Prostate cancer is one of the most common cancers affecting men worldwide, developing in the small walnut-shaped gland that plays a key role in the male reproductive system. While the diagnosis can be frightening, many prostate cancers grow slowly and can be successfully managed or cured, especially when detected early.
Understanding the Scale of Prostate Cancer
Prostate cancer affects millions of men around the world. In the United States alone, about one out of every eight men will be diagnosed with this disease during their lifetime. This makes it the most commonly diagnosed cancer in men, aside from skin cancer.[1] Globally, prostate cancer is the most commonly diagnosed malignancy in men in more than half of all countries worldwide. In 2020, there were approximately 1,414,249 newly diagnosed cases and 375,000 deaths annually due to this disease across the globe.[5]
The good news is that detection rates have improved significantly over recent decades, and most men diagnosed with prostate cancer do not die from it. About 96 percent of men who are diagnosed with prostate cancer are still alive five years later.[8] In the United States, approximately 35,770 people die from prostate cancer each year, but many more live long lives despite their diagnosis.[3] This is largely because prostate cancer tends to grow slowly in most cases, and many men die of other causes without the cancer ever causing serious problems.
Who Gets Prostate Cancer
Age is the most significant factor when it comes to prostate cancer risk. The disease is most common in older men, with risk increasing significantly after age 50. About 60 percent of all prostate cancer cases occur in people older than 65 years of age.[3] The older a man is, the greater his chance of developing this disease.[8]
Race and ethnicity also play important roles in determining risk. African American men face a particularly elevated risk. They are twice as likely to develop prostate cancer compared to white men, and they are more than twice as likely to die from the disease. African American men also tend to get prostate cancer at younger ages and often have more advanced disease when it is discovered. They also tend to develop more severe types of prostate cancer than men of other races.[7][8]
Family history matters considerably. If you have a father or brother who has been diagnosed with prostate cancer, your risk is two to three times higher than someone without this family connection. The risk increases even more if multiple close family members have had the disease, or if relatives were diagnosed at relatively young ages.[3][7] Some men may have inherited genetic changes that put them at higher risk. Men with Lynch syndrome or those who carry mutations in genes called BRCA1 and BRCA2, which are also associated with increased breast cancer risk, face elevated chances of developing prostate cancer.[3]
Other factors that may increase risk, though the evidence is not as strong, include smoking, having a body mass index greater than 30, a history of sexually transmitted infections, inflammation of the prostate called prostatitis, and exposure to certain chemicals such as Agent Orange, which was used during the Vietnam War.[3]
What Causes Prostate Cancer
Scientists don’t fully understand exactly what causes normal prostate cells to become cancerous. Like other cancers, prostate cancer develops when cells in the prostate gland begin to divide and multiply faster than they should. Normal cells follow an orderly cycle of growth and death, but cancer cells don’t follow these rules. Instead of dying when they should, they continue to multiply and pile up, forming a mass of tissue called a tumor.[3]
These changes happen at the level of the cell’s DNA, the genetic material that tells cells how to function. Small changes, or mutations, in DNA cause the cells to grow faster and live longer than normal cells would. As these abnormal cells accumulate, they use up resources that would normally support healthy cells and can damage the surrounding tissue.[1] In some cases, parts of the tumor can break away and travel through the bloodstream or lymphatic system to other parts of the body, a process called metastasis.
Fortunately, most prostate cancers grow slowly. Many tumors are diagnosed before the cancer has spread beyond the prostate gland itself. When caught at this stage, prostate cancer is highly treatable, and many men can be cured.[3]
Recognizing the Symptoms
One of the challenges with prostate cancer is that it rarely causes symptoms in its early stages. Many men have no signs at all when the cancer is small and confined to the prostate gland. This is why screening and regular checkups are so important for men in the higher-risk age groups.[3]
As prostate cancer progresses and grows larger, or if it begins to spread, men may start to notice changes. Common symptoms include a frequent need to urinate, especially at night. The flow of urine may become weak or may start and stop instead of flowing steadily. Some men experience pain or a burning sensation when they urinate, a condition called dysuria. Others may lose control of their bladder, a problem known as urinary incontinence, or lose control of their bowels, called fecal incontinence.[3][10]
Sexual problems can also develop. These include painful ejaculation, difficulty achieving or maintaining an erection, which is called erectile dysfunction, and the presence of blood in the semen or urine.[3] If prostate cancer spreads to other parts of the body, particularly the bones, men may experience pain in the lower back, hips, or chest. Advanced cancer that has spread to the bones or caused complications in other areas can lead to symptoms such as shortness of breath, extreme tiredness, fast heartbeat, dizziness, or pale skin caused by anemia.[10]
It’s important to note that many of these symptoms can also be caused by conditions that are not cancer. As men age, the prostate naturally tends to increase in size, which can narrow the tube that carries urine out of the bladder (the urethra) and decrease urine flow. This common condition is called benign prostatic hyperplasia, or BPH, and it is not the same as prostate cancer, though it can cause similar symptoms.[4][10] Men may also have other prostate problems that are not cancer but still require medical attention.
If you experience any of these symptoms, it’s essential to see your doctor right away. Only medical tests can determine whether symptoms are caused by cancer, BPH, or another condition.[8]
Preventing Prostate Cancer
There is no guaranteed way to prevent prostate cancer, but research suggests that certain lifestyle choices may help reduce your risk. These same habits can also improve your overall health and wellbeing, so they offer benefits beyond cancer prevention.[20]
Eating a healthy diet may play a role. Studies suggest that men who eat diets rich in fruits and vegetables may have a lower risk of prostate cancer, though more research is needed to confirm this connection. Fruits and vegetables contain vitamins, minerals, and other nutrients that support the body’s natural defenses. Limiting the amount of fat in your diet, especially from animal sources like red meat and high-fat dairy products, may also be helpful. Choosing leaner cuts of meat and low-fat or reduced-fat dairy products are simple ways to reduce fat intake.[20]
Staying physically active is another important step. Regular exercise has been shown to have protective effects against many diseases. Some research suggests that men who exercise after prostate cancer treatment may live longer than those who don’t, though more studies are needed. Even without definitive proof, exercise offers numerous known benefits and is a cornerstone of good health.[18] Experts generally recommend at least 30 minutes of exercise most days of the week.[9]
Maintaining a healthy weight is also important. Studies have found that being overweight may lower the chances of successful treatment outcomes for men diagnosed with prostate cancer. Keeping your weight within a healthy range supports your immune system and overall health.[18]
For men at higher risk due to family history or genetic factors, regular screening and conversations with a doctor about individual risk are especially important. Screening typically begins at age 55 for men at average risk, but men with higher risk factors may benefit from starting earlier. Screening recommendations vary, and it’s important to discuss the potential benefits and harms of screening with your healthcare provider.[3][8]
How the Body Changes with Prostate Cancer
The prostate is a small gland, about the size of a walnut, located just below the bladder and in front of the rectum in males. It surrounds part of the urethra, the tube that carries urine from the bladder out of the body. The prostate produces fluid that mixes with sperm from the testicles to create semen, which nourishes and protects sperm during reproduction.[4][10]
When cancer develops in the prostate, the most common type is called an adenocarcinoma. Adenocarcinomas start in the gland cells that secrete fluid. These are responsible for the vast majority of prostate cancer cases. Rarely, prostate cancer can develop from other types of cells, such as small cell carcinomas, transitional cell carcinomas, neuroendocrine tumors, or sarcomas, but these are much less common.[3]
Most prostate cancers grow slowly inside the prostate gland. Some tumors may remain small and confined to the gland for many years without causing problems. In these cases, the cancer may never pose a serious threat to health. However, other prostate cancers are more aggressive and can grow quickly, spreading beyond the prostate to nearby tissues or traveling to distant parts of the body such as the bones or lymph nodes. When cancer spreads, it is called metastatic or advanced cancer.[3]
As the tumor grows within the prostate, it can press on the urethra, making it harder to urinate. This can cause the urinary symptoms many men experience. If the cancer spreads outside the prostate, it can affect nearby structures such as the bladder, rectum, or the nerves that control sexual function. Cancer that has spread to the bones can weaken them and cause pain. Advanced cancer can also affect the body’s ability to produce healthy blood cells, leading to anemia and fatigue.[3][10]
The male hormone testosterone plays a role in prostate cancer growth. Prostate cancer cells usually depend on testosterone to grow and multiply. This is why one of the common treatments for prostate cancer is hormone therapy, which works to block the production of testosterone or prevent cancer cells from using it.[3]
Understanding how prostate cancer develops and behaves helps doctors decide on the best approach to treatment. For slow-growing cancers that are unlikely to cause problems, doctors may recommend careful monitoring instead of immediate treatment. For more aggressive cancers, or those that have spread, a combination of treatments may be needed to control the disease and manage symptoms.[3]
