By Mayo Clinic Staff

Prostate cancer is a growth of cells that starts in the prostate. The prostate is a small gland that helps make the fluid part of semen. It's found just below the bladder. The prostate is part of the male reproductive system.

Prostate cancer is one of the most common types of cancer. Prostate cancer is usually found early, and it often grows slowly. Most people with prostate cancer are cured.

People diagnosed with early prostate cancer often have many treatment options to consider. It can feel overwhelming to learn about all the options and make a choice. Treatments may include surgery, radiation therapy or carefully watching the prostate cancer to see if it grows.

If the cancer grows beyond the prostate or if it spreads, there are still many treatment options. Prostate cancer that spreads can be more difficult to cure. But even when a cure isn't possible, treatments can slow the growth of the cancer and help you live longer.

Prostate cancer may not cause symptoms at first. Most prostate cancers are found at an early stage. This means that the cancer is only in the prostate. An early-stage prostate cancer often doesn't cause symptoms.

When they happen, early-stage prostate cancer signs and symptoms can include:

• Blood in the urine, which might make the urine look pink, red or cola-colored.
• Blood in the semen.
• Needing to urinate more often.
• Trouble getting started when trying to urinate.
• Waking up to urinate more often at night.

If the prostate cancer spreads, other symptoms can happen. Prostate cancer that spreads to other parts of the body is called metastatic prostate cancer. It also might be called stage 4 prostate cancer or advanced prostate cancer.

Signs and symptoms of advanced prostate cancer can include:

• Accidental leaking of urine.
• Back pain.
• Bone pain.
• Difficulty getting an erection, called erectile dysfunction.
• Feeling very tired.
• Losing weight without trying.
• Weakness in the arms or legs.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

It's often not clear what causes prostate cancer. Healthcare professionals have found some things that raise the risk of this cancer. These include older age, obesity and a family history of prostate cancer. The exact cause of prostate cancer often isn't known.

Prostate cancer starts when cells in the prostate develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Factors that can increase the risk of prostate cancer include:

• Age greater than 50. The risk of prostate cancer goes up with age. It's most common after age 50.
• Black race. In the United States, Black people have a greater risk of prostate cancer than do people of other races and ethnicities. Healthcare professionals aren't exactly sure why. In Black people, prostate cancer also is more likely to grow quickly or be advanced when detected.
• Family history of prostate cancer. If a blood relative, such as a parent or sibling, has been diagnosed with prostate cancer, your risk may be increased. The risk also may be increased if other close relatives have had prostate cancer. This includes your grandparents and your parents' siblings.
• Family history of DNA changes. Some DNA changes that increase the risk of cancer are passed from parents to children. The DNA changes called BRCA1 and BRCA2 can cause a higher risk of prostate cancer. These DNA changes are best known for increasing the risk of breast cancer and ovarian cancer.
• Obesity. People who have obesity may have a higher risk of prostate cancer compared with people considered to have a healthy weight. Studies of this issue have had mixed results. In people with obesity, prostate cancer is more likely to grow quickly and more likely to come back after treatment.
• Smoking tobacco. Some research shows a link between smoking and prostate cancer. But not all studies agree. People with prostate cancer who smoke may have a higher risk of the cancer coming back. People who smoke also have a higher risk of the cancer spreading beyond the prostate.
• Chemical exposure. Research shows that the risk of prostate cancer may be higher in those who have been exposed to certain chemicals, including Agent Orange and arsenic.

Complications of prostate cancer and its treatments include:

• Cancer that spreads. Prostate cancer can spread to other parts of the body, such as the bones or other organs. When prostate cancer spreads, it's called metastatic prostate cancer. The spread often takes many years because most prostate cancers grow slowly. Studies of people who don't have treatment for prostate cancer show that most never develop metastatic cancer.

  Still, some people have cancer that spreads. There may be a higher risk of metastasis if the cancer is larger when first diagnosed and the Gleason score is high, which means the cancer is likely to grow quickly.

• Incontinence. Prostate cancer and its treatment can cause leaking of urine, also called urinary incontinence.
• Erectile dysfunction. Difficulty getting an erection is called erectile dysfunction. It can be caused by prostate cancer or its treatment.

There is no sure way to prevent prostate cancer. You can help reduce your risk of prostate cancer if you:

• Choose a healthy diet. Eat a variety of fruits, vegetables and whole grains. Limit the amount of animal fats you eat. Fruits and vegetables contain many vitamins and nutrients that can do good for your health.

  Foods that have been linked to a lower risk of prostate cancer include tomatoes, broccoli, cauliflower and soy. No studies have proved that these foods can prevent cancer. If you already enjoy eating these foods, there may be some added benefit in including them in your diet.

• Exercise most days of the week. It's not clear whether exercise can prevent prostate cancer. It may help you maintain a healthy weight. Exercise also may improve your overall health and your mood. Try to exercise most days of the week. If you're new to exercise, talk about it with a healthcare professional. Start slow and work your way up to more exercise time each day.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it. Choose a healthy diet and exercise most days of the week. If you need to lose weight, add more exercise and eat fewer calories. Ask your healthcare professional for help creating a plan for healthy weight loss.
• Don't smoke. If you don't smoke, don't start. If you smoke, talk with a healthcare professional about what might help you quit. Medicines, nicotine replacement products and counseling can help.

• Ask about medicines to lower the risk of prostate cancer. If you have a high risk of prostate cancer, you and your healthcare professional may consider medicines to lower the risk. These medicines include finasteride (Propecia, Proscar) and dutasteride (Avodart). They are most often used to treat prostate gland enlargement.

  Ask your healthcare professional to talk about the benefits and risks of these medicines with you. When prostate cancer happens in people taking these medicines, it tends to grow faster. Your healthcare professional can help explain your risk and whether these medicines are right for you.

Prostate cancer diagnosis often starts with an exam and a blood test. A healthcare professional might do these tests as part of prostate cancer screening. Or you might have these tests if you have prostate cancer symptoms. If these first tests detect something concerning, imaging tests can make pictures of the prostate to look for signs of cancer. To be sure whether you have prostate cancer or not, a sample of prostate cells might be removed for testing.

Prostate cancer screening tests look for prostate cancer in people who don't have any symptoms of the disease. Tests typically include a prostate-specific antigen blood test and a digital rectal exam.

Most experts recommend that men talk with their healthcare professionals about prostate cancer screening around age 50. Together you can decide whether screening is right for you. You might consider starting the discussions sooner if you're a Black person, have a family history of prostate cancer or have other risk factors.

A digital rectal exam lets a healthcare professional examine the prostate. It's sometimes done as part of prostate cancer screening. It might be recommended if your symptoms lead your health professional to think you might have a prostate condition.

During a digital rectal exam, a healthcare professional inserts a gloved, lubricated finger into the rectum. The prostate is right by the rectum. The health professional feels the prostate for anything concerning in the texture, shape or size of the gland.

A prostate-specific antigen test is a blood test that measures the amount of prostate-specific antigen in the blood. Prostate-specific antigen, also called PSA, is a substance that prostate cells make. Some PSA circulates in the blood. A PSA test detects the PSA in a blood sample.

Having a high level of PSA in your blood can be a sign of prostate cancer. But many other things also can cause a high PSA level, including prostate infection and prostate enlargement. If a PSA test detects an increased level of PSA in your blood, the test is usually repeated. Your healthcare professional might recommend doing the test again in a few weeks to see if the level goes down. If the level stays high, you might need an imaging test or a biopsy procedure to look for signs of cancer.

A PSA test is often used for prostate cancer screening. It also might be used if you have prostate cancer symptoms. The results can give your healthcare professional clues about your diagnosis.

Ultrasound is an imaging test that uses sound waves to make pictures of the body. A prostate ultrasound makes pictures of the prostate. A healthcare professional might recommend this test if a digital rectal exam detects something concerning.

To get ultrasound pictures of the prostate, a healthcare professional puts a thin probe into the rectum. The probe uses sound waves to create a picture of the prostate gland. When an ultrasound is done this way, it's called a transrectal ultrasound.

Magnetic resonance imaging, also called MRI, uses a magnetic field and radio waves to create pictures of the inside of the body. A prostate MRI makes pictures of the prostate. It's often used to look for concerning areas in the prostate that could be cancer.

Prostate MRI images may help your healthcare team decide whether you should have a biopsy procedure to remove prostate tissue for testing. The prostate MRI images also might help with planning the biopsy. If the MRI detects concerning areas in the prostate, the biopsy can target those areas.

During a prostate MRI, you lie on a table that goes into an MRI machine. Most MRI machines are large, tube-shaped magnets. The magnetic field inside the machine works with radio waves and hydrogen atoms in your body to create cross-sectional images.

Healthcare professionals use different kinds of MRI tests for prostate cancer, including:

• Contrast-enhanced MRI. A contrast-enhanced MRI scan uses a dye to make the pictures clearer. A healthcare professional puts the dye into a vein in your arm before the MRI.
• MRI with endorectal coil. MRI with endorectal coil uses a device inserted in the rectum to get better pictures of the prostate. Before this kind of MRI, a healthcare professional inserts a thin wire into your rectum. This thin wire, called an endorectal coil, sends signals to the MRI machine.
• Multiparametric MRI. A multiparametric MRI, also called mpMRI, tells the healthcare team more about the prostate tissue. This kind of MRI can help show the difference between healthy prostate tissue and prostate cancer.

A biopsy is a procedure to remove a sample of tissue for testing in a lab. A prostate biopsy involves removing tissue from the prostate. It's the only way to know for sure whether there is cancer in the prostate.

A prostate biopsy involves removing prostate tissue with a needle. The needle can go through the skin or through the rectum to get to the prostate. Your healthcare team chooses the kind of prostate biopsy that's best for you.

Types of prostate biopsy procedures include:

• Transrectal prostate biopsy. A transrectal prostate biopsy is a procedure to get a sample of prostate tissue. It involves putting a needle through the wall of the rectum and into the prostate. This is the most common type of prostate biopsy.

  During this procedure, a healthcare professional inserts a thin probe into the rectum. The probe makes ultrasound pictures of the rectum. The probe also holds a needle. A healthcare professional uses the ultrasound images to guide the needle. The needle goes through the rectum and into the prostate to remove tissue samples. Samples are removed from different parts of the prostate.

• Perineal prostate biopsy. A perineal prostate biopsy is a procedure to get a sample of prostate tissue. It involves putting a needle through the perineum and into the prostate. The perineum is the area of skin between the scrotum and the anus. This kind of prostate biopsy is less common.

  During this procedure, a healthcare professional uses an imaging test to help guide the needle. Often this imaging test is an ultrasound. The health professional uses the needle to remove tissue from different parts of the prostate.

Prostate tissue samples go to a lab for testing. In the lab, tests can show whether samples contain cancer.

Prostate biopsy carries a risk of bleeding. Other side effects include blood in the urine and blood in the semen. Sometimes a prostate biopsy causes difficulty urinating or an infection. Side effects may depend on the procedure you have. Ask your healthcare team what you can expect as you recover.

A cancer's grade is a number that tells the healthcare team how different the cancer cells look from healthy cells. For prostate cancer, the care team uses the grade to figure out the Gleason score and grade group.

To decide on the grade, doctors in the lab, called pathologists, look at the prostate cancer cells from a prostate biopsy. If the cancer cells look similar to healthy cells, then the cancer cells are low grade. Low-grade cancer grows slowly. If the cancer cells look very different from healthy cells, then the cancer cells are high grade. High-grade cancer grows quickly.

Prostate cancer grades range from 3 to 5. The grades used to go from 1 to 5, but grades 1 and 2 are no longer used. Grade 3 is low grade and grade 5 is high grade.

To get the Gleason score, pathologists look at all the prostate biopsy samples to find the grade of each one. To calculate the Gleason score of a prostate biopsy, they add the most common grade from the samples with the highest grade from the samples. To get the Gleason score from prostate tissue removed during surgery, they add the most common grade and second most common grade.

Gleason scores range from 6 to 10. A Gleason score of 6 means the cancer is growing slowly. A Gleason score of 10 means the cancer is growing quickly.

Pathologists also report the prostate cancer grade as a group. The grade group is another way of stating how quickly the cancer cells are growing. The grade groups for prostate cancer are:

• Grade group 1. This means the Gleason score is 6 or less.
• Grade group 2. This means the Gleason score is 7. The most common grade in the prostate biopsy samples is 3. The second grade is 4.
• Grade group 3. This means the Gleason score is 7. The most common grade in the prostate biopsy samples is 4. The second grade is 3.
• Grade group 4. This means the Gleason score is 8.
• Grade group 5. This means the Gleason score is 9 or 10.

Your healthcare team uses your grade group to decide on your cancer's stage. The grade group also can help your care team plan your treatment.

Biomarkers are things that can be detected in the body. Results from biomarker tests tell healthcare professionals about what's going on inside the body. Biomarker testing for cancer looks for biomarkers in the cancer cells. The results help healthcare professionals learn more about what's going on inside the cancer cells.

Healthcare professionals use prostate cancer biomarker tests to:

• Decide whether to do a prostate biopsy. Some prostate cancer biomarker tests use blood and urine samples to detect signals made by prostate cancer cells. The tests can tell your healthcare team whether a prostate biopsy is likely or not likely to find prostate cancer.
• Decide on a treatment for early prostate cancer. Some prostate cancer biomarker tests involve testing the cancer cells to see if the cancer has a high risk or a low risk of spreading beyond the prostate. If the results of other tests haven't been clear, this kind of test might help your care team understand your risk. The results can help decide between starting treatment right away or watching the cancer closely to see if it grows.
• Decide on a treatment for advanced prostate cancer. Other prostate cancer biomarker tests help when the cancer is advanced. For prostate cancer that has spread to other parts of the body, the results of these tests can tell your healthcare team whether certain treatments are likely to work on your cancer cells. For this kind of test, your healthcare team may test some of the cells that have spread. The cells might be removed with a biopsy procedure or collected from a blood sample.

Not everyone needs a prostate cancer biomarker test. These tests are new, and healthcare professionals are still deciding how best to use them.

Imaging tests can look for signs that the cancer has spread beyond the prostate. These tests might detect cancer that has spread to the lymph nodes or to other parts of the body.

Most people with prostate cancer only have cancer in the prostate. They might not need these other imaging tests to look for signs of cancer spread. Ask your healthcare team whether you need these imaging tests.

When prostate cancer spreads beyond the prostate, it might be called metastatic prostate cancer, stage 4 prostate cancer or advanced prostate cancer. Imaging tests used to detect this kind of prostate cancer include:

• Bone scans. A bone scan uses nuclear imaging to make pictures. Nuclear imaging involves using small amounts of radioactive substances, called radioactive tracers. A special camera that can detect the radioactivity also is used along with a computer. The tracer is absorbed more by cells and tissues that are changing. Cancer cells are often growing and changing quickly. Bone scan images can detect places in the bones that absorb the tracer. These may be signs of prostate cancer in the bones.
• CT scans. A computerized tomography (CT) scan is a type of imaging that uses X-ray techniques to create detailed images of the body. It then uses a computer to create cross-sectional images, also called slices, of the bones, blood vessels and soft tissues inside the body. A CT scan can detect prostate cancer that has spread to the lymph nodes or other places in the body.
• MRI scans. A magnetic resonance imaging (MRI) scan uses a magnetic field and radio waves to create pictures of the inside of the body. An MRI can detect prostate cancer that has spread to the lymph nodes or other places in the body.
• PET scans. A positron emission tomography (PET) scan is a nuclear imaging test. It uses a radioactive tracer that's injected into a vein. The tracer contains a substance that helps it stick to fast-growing cells, such as cancer cells. The PET images show the places where the tracer builds up. A PET scan can detect prostate cancer that has spread to other places in the body.
• PSMA PET scans. A prostate-specific membrane antigen (PSMA) PET scan uses a radioactive tracer, as other PET scans do. The tracer contains a substance that helps the tracer stick to prostate cancer cells. The substance attaches to a protein that's found on the surface of prostate cancer cells. A PSMA PET scan can detect prostate cancer that has spread to the lymph nodes or other places in the body.

Your healthcare team uses the results of your tests and procedures to give your cancer a stage. The cancer's stage tells your healthcare team about the size of the cancer and how quickly it's growing.

Prostate cancer stages range from 1 to 4. A lower number means the cancer is small and only in the prostate. A lower number stage typically means the cancer is very likely to be cured. If the cancer grows larger or spreads, the number goes up.

Your healthcare team uses your stage and the results of your tests to decide on your treatment plan.

The prostate cancer stages tell the healthcare team about the size of the cancer and how quickly it's growing. The stage helps the care team make a treatment plan.

The healthcare team uses this information to decide on the prostate cancer stage:

• How much of the prostate has cancer. If the cancer only involves part of the prostate, the stage is low. If the cancer takes up more of the prostate, the stage may be higher.
• Whether the cancer grows beyond the prostate. If the cancer grows through the wall of the prostate, it's considered stage 3. The cancer may extend through the prostate and into the rectum, bladder or other nearby areas.
• Whether the cancer spreads to the lymph nodes. Prostate cancer can spread through the lymphatic system to nearby lymph nodes. If this happens, it's considered stage 4.
• Whether the cancer spreads to other parts of the body. Prostate cancer can spread to the bones, liver, lungs and other parts of the body. If this happens, it's considered stage 4.
• The level of PSA in the blood. An increased PSA level usually makes the stage higher. For staging, a low PSA level is less than 10 nanograms per milliliter (ng/mL). An intermediate level is between 10 and 20 ng/mL. A high PSA level is greater than 20 ng/mL.
• The grade group. Grade group is based on the Gleason score. The groups go from 1 to 5, with a low number meaning the cancer is likely to grow slowly. A higher number means the cancer is more aggressive and is likely to grow quickly. A higher grade group number makes the stage higher.

Prostate cancer stages use numbers and letters to describe the extent of the cancer and how quickly it's growing. The numbers go from 1 to 4. A smaller number often means a smaller cancer that is growing more slowly. Cancers that are bigger or more aggressive get higher numbers. Some stages also have letters, such as 2A, 2B and 2C. The letters divide up the numbered stages into smaller categories.

A stage 1 prostate cancer means the cancer is small and only in the prostate. The cancer affects less than one half of one side of the prostate gland. The PSA level is low and the grade group is 1.

Stage 1 treatment usually involves active surveillance because the cancer is small and growing slowly. Still, some people might choose to have treatment if they are younger and willing to accept some side effects in order to cure the cancer.

A stage 2 prostate cancer means the cancer is only in the prostate, but it may involve more of the gland than in stage 1. Stage 2 includes low and intermediate PSA levels and grade groups 1 to 4.

• Stage 2A. Stage 2A prostate cancers are grade group 1. At this stage, the cancer may be a small cancer that only affects one side of the prostate but has an intermediate PSA level. Or it can be a larger cancer that affects both sides of the prostate but has a low PSA level.
• Stage 2B. Stage 2B prostate cancers are grade group 2 and the PSA level is low or intermediate. This stage includes any size cancer, as long as the cancer hasn't grown beyond the prostate.
• Stage 2C. Stage 2C prostate cancers are grade group 3 or 4 and the PSA level is low or intermediate. This stage includes any size cancer, as long as the cancer hasn't grown beyond the prostate.

Stage 2 treatment can involve active surveillance, especially if the PSA level and the grade group are low. If you choose treatment, the options typically include surgery to remove the prostate, called prostatectomy, and radiation therapy. Radiation therapy options include external beam radiation therapy and brachytherapy.

A stage 3 prostate cancer means the cancer is more advanced than in stage 2. The cancer may have grown through the prostate. This stage includes cancers that happen with high PSA levels and high grade group numbers.

• Stage 3A. With stage 3A prostate cancers, the PSA level is high. This stage includes grade groups 1 to 4. The cancer can be any size, as long as it hasn't grown beyond the prostate.
• Stage 3B. Stage 3B prostate cancers have grown beyond the prostate. The cancer might extend to the seminal vesicles, bladder, rectum or other nearby organs. This stage includes all PSA levels and grade groups 1 to 4.
• Stage 3C. Stage 3C prostate cancers are grade group 5. This stage includes any size prostate cancer and all PSA levels. The cancer may have grown beyond the prostate, but it hasn't spread to the lymph nodes or to other parts of the body.

Stage 3 treatment usually involves treating the cancer unless you have other health conditions that are more urgent. Stage 3 cancers have a high risk of spreading because the cancer has grown beyond the prostate or shows signs of growing quickly. Treatment options may include surgery or a combination of radiation and hormone therapy.