How does prostate cancer develop

In many cases, prostate cancer is a slow-growing cancer that does not spread beyond the prostate gland before the time of diagnosis. Once prostate cancer forms, it feeds on androgens and uses them as fuel for growth. Prostate cancers that are composed of very abnormal cells are much more likely to both divide quickly and spread, or metastasize, from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including the seminal vesicles and nearby lymph nodes.

Researchers have identified various biological and genetic subtypes of prostate cancer. Although these subtypes are typically not yet used to guide treatment recommendations, they are the subject of active research funded by the Prostate Cancer Foundation. In rare cases, the cancer cells may be more aggressive, grow quickly, and spread to other areas of your body.

The earlier your doctor finds and treats the tumor, the higher the chances are of finding curative treatment. According to the Urology Care Foundation , prostate cancer is the second most common cause of all cancer-related deaths among American men. About 1 in 7 men will be diagnosed with the disease in their lifetime. Approximately 1 in 39 men will die from it. Most of these deaths occur among older men. In many cases, multiple factors may be involved, including genetics and exposure to environmental toxins, like certain chemicals or radiation.

Ultimately, mutations in your DNA, or genetic material, lead to the growth of cancerous cells. These mutations cause cells in your prostate to start growing uncontrollably and abnormally. Abnormal or cancerous cells continue to grow and divide until a tumor develops. If you have an aggressive type of prostate cancer, the cells may metastasize, or leave the original tumor site and spread to other parts of your body.

Read more: 9 tips to prevent prostate cancer ». In some cases, the mutations that lead to prostate cancer are inherited. According to the American Cancer Society , approximately percent of prostate cancer cases are caused by inherited mutations. One of the biggest risk factors for prostate cancer is age. This disease rarely affects young men. The Prostate Cancer Foundation reports that only 1 in 10, men under the age of 40 in the United States will develop it. That number jumps to 1 in 38 for men between the ages of 40 and It leaps to 1 in 14 men between the ages of 60 and Men who use testosterone therapy are at a higher risk of developing prostate cancer, as an increase in testosterone stimulates the growth of the prostate gland.

Prostatic intraepithelial neoplasia PIN : This condition may be associated with increased risk of prostate cancer. PIN is a condition in which prostate gland cells look abnormal when examined with a microscope. Nearly half of men will be diagnosed with PIN before age Race: Studies show that African-American men are about 70 percent more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.

The evidence for prostate cancer prevention and cancer prevention in general suggests adopting these habits:. Deciding what treatment you should get can be complex. Talk with your healthcare team about your options. Your treatment plan will depend on:. Results from other diagnostic tests will help your provider understand if the cancer can spread or recur return after treatment.

Before you decide what to do, you should consider how immediate and long-term side effects from treatment will affect your life, and what you're willing to tolerate. Also, you should consider that you may try different things over time. If you have time before you start treatment, consider your range of options.

Get a second opinion from different prostate cancer experts. You may need to see another urologist, oncologist or radiation oncologist. Consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects like incontinence is lower.

Also, it helps to talk with other survivors and learn from their experiences. In addition, try and get or stay healthy. Eating a well-balanced diet, maintaining a healthy weight, exercising and not smoking are all important factors when fighting prostate cancer..

Moreover, don't ignore your emotions. Think about how you're coping with this diagnosis. Many men who have prostate cancer feel worried, stressed and angry. You and those that care about you may need to consider professional counseling. Active surveillance does not actively treat prostate cancer.

A schedule for tests will be set with your provider. To help your provider do these biopsies, a multiparametric magnetic resonance imaging pmMRI exam might be done. With active surveillance, your doctor will know very quickly if the cancer grows. At that point, radiation and surgery may be the best treatment options. Active Surveillance is best if you have a small, slow growing low-risk cancer. It is good for men who do not have symptoms. If you want to avoid sexual, urinary or bowel side effects for as long as possible, this may be the treatment for you.

Active surveillance allows men to maintain their quality of life longer without risking the success of treatment if and when it's needed. Action is taken only if the disease changes or grows. For many men, they never need more aggressive treatments. Active surveillance is mainly used to delay or avoid aggressive therapy. On the other hand, this method may require you to have several biopsies over time to track cancer growth.

Download our fact sheet on Active Surveillance [pdf] to learn more. Watchful waiting is a less involved system of monitoring the cancer without treating it. It does not involve regular biopsies or other active surveillance tools. It is best for men with prostate cancer who do not want or cannot have therapy. It is also good for men who have other medical conditions that would interfere with more aggressive forms of treatment.

The main benefit of the watchful waiting treatment is that there are no treatment-related risks, complications or side effects. Also, it is low cost. The risk of watchful waiting is that the cancer could grow and spread between follow-up visits.

This makes it harder to treat over time. The surgeon is assisted with a robotic system that holds and guides the laparoscopic surgical tools and camera. It also allows the prostate to be removed through tiny ports placed in your belly.

In experienced hands, RALP and retropubic prostatectomy see below have similar outcomes. There is also less blood loss with robotic surgery than other methods. The success of this surgery depends on how experienced your surgeon is. For this procedure, your surgeon will make a cut incision in your lower belly and remove the prostate through this opening.

The entire prostate gland is removed. Your surgeon can assess the prostate gland and surrounding tissue at the same time, while reducing injury to nearby organs. There can be enough blood loss to need a transfusion. This surgery uses small cuts in the abdomen to remove the prostate with small tools and a camera.

This surgery has mostly been replaced with robotic assisted laparoscopic surgery. After the prostate has been removed, the urinary tract and the bladder are reconstructed. A catheter is passed through the urethra into the bladder to drain the urine while the new connections heal. One or two suction drains may be left in the pelvic cavity after surgery.

They are brought through the lower belly to drain fluid from the wound. They help lower the risk of infection. The drains are usually removed before you are discharged from the hospital. After surgery, your surgeon will review the final pathology report. Together you will make plans for next steps. The main benefit of a radical prostatectomy is the prostate with cancer is removed.

This is true as long as the cancer hasn't spread outside the prostate. Surgery also helps the healthcare provider know if you need more treatment. The goal of surgery is to get a PSA value of less than 0. Surgery is often a good choice if prostate cancer has not spread beyond the prostate.

Surgery always comes with risks. Some complications from surgery can happen early and some later. Bleeding or infection can happen with any major operation, so you will be monitored to prevent or manage these problems. Not everyone has the same side effects for the same amount of time. With surgery and with radiation therapy , there are two main side effects to consider: erectile dysfunction ED and urinary incontinence a loss of urine control.

For some men, surgery can relieve pre-existing urinary obstruction. Most men with these side effects find ways to manage them over time. All men have some form of erectile dysfunction after prostate surgery.

Erectile dysfunction is the inability of a man to have an erection long enough for satisfying sexual activity. Nerves involved in the erection process surround the prostate gland, and they can be affected by surgery. They can also be affected by radiation treatment. These nerve bundles help control blood flow to the penis. The length of time ED lasts after treatment depends on many things, including how firm your erections are before treatment.

Sometimes, it may take one year or longer to recover erectile function. In the meantime, your doctor may have ED treatment options for you. If it's possible, nerve-sparing surgery may help prevent long-term damage. Older men have a higher chance of permanent ED after this surgery.

For more information on how prostate cancer surgery can affect your erections, read our After Treatment: Erectile Dysfunction Issues After Prostate Cancer Treatment section.

It may surprise you to know that men are still able to have an orgasm climax , even after a radical prostatectomy. An erection is not needed to climax.

There will be very little, if any, fluid with an orgasm. In addition, you can no longer cause a pregnancy after surgery. This is because the prostate, seminal vesicles, and connections to the testicle were removed and the vas deferens was divided during surgery. Planning for fertility preservation in advance of surgery is an option for men who want to have children.

Read our Fertility Preservation fact sheet to learn more on this. It is important to know that sexual desire is not lost with this surgery or radiation treatment. The exception to this is if hormones are also given as part of treatment, usually given temporarily with radiation therapy. Incontinence is the inability to control your urine. After prostate cancer surgery, you may experience one or more type of Incontinence. Stress Incontinence - is urine leakage when coughing, laughing, sneezing or exercising.

It is the most common type of urine control problem after radical prostatectomy. Overactive Bladder Urge Incontinence - is the sudden need to go to the bathroom even when the bladder is not full because the bladder is overly sensitive. This type of incontinence is the most common form after radiation treatment. Mixed Incontinence - is a combination of stress and urge incontinence with symptoms from both types.

Because incontinence may affect your physical and emotional recovery, it is important to understand your treatment options. For more information on how prostate cancer surgery can affect incontinence, read our After Treatment: Incontinence Issues After Prostate Cancer Treatment article.

Updated January Radiation therapy uses high-energy rays to kill or slow the growth of cancer cells. Radiation can be used as the primary treatment for prostate cancer in place of surgery. It can also be used after surgery if the cancer is not fully removed or if it returns. Radiation therapy mostly involves photon beams or proton beams. Photon beams make up traditional x-rays. They carry a very low radiation charge and mass, and can scatter to nearby health tissue.

On the other hand, proton beams have more charge and heavy mass and can target deep tissue. A physician can direct proton radiation treatment to the specific site of cancer, minimizing damage to nearby healthy tissue. Before you begin, it helps to ask your doctor s why they recommend one type of radiation therapy over another.

Photon-based external-beam x-rays may damage nearby healthy tissue. That damage can cause side effects. Some newer 3DCTR machines have imaging scanners built into them. It allows higher doses of radiation to be delivered to cancer cells while protecting surrounding healthy tissue. It uses a machine called a synchrotron or cyclotron to speed up and control the protons. High-energy protons can travel deeper into body tissue than low-energy photons. With proton therapy, radiation does not go beyond the tumor, so nearby tissue is not affected.

There are fewer side effects. Intensity-modulated proton beam therapy IMPT is a new way to deliver targeted PBT, but these machines are expensive and are not offered everywhere. Stereotactic Body Radiation Therapy SBRT delivers large doses of radiation to exact areas, such as the prostate, with advanced imaging.

The entire course of treatment is given over a shorter period, for just a few days. With any radiation treatment, the side effects should be discussed with you before you begin. With brachytherapy, radioactive material is placed directly into the prostate using a hollow needle. LDR brachytherapy is when your doctor uses a thin needle to insert radioactive "seeds" the size of a rice grain into the prostate.

These seeds send out radiation, killing the prostate cancer cells nearby. In LDR, the seeds are left in the prostate even after treatment is finished. HDR brachytherapy is when your doctor puts radiation into your prostate using a slightly larger hollow needle to insert a thin catheter. This catheter stays in your body until treatment is done.

The radiation source stays in your prostate for a short period of time. Once your treatment is done, all radioactive material is removed. You may need to stay in the hospital overnight. Sometimes radiation therapy is combined with hormone therapy to shrink the prostate before starting. Or, hormone therapy may be combined with external beam therapy to treat high-risk cancers. The benefit of radiation therapy is that it is less invasive than surgery.

Whether the radiation is given externally or internally, this treatment is effective for early stage prostate cancer. Some need both types of radiation combined to treat their cancer. The main side effects of radiotherapy are incontinence and bowel problems. Urinary problems usually improve over time, but in some men they never go away. Erectile dysfunction, including impotence, is also possible. Many men feel tired for a few weeks to months after treatment.

If hormone therapy is used with radiation, sexual side effects are common.