What Is Prostate Cancer?

Prostate cancer is cancer that starts in the tissues of the prostate. The prostate sits below the bladder and in front of the rectum, and it helps make fluid that is part of semen. When prostate cells begin to grow abnormally and keep dividing when they should not, a tumor can form. Some prostate cancers stay limited to the prostate for a long time, while others can grow more quickly or spread beyond the gland.

How Does Prostate Cancer Develop?

Like many cancers, prostate cancer develops because of changes in the genes of cells. These changes can affect how cells grow, divide, and die. Over time, enough harmful changes may build up that the cells no longer respond normally to the body’s control systems. NCI explains that cancer is caused by changes in genes that control how cells function, especially how they grow and divide.

Not all prostate cancers behave the same way. Some grow very slowly and may never cause serious problems during a person’s life, while others are more aggressive. This difference is one reason prostate cancer care can be complex and why doctors often use more than one piece of information when deciding what to do next.

Why Can Prostate Cancer Be Hard to Notice Early?

One reason prostate cancer can be difficult to detect early is that it often does not cause symptoms at first. The American Cancer Society notes that most prostate cancers are found early, through screening, before they have a chance to cause noticeable problems. That means a person may have prostate cancer and feel completely normal.

This can make prostate cancer different from cancers that cause obvious pain, bleeding, or visible changes early on. In prostate cancer, the first clue may come from a screening test, a blood test such as PSA, or an abnormal finding during an exam rather than from symptoms alone.

What Symptoms Can Appear Later?

When prostate cancer does cause symptoms, they may include difficulty urinating, a weak urine stream, needing to urinate more often, especially at night, blood in the urine or semen, erectile problems, or pain in the hips, back, chest, or other areas if the cancer has spread. These symptoms do not always mean cancer, because noncancerous prostate conditions can cause some of the same problems, but persistent symptoms should not be ignored.

What Increases the Risk of Prostate Cancer?

Age is one of the strongest risk factors for prostate cancer. The CDC states that the older a man is, the greater his chance of getting prostate cancer. Family history also matters, and some groups are at higher risk, including African American men, who are more likely both to develop prostate cancer and to die from it than other men in the United States.

These risk factors do not mean someone will definitely develop prostate cancer, but they can help guide conversations about awareness and screening. They also help explain why one-size-fits-all advice does not always work for prostate cancer decisions.

Why Is Screening a Conversation, Not a Simple Rule?

Prostate cancer screening is more complex than screening for some other cancers. The CDC says there is no standard test to screen for prostate cancer, and NCI notes that prostate screening remains controversial because it has not been clearly shown to reduce deaths from prostate cancer in all settings. Screening can also find cancers that may never have caused symptoms or become life-threatening.

That is why groups such as the American Cancer Society recommend that men have a chance to make an informed decision with their health care provider about whether to be screened. ACS says this discussion should generally start at age 50 for men at average risk who are expected to live at least 10 more years, and earlier for some higher-risk groups. The CDC also says men ages 55 to 69 should talk with a doctor about the benefits and harms before deciding on PSA screening, while routine screening is not recommended for men 70 and older.