The prostate is a male organ located beneath the bladder whose primary roles are to produce a fluid which mixes with sperm from the testicles to form semen, and to contract in order to cause ejaculation.
Prostate cancer is the most common form of cancer in men, and the second-leading cause of cancer death in men; about 1 in 8 will receive a diagnosis at some point in their lifetime. It is more common in older men, with the average age of diagnosis at 67. Prostate cancer is rare before the age of 40.
Prostate cancer is more likely to cause symptoms once it has spread, but even early stage cancer can commonly cause:
Trouble urinating
Blood in the urine
Weakened urine stream
Blood in the semen
Unexplained weight loss
Bone pain
Erectile dysfunction
These symptoms may be caused by any number of health conditions, but when they are a change from your normal experience, increase in severity, or are persistent, they may indicate prostate cancer. Unexplained symptoms should always be evaluated by a medical professional.
While there are some rare forms of cancer that can start in the prostate–including small cell carcinoma, large cell carcinomas, transitional cell carcinomas, and sarcomas–the overwhelming majority of prostate cancers are adenocarcinomas. These cancers form in the gland cells responsible for making the seminal fluid. There are also both benign growths and precancerous cell changes that can occur in the prostate, some of which may increase your risk for developing prostate cancer. These should be discussed with your doctor to determine what, if any, treatment is necessary.[1]
Prostate cancer survival rates are based on how far the cancer has spread:
Localized: There is no sign the cancer has spread outside the prostate.
Regional: The cancer has spread to nearby structures or lymph nodes
Distant: The cancer has spread to distant parts of the body, such as the liver or lungs.
The 5-year survival rate for each stage is shown below[2]:
Incidence
Below is the overall incidence of prostate cancer by age group:
Risk Factors
There are several confirmed risk factors that contribute to an individual’s risk for prostate cancer:
Alcohol use: Alcohol has been shown to increase the risk of prostate cancer. This risk increases the more you drink.
Family history of prostate or breast cancer: A family history of prostate cancer, even in the absence of known genetic conditions, increases your risk for likewise developing prostate cancer. Similarly, a family history of breast cancer raises your overall risk.
Genetic conditions: Certain inherited genetic conditions can increase one’s risk of developing prostate cancer. These conditions include: some text
Hereditary breast and ovarian cancer syndrome (HBOC, caused by mutations to the BRCA1 or BRCA2 gene)
Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC)
Working as a firefighter: Multiple studies have shown firefighters are at an increased risk for several forms of cancer, including prostate. This is likely due to the known and suspected carcinogens they are exposed to in their work, some of which can be inhaled or absorbed through the skin.
Processed and red meat consumption: High consumption of red and processed meat has been linked to both higher risk of developing prostate cancer, and higher mortality rates among those diagnosed.
Protective Factors
Several factors have been shown to have protective effects against prostate cancer:
Physical activity: Regular exercise can reduce your risk of several types of cancer through a combination of physiological, hormonal, and immunological changes. It can reduce inflammation, improve immune function, improve hormonal regulation, and lower insulin levels. The American Cancer Society recommends engaging in at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week. Furthermore, data indicates that individuals can see significant incremental benefit with additional exercise.
Coffee: Several studies have found that coffee consumption decreases your risk of certain types of cancer, including prostate. The beneficial effects may be due to the presence of bioactive compounds in coffee, such as caffeine and polyphenols, which have antioxidant and anti-inflammatory properties. Most studies suggest that protective effects of coffee are observed with moderate consumption (typically 3-4 cups per day). It's important to recognize that individual responses to coffee intake may vary based on factors such as genetics, metabolism, and overall diet and lifestyle. Therefore, recommendations regarding coffee consumption should be personalized to each individual's health profile.
Fruit and vegetables: Fruit and vegetables are rich in various nutrients which have been shown to have protective effects against multiple cancers, including prostate. These foods contain a variety of antioxidants, which help neutralize free radicals in the body and reduce inflammation.
Oily fish / fish oil supplements: Oily fish (such as salmon, mackerel, trout, sardines, and herring) are known to have various health benefits. Rich in omega-3 fatty acids, protein, vitamins, and minerals, studies have shown that eating oily fish has protective effects against several types of cancer, including prostate, and that increased consumption increases these benefits.
Statins: Statins are a class of prescription drugs that lower cholesterol levels and can reduce the risk of heart attack and stroke, and studies have shown that statins may also lower the risk of several cancers, including prostate. While the exact mechanism is unknown, this could be due to several factors. Statins have anti-inflammatory properties that may inhibit the inflammatory processes involved in cancer development and progression.
Soy: Multiple studies have shown that higher soy consumption correlates with a reduction in prostate cancer risk as well as better outcomes for individuals who receive a prostate cancer diagnosis. This observation holds across a wide variety of soy-based products.[3]
Screening
Early detection of prostate cancer has a dramatic impact on prognosis. The 5-year survival rate for localized cancer is 100%, but drops to just 36.6% once the cancer has spread to distant parts of the body.
Depending on your age and risk factors, the optimal prostate cancer screening will vary:
Prostate-specific antigen (PSA) blood test & PSA velocity over time: PSA is a protein made in the prostate, a small amount of which is found in the blood. Levels of this protein can indicate whether prostate cancer is likely (though further tests would be required for a definitive diagnosis). It’s important to note that there is no absolute “safe” or “risky” level of PSA in the blood, as various outside factors–ranging from age to dietary supplementation to recency of ejaculation–can influence levels. This is why PSA velocity (i.e. how PSA levels rise over time) is an important measure to assess risk.
Digital rectal exam (DRE): In a DRE, your doctor will insert a gloved finger into the rectum in order to palpate the prostate. Any hard areas or lumps may indicate cancer. As with PSA testing, any abnormal results from a DRE would require further evaluation, most likely via biopsy. While DRE is considered an overall less effective test than PSA blood testing, it can locate some cancers that PSA tests miss.
MRI: If you receive an abnormal result on a PSA or DRE test, you may be encouraged to undergo imaging tests such as an MRI to determine whether there are any growths on the prostate. Because PSA testing is very informative and non-invasive, this is not usually recommended as a frontline screening option.
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