Cancer - Oncology

What is Prostate Cancer?

Prostate cancer means you have cancer cells in your prostate tissue. The prostate is a walnut-sized gland located between the bladder and the penis. It produces a fluid that is part of semen.

Several types of cancer can develop in the prostate. Almost all prostate cancers are adenocarcinomas, which start in the gland cells. Other prostate cancers include small cell carcinomas, neuroendocrine tumors (other than small cell carcinomas), transitional cell carcinomas, and sarcomas. These other types of cancer are rare.

After skin cancer, prostate cancer is the most common cancer in men in the United States. About one in nine men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society.

Risk Factors

Men over age 50 have the greatest risk of developing prostate cancer. More than 60 percent of prostate tumors occur in men age 65 or older. Starting at age 50, men should have an annual prostate-specific antigen (PSA) test. If your PSA level is high, it can be a sign of prostate cancer. A high PSA reading also can indicate non-cancerous conditions. These can include inflammation of the prostate (prostatitis) and enlargement of the prostate (benign prostatic hyperplasia).

Ethnic background can play a role, too. African-American men and Caribbean men of African ancestry are at higher risk of developing prostate cancer than men of other races.

Family history can increase the risk of prostate cancer. If a close relative, such as your father or brother, has had prostate cancer, your risk is higher than average. However, while prostate cancer seems to run in some families, most prostate cancers occur in men without a family history.

Genetic changes that occur after birth can also contribute to prostate cancer risk. Male hormones such as testosterone promote prostate cell growth. When testosterone causes cells to grow and divide very quickly, mutations can occur, which can cause cancer.

Symptoms

In its early stages, prostate cancer has no obvious symptoms. Doctors usually find the disease during a routine prostate-specific antigen (PSA) screening. With more advanced prostate cancer, symptoms may include: 

  • Blood in the urine or semen
  • Difficulty starting or holding back urination
  • Painful urination or ejaculation
  • Pain in the spine, hips, ribs, or other bones
  • Pressure or pain in the rectum
  • Trouble having or keeping an erection
  • Weak, dribbling, or interrupted flow of urine
  • Weakness or numbness in the legs or feet

Screening and Diagnosis

All men should be screened for prostate cancer. Certain risk factors, including age, race, and family history, can influence when and how often we screen you.  

At Mount Sinai, our screening guidelines follow the American Urological Association suggestions. You can ask your primary doctor or urologist about your risk and the benefits of screening. Prostate cancer screening carries no risk.  

Many men have a baseline prostate-specific antigen (PSA) test at age 40. This test tells us about your future risk for the disease. Screening should also include a digital rectal exam. This test can show any physical abnormalities of the prostate that could be a sign of cancer.  

While most men with an elevated PSA do not have cancer, there is no PSA level that guarantees that you are cancer free. At Mount Sinai, our doctors do not look at the PSA level in isolation; rather we consider it in the context of your age, race, family history, size of your prostate, and the percentage of free PSA (PSA unbound to other proteins).

If more information is needed, we may perform a prostate biopsy. To perform a biopsy, we remove some of your prostate tissue and look at it under a microscope. Performing a biopsy is the only way to be sure if you have prostate cancer. About 20 percent of men diagnosed with prostate cancer in the United States have a normal PSA but have cancerous cells in their prostate.

At Mount Sinai, we use the latest diagnostic techniques. One of these is fusion biopsy. This approach uses magnetic resonance imaging (MRI) and real-time ultrasound images to help us precisely track, target, and sample any suspicious prostate tissue. 

Prostate cancer usually grows slowly. This means we have some time to develop the treatment plan that is best for you.