Prostate cancer is a type of cancer that forms in the tissues of the prostate gland—a small, walnut-shaped organ located just below the bladder in men. The prostate is part of the male reproductive system and is responsible for producing seminal fluid, which nourishes and helps transport sperm.

Most prostate cancers are adenocarcinomas, which develop slowly. In many cases, prostate cancer may remain confined to the gland for years without causing noticeable symptoms. However, in some men, the disease may grow aggressively and spread (metastasize) to other parts of the body if left undiagnosed.

Prostate cancer often begins with changes in the gland’s cells that may go unnoticed for years. Early prostate cancer usually does not present symptoms, which makes routine screening essential for timely detection.

Understanding the Prostate Gland

The prostate gland is part of the male reproductive system and is located below the bladder and in front of the rectum. It surrounds the urethra—the tube through which urine and semen exit the body.

Key functions of the prostate include:

• Producing seminal fluid that supports and transports sperm
• Aiding ejaculation by contracting and pushing semen into the urethra
• Secreting prostate-specific antigen (PSA), a protein that helps keep semen in a liquid state

Since the urethra passes through the prostate, any enlargement or abnormality in the gland—whether benign or cancerous—can affect the flow of urine. This is why symptoms such as difficulty urinating or increased frequency are commonly associated with prostate issues.

Types of Prostate Cancer

Prostate cancer is classified based on the type of cells where the cancer originates. The majority of cases involve the glandular cells of the prostate, but a few rare forms also exist.

1. Adenocarcinoma

This is the most common type of prostate cancer, accounting for over 95% of cases. It begins in the gland cells of the prostate that produce seminal fluid. Adenocarcinomas typically grow slowly, but some forms may be aggressive.

2. Rare Types of Prostate Cancer

Although uncommon, prostate cancer can also develop from non-glandular cells within or near the prostate. These include:

• Small Cell Carcinoma (a type of neuroendocrine tumor): Aggressive and fast-growing, often diagnosed at a more advanced stage
• Other Neuroendocrine Tumors: Includes large cell neuroendocrine carcinoma
• Transitional Cell Carcinoma: Typically starts in the bladder and may spread to the prostate
• Sarcomas: Originate in the soft tissues or connective tissues of the prostate

These rare subtypes tend to be more aggressive and require specialized treatment approaches.

Most individuals diagnosed with prostate cancer are found to have adenocarcinoma, while the rarer types represent a small fraction of overall cases.

Stages of Prostate Cancer

Prostate cancer is staged based on how much the cancer has grown within the prostate and whether it has spread to surrounding or distant tissues. This staging helps determine treatment options and prognosis.

Stage 1: Very Early-Stage Prostate Cancer

• Cancer is confined to a small area within the prostate.
• It is often not causing symptoms and may be detected through routine PSA screening or biopsy.
• The tumor is usually not palpable on a digital rectal exam.

Stage 2: Localized but Larger Tumor

• The cancer remains within the prostate but is larger and may involve both lobes.
• May be detectable during physical exam or imaging but has not spread beyond the prostate.

Stage 3: Locally Advanced Cancer

• Cancer has grown beyond the prostate capsule and may have spread to nearby tissues, such as the seminal vesicles.
• This stage indicates a higher risk of progression and may require a combination of treatment approaches.

Stage 4: Advanced or Metastatic Prostate Cancer

• Cancer has spread to nearby organs (like the bladder or rectum), lymph nodes, or distant organs such as the bones or lungs.
• This stage is often associated with more serious complications and systemic symptoms such as fatigue, bone pain, or weight loss.

Clarification: Is There a Stage 5?

There is no official Stage 5 in prostate cancer staging. Stage 4 is the most advanced stage, and any further classification is based on specific metastasis sites or treatment response.

Summary: Early vs. Late-Stage Prostate Cancer

 

Symptoms of Prostate Cancer

Prostate cancer often develops silently in its early stages and may not produce noticeable symptoms for years. This is why routine screening is crucial, especially for men over 50 or those at higher risk. When symptoms do occur, they are often related to urinary or reproductive function, due to the prostate’s location around the urethra.

Early-Stage Symptoms

In the early stages, prostate cancer symptoms may be subtle or mistaken for benign conditions such as Benign Prostatic Hyperplasia (BPH) or prostatitis. Common signs include:

• Frequent urination, especially at night
• Difficulty starting or stopping urination
• Weak or interrupted urinary stream
• Burning or painful sensation while urinating
• Painful ejaculation
• Erectile dysfunction
• Blood in the urine (hematuria) or blood in semen (hematospermia)
• Feeling of incomplete bladder emptying
• Urine leakage while coughing, sneezing, or laughing

These symptoms are not exclusive to prostate cancer and may also occur with non-cancerous prostate conditions, but they warrant evaluation by a healthcare provider.

Advanced-Stage Symptoms

As prostate cancer progresses, it can spread to nearby tissues, lymph nodes, and bones. Symptoms of advanced prostate cancer may include:

• Persistent pain or stiffness in the pelvic region, lower back, hips, ribs, or upper thighs
• Swelling in the legs or pelvic area due to lymphatic obstruction
• Unexplained weight loss and fatigue
• Numbness, weakness, or even paralysis in the lower limbs (if cancer spreads to the spine)
• Loss of bladder or bowel control in extreme cases

Are These Symptoms Definitive for Prostate Cancer?

Not necessarily. Several conditions, such as BPH and prostatitis, can mimic the symptoms of prostate cancer. These are non-cancerous and more common in younger men. However, any persistent urinary, sexual, or pelvic symptoms should be evaluated by a urologist to rule out cancer and ensure early intervention if needed.

Causes of Prostate Cancer

The exact cause of prostate cancer remains unclear, but it begins when the cells in the prostate gland undergo abnormal changes—typically at the genetic level. These changes cause the cells to grow uncontrollably, live longer than normal, and eventually form a tumor.

Genetic Mutations and Cell Abnormalities

At the core of most prostate cancers are mutations in the DNA of prostate cells. These mutations may:

• Trigger uncontrolled cell division
• Prevent normal cell death
• Promote abnormal protein production that fuels tumor growth
• Enable cancer cells to invade nearby tissue or spread (metastasize) to distant parts of the body

Some prostate cancers remain slow-growing and may never cause significant harm, while others are aggressive and fast-spreading.

Contributing Factors

While the mutations themselves are often spontaneous, certain underlying factors may contribute to or increase the chance of these genetic changes, including:

• Inherited genetic mutations (e.g., BRCA1, BRCA2, or genes linked to Lynch syndrome)
• Long-term exposure to toxins, such as cigarette smoke or environmental chemicals
• Oxidative stress and chronic inflammation in the prostate

Lifestyle choices such as smoking and heavy alcohol use may also play a role by introducing carcinogens into the body that can damage cellular DNA over time.

How Prostate Cancer Spreads in the Body

Prostate cancer typically starts in the gland cells of the prostate, but in some cases, it can spread beyond the prostate. This process is called metastasis and it significantly affects treatment options and outcomes.

1. Lymphatic Spread

Cancer cells can break away from the primary tumor and travel through the lymphatic system, reaching nearby lymph nodes. Once inside the lymph system, cancer cells can circulate and form new tumors in distant nodes or organs.

2. Hematogenous (Bloodstream) Spread

Cancer cells can enter the bloodstream, allowing them to reach distant parts of the body such as the bones, lungs, or liver. Bone metastasis is one of the most common complications of advanced prostate cancer, often causing pain or fractures.

3. Local Invasion

Prostate cancer can also spread by direct invasion into surrounding tissues, such as the seminal vesicles, bladder, or rectum. In some cases, this may lead to urinary obstruction or rectal discomfort.

4. Urinary Tract Involvement

In rare instances, cancer cells may enter the urethra or bladder, potentially causing urinary symptoms such as blockage or blood in urine.

Risk Factors for Prostate Cancer

While having one or more risk factors does not guarantee that you will develop prostate cancer, certain factors are known to increase your likelihood of getting the disease. Understanding these risk factors can help with early screening and informed decision-making.

1. Age

• Age is the strongest risk factor. Prostate cancer is rare in men under 50 but becomes increasingly common as men age.
• More than 60% of prostate cancer cases occur in men aged 65 and older.

2. Family History & Genetics

• Having a first-degree relative (father, brother, or son) with prostate cancer doubles or triples your risk.
• The risk increases further if multiple relatives are affected or if they were diagnosed at a young age.
• A family history of breast or ovarian cancer may also increase your risk, especially with known BRCA1 or BRCA2 mutations or Lynch syndrome.

3. Race and Ethnicity

• Black men have the highest risk of developing prostate cancer and are more likely to develop aggressive forms of the disease.
• Asian men tend to have lower rates of prostate cancer, though rates are rising globally due to lifestyle and environmental changes.
• The exact reasons for racial disparities are still being studied.

4. Diet and Nutrition

• Diets high in red meat, processed meats, and high-fat dairy products, with low intake of fruits and vegetables, are linked to increased risk.
• Deficiencies in nutrients like vitamin E, selenium, and omega-3 fatty acids may also contribute.
• A balanced, plant-rich diet may help lower risk.

5. Obesity

• Obese men are more likely to develop aggressive and advanced-stage prostate cancer.
• Obesity may cause hormonal imbalances and chronic inflammation, both of which can fuel cancer development.

6. Smoking and Lifestyle

• Smoking has been associated with an increased risk of aggressive prostate cancer and poorer outcomes.
• Sedentary lifestyle and poor physical activity levels may also contribute.

7. Sexually Transmitted Infections (STIs)

• STIs such as chlamydia or gonorrhea may cause inflammation of the prostate, potentially increasing cancer risk. However, this link is not yet fully established.

8. Environmental Exposure

• Long-term exposure to environmental toxins like cadmium, asbestos, and pesticides may increase risk, particularly in occupational settings.
• Geographic variations in incidence rates are observed globally, but these are likely due to differences in diet, healthcare access, and screening awareness.

Complications of Prostate Cancer

Prostate cancer can lead to several physical and functional complications, both from the disease itself and its treatment. These complications vary depending on the stage of cancer, its rate of progression, and the type of treatment received.

1. Erectile Dysfunction

Prostate cancer or its treatments—such as surgery, radiation therapy, or hormone therapy—can damage the nerves and blood vessels responsible for erections. While erectile dysfunction may be temporary in some cases, others may require long-term solutions like medications, vacuum devices, or penile implants.

2. Urinary Incontinence

The prostate surrounds the urethra, and both the cancer and its treatment can affect bladder control. Some men may experience:

• Urinary leakage during coughing or exertion (stress incontinence)
• Sudden urge to urinate (urge incontinence)
• Continuous dribbling or difficulty emptying the bladder

Management options include medications, pelvic floor therapy, catheters, or surgical procedures.

3. Infertility

Treatments such as prostatectomy or radiation can impact semen production and ejaculatory function, reducing or eliminating the ability to conceive naturally. Men concerned about fertility may opt for sperm banking before treatment.

4. Cancer Metastasis (Spread)

Advanced prostate cancer can spread beyond the prostate to nearby lymph nodes, bones, or distant organs such as the liver or lungs. This is called metastasis and can lead to complications like:

• Chronic bone pain
• Fractures
• Neurological issues if the spine is involved
  Metastatic prostate cancer is not typically curable but can be managed with appropriate therapies to extend life and improve quality of life.

Diagnosis of Prostate Cancer

Early and accurate diagnosis of prostate cancer significantly improves treatment outcomes. Since prostate cancer often develops slowly and may not show symptoms in its early stages, screening plays a vital role, particularly in men over 50 or those at higher risk.

Screening Tests

1. PSA (Prostate-Specific Antigen) Blood Test
   This is the most common initial screening tool. PSA is a protein produced by both normal and cancerous prostate tissue. Elevated levels may suggest cancer, but can also be caused by benign conditions like Benign Prostatic Hyperplasia (BPH) or prostatitis.
   • If PSA levels are high, the test may be repeated to confirm results.
   • A Free PSA test may also be used. A low free PSA percentage suggests a higher risk of cancer.
2. Digital Rectal Examination (DRE)
   A doctor manually checks the prostate by inserting a gloved, lubricated finger into the rectum to feel for abnormal growths or nodules.
3. Transrectal Ultrasound (TRUS)
   Uses sound waves to create images of the prostate. It is often used to guide biopsies.
4. Prostate MRI (Multiparametric MRI)
   This advanced imaging helps identify suspicious areas within the prostate and assess cancer spread, using a PIRADS score to grade risk.

Confirmatory Diagnostic Tests

If screening tests suggest the possibility of cancer, further investigations are conducted:

1. Prostate Biopsy
   A TRUS-guided biopsy is typically done where small tissue samples are taken from multiple regions of the prostate.
   • A positive biopsy confirms prostate cancer.
   • The tissue is graded using the Gleason score, which helps predict how likely the tumor is to grow or spread.
2. Gleason Grading System
   Pathologists assess cancer cells under a microscope and assign a score from 2 to 10 based on patterns of cell abnormality:
   • Grade 1 (≤6): Well-differentiated, less aggressive
   • Grade 2 (7): Moderately aggressive
   • Grade 3 (8–10): Poorly differentiated and aggressive

Additional Imaging to Determine Cancer Stage

If cancer is confirmed, imaging tests may be used to assess the extent of spread (metastasis):

• CT (Computed Tomography) scan – to check pelvic lymph nodes and nearby organs
• Bone Scan – to detect spread to bones, especially in cases with bone pain or high PSA
• PET scan – used when detailed information about spread is required
• Ultrasound KUB – evaluates kidney, bladder, and prostate status

When Should You Get Screened?

Routine screening is advised for:

• Men aged 50 and above
• Men with a family history of prostate cancer
• Individuals with certain genetic risk factors (e.g., BRCA mutations, Lynch syndrome)
• Men of African descent (who have a higher risk)
• Individuals with obesity, as they may develop more aggressive forms

Discussing screening options with a urologist is essential to balance the benefits of early detection with the risks of overdiagnosis.

Treatment for Prostate Cancer

The treatment of prostate cancer depends on multiple factors, including the stage of the disease, Gleason score, PSA levels, patient’s age, overall health, and whether the cancer is localized or has spread. Treatment aims to either cure the cancer or manage it effectively to enhance the patient’s quality of life.

1. Active Surveillance (Watchful Waiting)

For patients with early-stage, slow-growing prostate cancer, especially in older adults, immediate treatment may not be necessary. Instead, doctors may recommend careful monitoring through:

• PSA blood tests
• Digital Rectal Examinations (DRE)
• Periodic biopsies and imaging

This approach avoids overtreatment in cases where the cancer may never progress or cause symptoms.

2. Curative Treatment Options

When prostate cancer is confined to the gland or diagnosed early, curative treatments may be advised.

a. Surgery – Radical Prostatectomy

Surgical removal of the prostate gland and sometimes surrounding tissue or lymph nodes. Options include:

• Open Radical Prostatectomy
• Laparoscopic Prostatectomy
• Robot-Assisted Laparoscopic Prostatectomy
  (Minimally invasive, faster recovery, less blood loss)

b. Radiation Therapy

Radiation uses high-energy rays to kill cancer cells. Common types include:

• External Beam Radiation Therapy (EBRT)
• Intensity-Modulated Radiation Therapy (IMRT)
• Stereotactic Body Radiotherapy (SBRT)
• Brachytherapy (Internal Radiation using radioactive seeds)

c. Proton Beam Therapy (See Section 3)

A newer, more precise type of radiation that minimizes damage to surrounding tissues like the bladder and rectum. Detailed separately below.

3. Proton Therapy for Prostate Cancer at Apollo Hospitals

Apollo Hospitals is home to Asia’s first and only Proton Therapy Centre, Apollo Proton Cancer Centre, Chennai.

Proton therapy uses proton particles instead of traditional X-rays to deliver radiation directly to the tumor. This method deposits most of its energy at the tumor site, sparing healthy tissues around the prostate.

Why Proton Therapy?

• Unmatched Precision – Ideal for tumors close to vital organs
• Minimal Side Effects – Lower risk of urinary incontinence, bowel dysfunction, and sexual side effects
• High-Quality of Life – Especially for patients with localized or recurrent cancer
• Outpatient Convenience – No hospital stay needed in most cases

Who Can Benefit?

• Early-stage prostate cancer
• Patients with high-risk or recurrent disease
• Men who are unfit for surgery or wish to avoid it

Apollo Proton Cancer Centre, Chennai, offers this breakthrough technology with global expertise and personalized care. If you’re considering treatment options, consult with our proton therapy team to see if you're eligible.

4. Hormone Therapy (Androgen Deprivation Therapy – ADT)

This therapy aims to reduce the levels or effects of testosterone, which fuels prostate cancer growth.

• Medications – To block testosterone production or action
• Surgical removal of testicles (Orchiectomy) – A permanent hormone-blocking option

Used in:

• Advanced or metastatic cancer
• As a preparatory step before radiation
• When surgery isn’t feasible

5. Chemotherapy

Used for advanced prostate cancer that has spread beyond the gland or doesn’t respond to hormone therapy.

• Administered orally or intravenously
• Helps shrink tumors and slow progression
• Side effects: fatigue, hair loss, nausea, appetite loss

6. Immunotherapy

Boosts the body’s immune system to fight cancer.

• Sipuleucel-T (Provenge) – A personalized treatment designed for advanced cases
• Side effects: flu-like symptoms, mild fatigue, or nausea

7. Cryotherapy (Cryoablation)

Involves freezing prostate tissue using liquid nitrogen to destroy cancer cells. It’s a minimally invasive option suitable for:

• Early-stage cancers
• Recurrent cases after radiation

8. Targeted Therapy

This involves drugs that specifically target molecular changes in cancer cells. Still under research for prostate cancer, targeted therapy may be used in selected cases with identifiable genetic mutations.

9. Palliative Care for Advanced Prostate Cancer

For stage 4 or metastatic prostate cancer, the focus shifts to:

• Managing symptoms
• Slowing disease progression
• Improving comfort and quality of life

Palliative treatments may include:

• Hormone therapy
• Low-dose radiation for bone pain
• Supportive medications for fatigue, urinary issues, and pain

Final Note - With early diagnosis and access to cutting-edge treatments like robotic surgery, proton therapy, and personalized immunotherapy, prostate cancer is among the most treatable cancers. Every case is different, and your treatment should be personalized by a urologist or oncology expert.

Recurrent Prostate Cancer

Recurrent prostate cancer refers to cancer that returns after initial treatment. It can reappear in the prostate region (local recurrence) or spread to other parts of the body (distant recurrence), such as the bones, liver, lungs, or lymph nodes.

Common Signs of Recurrence:

• Rising PSA levels – often the earliest and most reliable sign
• Blood in the urine
• Difficulty urinating or new urinary obstruction
• Persistent lower back or pelvic pain
• Fatigue or weakness
• Shortness of breath (if lungs are affected)
• Jaundice (if the liver is involved)

Monitoring After Treatment

After primary treatment (surgery, radiation, etc.), regular PSA tests, imaging scans, and clinical check-ups are essential for early detection of recurrence. Early intervention may help manage recurrence effectively and improve quality of life.

When to Consult a Doctor About Prostate Cancer

If you notice persistent symptoms such as frequent urination, difficulty urinating, blood in the urine or semen, pelvic discomfort, or erectile dysfunction, it is important to consult a doctor. These could be early warning signs of prostate cancer or other prostate-related conditions.

You should see a urologist or oncologist for further evaluation and screening, especially if:

• You are over the age of 50
• You have a family history of prostate or breast cancer
• Your symptoms are gradually worsening
• You have previously elevated PSA levels or abnormal test results

Early diagnosis is key to effective treatment. If caught in its early stages, prostate cancer is one of the most treatable cancers. Don’t delay medical attention if symptoms persist or raise concern.

Prevention of Prostate Cancer

While there is no guaranteed way to prevent prostate cancer, certain lifestyle changes may help lower your risk and support overall prostate health:

• Maintain a healthy diet: Focus on a diet rich in fruits, vegetables, whole grains, and healthy fats. Reduce intake of red meat, processed foods, and high-fat dairy products.
• Exercise regularly: Physical activity can help maintain a healthy weight and improve immune function, both of which are linked to a lower risk of prostate cancer.
• Maintain a healthy weight: Obesity is associated with a higher risk of aggressive prostate cancer. Aim for a healthy body mass index (BMI).
• Limit smoking and alcohol consumption: Avoiding tobacco and reducing alcohol intake may help improve overall health and lower cancer risk.
• Stay informed about your family history: If prostate or breast cancer runs in your family, speak with your doctor about earlier or more frequent screenings.
• Get regular checkups: Talk to your doctor about prostate health, especially after the age of 50 or earlier if you're in a high-risk group.
• Manage stress: Long-term stress may negatively affect overall health; incorporating relaxation techniques such as meditation, yoga, or hobbies can be beneficial.

Although you can't eliminate the risk completely, these proactive steps can help reduce your chances of developing prostate cancer and support better health outcomes if diagnosed early.

Outlook and Final Thoughts

Prostate cancer, when detected early, is highly treatable. If diagnosed before it spreads beyond the prostate, the 5-year survival rate can be as high as 99%. However, once metastasized to distant organs, the survival rate drops significantly, to around 29%. This makes early diagnosis and timely treatment absolutely vital.

Men over 45, especially those with risk factors like family history or certain genetic traits, should speak to their doctor about regular screening options such as PSA tests and digital rectal exams. Early intervention not only improves survival but also reduces complications and preserves quality of life.

Conclusion

Being informed about the warning signs, risk factors, and treatment options for prostate cancer can make a life-saving difference. While symptoms may be subtle in the early stages, any changes in urinary habits, sexual health, or unexplained fatigue should be discussed with a healthcare provider.

Make your prostate health a priority. Schedule routine screenings, maintain a healthy lifestyle, and consult a specialist if you notice anything unusual. Early detection saves lives.

 

Frequently Asked Questions (FAQs)

1. Does increased sexual activity increase the risk of prostate cancer?
   No, there is no scientific evidence linking frequent sexual activity or masturbation to an increased risk of prostate cancer.
2. Are there any supplements that help prevent prostate cancer?
   Some studies suggest that nutrients like vitamin E or selenium may reduce the risk of prostate cancer, but evidence is inconclusive. It’s best to consult a doctor before taking any supplements for prevention.
3. Does hormone therapy affect mood or emotions?
   Yes, androgen deprivation therapy (ADT) can lead to mood swings, depression, irritability, or emotional sensitivity in some men due to lowered testosterone levels.
4. What are the side effects of prostate cancer treatments?
   Side effects vary by treatment but may include urinary incontinence, erectile dysfunction, fatigue, hot flashes, nausea, and bowel changes. Many of these are temporary and manageable with supportive care.
5. Can prostate cancer return after treatment?
   Yes, prostate cancer can recur locally or spread to other organs (metastasize). Regular PSA monitoring and follow-up scans help detect recurrence early.
6. Is prostate cancer only a concern for older men?
   While it is more common in men over 50, younger men can also develop prostate cancer, especially if there’s a family history or genetic predisposition.
7. Is prostate cancer always life-threatening?
   Not necessarily. Many cases grow slowly and remain confined to the prostate gland. Early-stage prostate cancer has a very high survival rate and may not always require aggressive treatment.
8. How often should I get screened for prostate cancer?
   If you're over 45 years old or have risk factors (like a family history), consult your doctor about starting annual PSA tests and digital rectal exams (DREs). For others, screening may begin at age 50.
9. Does diet play a role in prostate cancer prevention?
   Yes, a low-fat diet rich in fruits, vegetables, and whole grains may help reduce prostate cancer risk. Limiting red meat and high-fat dairy is also advisable.
10. Can I have children after prostate cancer treatment?
    Treatments like surgery or radiation may affect fertility. If you wish to have children, discuss sperm banking or fertility preservation options before starting treatment.