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Prostate Cancer: A Guide for Aging Men
Updated on: November 2022
Reviewed by: Nancy Leahy, RN, APNP
Prostate cancer is one of the most frequently diagnosed cancers in the world, despite it only being diagnosed in males (females do not have prostate glands). In fact, more than 70 percent of men over the age of 80 have some quantity of cancer cells in their prostate.
It’s so common that it sometimes doesn’t go diagnosed until autopsies are performed, though that doesn’t mean the cancer is the cause of death. On the contrary, the overall prognosis for men diagnosed with prostate cancer is as positive as you can get when talking about the dreaded “c” word. The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the process—before it spreads.
Nevertheless, prostate cancer is serious business, and the best way to handle a diagnosis is to be informed. Let’s take a look at the frequency at which it’s diagnosed, how you’re tested for it, how it can affect your daily life, and what we can do to try and prevent the disease.
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What is Prostate Cancer?
Prostate cancer is the second most common form of cancer in the world among men (skin cancer is first, lung cancer is third). Males are the only people who can contract prostate cancer, simply because they are the only people who have prostates. (Just like women are the only people who can have ovarian cancer.) Nearly 200,000 men are diagnosed with the disease every year, and most of them are over the age of 50. It’s estimated that nearly 35,000 men died because of prostate cancer in 2021. Despite these large mortality numbers, the overall prognosis of prostate cancer is positive. The American Cancer Society (ACS) notes that the 15-year survival rate for those diagnosed with prostate cancer is 96 percent—meaning that 96 percent of people diagnosed with the disease live for 15 years past their diagnosis date. That number is even higher when you look at the 5- and 10-year survival rates. This can be attributed to early detection and treatment options, which we’ll discuss soon. It’s also entirely possible for a man to die while having prostate cancer, but the prostate cancer not be the cause of death. The prostate is a small gland, about the size of a walnut (about an inch and a half in diameter) located between your bladder, penis, and rectum.
The primary function of the prostate is to excrete prostate fluid, which mixes with sperm to become semen during ejaculation. The urethra also runs through the prostate from the bladder to the penis. When ejaculating, the prostate closes off the urethra from the bladder and thrusts the semen from the testes, through the prostate, and to the penis. The fluid that comes from the prostate makes up about one-third of the overall semen fluid composition. Because the prostate is packed between other vital organs like the bladder, rectum, penis, and urethra, when it grows—as it usually does with prostate cancer—it can cause a lot of issues.
Early Stage Prostate Cancer
Most prostate cancer (about four out of every five cases) is caught in the early stage. Prostate cancer is in the early stage when the prostate hasn’t grown or swelled because of the cancer’s presence, and it’s still localized in the gland. While there are four stages of prostate cancer, each with their own levels of severity, nearly all of these stages are considered in the “early stage” as long as the cancer hasn’t spread outside of the prostate. After various tests, your doctor will assign a stage or a Gleason score based on what your
prostate looks like and how aggressive the cancer is. The higher Gleason score you have (it runs grade one through five), the more aggressive the cancer is. While the cancer is still is in the prostate, it’s still in the early stages. According to the ACS, the five-year survival rate for those diagnosed with prostate cancer is almost 100 percent.
Treatment
There are several treatment options available in the early stages of prostate cancer. These options include:
- Surgery: A prostatectomy—surgery that removes parts of the prostate—is typically a choice in younger, healthy men who want to get rid of the problem while the side effects from surgery are less likely to be risky. There are different types of surgery (open prostatectomy, laparoscopic surgery, perineal prostatectomy) that require incisions on different parts of the body and have varying risk factors, which can also affect someone’s decision. A study found that men who did decide to undergo surgery to remove the part of the affected prostate within a year of being diagnosed didn’t have higher rate of relapsing the longer they waited to decide to undergo this treatment process. So while surgery is an effective treatment, it’s also okay to sit on the decision and make sure that it’s the right treatment for you.
- Radiation: Treating prostate cancer with radiation is a good option for older men with diminished health whose cancer is progressing. Surgery may be too risky of an option for these older patients, so radiation attacks the cancer without having to surgically invade an older body. Like surgery, there are varying radiation options that require different lengths of treatment, and whichever one is recommended as the best option to you may sway you toward or away from this treatment. For example, one treatment option sees small seeds placed in your prostate that emit radiation over the course of many months to attack the cancer, while another option requires radiation sessions that run 15 to 30 minutes long, four or five days a week.
- Observation: Sometimes the best treatment is no treatment at all, but rather consistent check-ups and tests to make sure the cancer isn’t progressing faster than usual. The risks of waiting and monitoring can outweigh the risks of other treatments, making observation the best treatment option for the time being. This option makes sense for many men. If an 80-year-old man is diagnosed with a beginning-stage prostate cancer, and it’s not expected to affect the man’s life over the next couple years, why rush treatment? The same can be said for a man in his 50s, who doesn’t feel the need to address the problem until it starts spreading and affecting his health.
When prostate cancer is in its early stages, patients have time to consult other doctors and family members to decide which treatment is best for them and their health. For instance, an man in his 80s may be more reluctant to surgery than a man in his 50s, whose body may be able to handle the treatment option better. Also, men whose cancer is diagnosed with a low Gleason score may be more inclined to wait rather than a man whose cancer is close to spreading to other parts of the body. You can change your mind on treatment options whenever you’d like. If you decide to wait and later feel surgery is the best option, inform your doctor of your decision.
Late-Stage Prostate Cancer
Treatment
At this point, treatment options in earlier stages like the waiting game and surgery are out of the question. So what are your options now? In this later stage, treatment options tend to try and attack the cancer as a whole rather than the area it’s localized to, like the prostate or your spine. Let’s take a look at some options:
- Hormone therapy: Hormone therapy tries to keep male hormones at normal levels, as high testosterone levels have been shown to be a risk factor in the development of prostate cancer. Reducing the amount of hormones that reach the cancer can help shrink cancer cells or stop them from multiplying altogether. Hormone therapy can be done through various procedures and medications, including removing the testicles to help severely minimize how many hormones are reaching the cancer. This therapy can’t cure prostate cancer, but it can help stop it from growing and spreading, allowing for other treatment options to get rid of it.
- Chemotherapy: A common treatment for all types of cancer, chemotherapy is used to either kill cancer cells or stunt their ability to metastasize. Newer chemotherapy drugs have been shown to be effective in helping treat prostate cancer and the areas it spreads to. They also have proven to help men live longer than older chemotherapy drugs. While it’s not the primary treatment option, chemotherapy can add a layer of effectiveness.
- Immunotherapy: This form of treatment uses your body’s immune system to attack cancerous cells. For prostate cancer treatment specifically, there is only one medication, Provenge, that is approved by the Food & Drug Administration, but it has shown to help men survive longer while having advanced prostate cancer. However, Provenge hasn’t been proven to work for prostate cancer that is localized in the gland.
- Radiation: Unlike other early stage treatments, radiation is still in the cards as a treatment plan in the later stages. While it’s a more difficult treatment, because the area where the cancer exists isn’t confined to one area, radiation remains an option.
Unlike early stage treatments, where you have time to think over your options, you should follow your doctor’s advice for treatment—and follow it soon—as late-stage prostate cancer can become fatal quickly.
Who is Most at Risk of Being Diagnosed?
The average age of a prostate cancer diagnosis is 66, according to the ACS, and it’s rare to be diagnosed with prostate cancer before the age of 40. This is why testing isn’t usually suggested until you are at least 45. The men most affected by prostate cancer are older than 50. Your chance of being diagnosed with prostate cancer increases with age, too. According to the Prostate Cancer Foundation, the following is a list of a man’s chances of developing prostate cancer at different age ranges:
- Before 50: 1 in 403
- Between 50 and 59: 1 in 58
- Between 60 and 69: 1 in 21
- Between 70 and 79: 1 in 14
The chances of being diagnosed with the disease continue to rise after 80.
In addition to age being a telling factor in how likely it is a male will develop prostate cancer, so is race. While diagnosis rates fell for all races between 1999 and 2022, according to the Centers for Disease Control and Prevention, black men consistently were diagnosed with prostate cancer far more frequently than any other racial group. Some trends over the 16 years include:
- Black men were diagnosed with prostate cancer more than 50 percent the national average per 100,000 people.
- Whites and Hispanics were diagnosed at similar rates, both of which fell just below the national average.
- American Indian/Alaska Natives and Asian/Pacific Islanders both fell more than 50 percent below the national average of diagnosis rates per 100,000 people.
It’s suggested that black males in America start to get tested earlier than white men (in their 40s rather than their 50s), because black men have been found to have more advanced prostate cancer when it is diagnosed, which means earlier testing could catch the disease earlier on. Researchers chalk this trend up to a couple reasons, including, but not limited to: generally having less quality facilities (thus lower quality care), genetics, and having certain environmental and dietary differences than other black populations around the world. (Black men in Africa are diagnosed with prostate cancer less frequently than African-American men, which would suggest the living environment—and all the stress and differences in diet that come with it—could influence the higher diagnosis rates.)
Other Risk Factors
Outside of age and race, there are lifestyle choices and genetic predispositions that put you at a higher risk of developing prostate cancer. These can include:
- Family history: How often prostate cancer occurs in your family can be an indicator of the likelihood that you are diagnosed with prostate cancer, too. If more than three immediate family members (like a brother, father, grandfather, uncle) on the same side of the family have been diagnosed with prostate cancer, then you may want to get screened earlier than planned. The same cancer occurring in multiple family members may be explained by similar lifestyle habits and genetics that inhibit the disease’s development.
- Genetic mutations: Mutations of certain genes—like BRCA1 and BRCA2, which are most commonly associated with breast cancer in women—have been shown to indicate a higher chance of developing prostate cancer in men, as well as breast cancer. These genetic mutations can be passed down for generations, but this is usually the case in less than 5 percent of prostate cancer diagnosis.
- Agent Orange: While this may be a specific demographic, the United States government lists Agent Orange—a chemical used in the Vietnam War—as a cause of the disease through exposure.
Symptoms of Prostate Cancer
Now that we know what prostate cancer is, how can we tell if we have it aside from being tested regularly? A lot of the symptoms of the disease have to do with discomfort while urinating while ejaculating. According to the Prostate Cancer Foundation, these can include:
- Blood in your urine
- Pain while ejaculating
- Frequently having to urinate— especially at night— and not being able to hold it back
- Pain while urinating
- Sporadic flow of urination
- Trouble getting and maintaining an erection
- Loss of control of your bladder and bowels
- Pain in your hips, back, spine, and other parts of your body close to your prostate, indicating the cancer may have spread
- Pressure in your rectum
- A decrease in the amount of fluid you ejaculate
In its earliest stages, none of these symptoms may be present, which is why it’s important to get ahead of the disease with testing.
How to Find Out if You Have Prostate Cancer
Ah, the dreaded, stigmatized prostate exam: a necessity (or at least suggested necessity) for every man over 50. As we’ve learned, an symptom of prostate cancer is an enlarged prostate, so the main way doctors test for it is by feeling the prostate. Formally called a “digital rectal exam,” doctors place a lubricated finger, covered with a glove, up your rectum and feel for the prostate, which is right next to the rectum. The doctor feels for any abnormalities, like if it’s larger than it should be, feels different than it should, or the shape of it is different. But a DRE is not the be-all, end-all of prostate tests. There are plenty of tests doctors run to confirm a diagnosis. These tests include:
- Blood test (PSA Test): One of the other primary tests to see if you have prostate cancer is called a prostate-specific antigen test, or a PSA test. For this, doctors take a blood sample from your arm and test it for a specific substance (antigen) that is produced by your prostate. “Normal” PSA levels are 4.0 ng/mL, according to the National Cancer Institute, though people have been found to have prostate cancer with lower levels. Anything below 4.0 is still considered in the healthy range, though the closer the levels are to 4.0, the closer it should be watched. It’s also healthy to have extremely low PSA levels. While levels over 4.0 don’t strictly indicate cancer, it’s a strong indicator of prostate growth and swelling, which is a leading sign of cancer. A PSA test is usually done in the same session as a DRE.
- Urinalysis: Your urine may be tested for certain infections. If an infection or disease is found after the first test, doctors may take a couple more samples to confirm the infection is in the prostate and not the urethra or bladder.
- Ultrasound: If a doctor notices any abnormalities with a DRE and your PSA levels, they may conduct an ultrasound in order to get a better view of the condition of your prostate. This form of testing—formally called a Transrectal ultrasonography—helps doctors get closer to the prostate than their finger can during a DRE and can take images that allows doctors to examine the change in your prostate over time.
- Sampling prostate tissue (biopsy): A pretty direct way in testing if you have prostate cancer or not is directly testing prostate tissue. A small needle takes a sample of tissue from the prostate and then is tested to see if there are abnormal amounts of cancer cells. This is typically done in conjunction with an ultrasound, which may confirm growth or swelling.
- Various scanning procedures: Doctors sometimes use other non-invasive scanning procedures to help try and get a better picture of your prostate. These tests include CT scans, MRIs, x-rays, and bone scans, according to the ACS. While these aren’t the prefered methods of testing for confirmation, they can help give a better picture of where the cancer is in the prostate and how far it may have spread if its presence is confirmed.
Now, it’s natural to think, why not just do some of these tests in the first place rather than a DRE? It’s because a DRE lets doctors know if it’s even worth running you through these other extensive, time-consuming tests in the first place. It’s suggested you get tested once a year, like at an annual check up, starting in your 50s. Your doctor may suggest you start getting a test sooner if you are particularly prone to prostate cancer based on your family history or demographics. Despite these yearly tests, it was still found that prostate cancer often went undiagnosed or misdiagnosed in the past. Harvard’s Medical School reported that prostate cancer cells were found in millions of undiagnosed men in postmortem autopsies. While it may not have been the specific cause of death, Harvard noted that cancer cells were found in prostates of one-third of men over 50, and 90 percent of men over 90. In addition, it was found that anywhere from 16 to 56 percent of men with prostate cancer didn’t exactly have prostate cancer that would be threatening during their lifetime. The tumors found on the gland during autopsies were often found benign or harmless, but the patients were diagnosed with prostate cancer anyway due to their high PSA test levels. These misdiagnoses can help explain why the survival rates for prostate cancer are so high.
Prostate Cancer Prevention
As we’ve seen with high diagnosis rates in men in their 80s and 90s, prostate cancer is almost inevitable if you live long enough. This doesn’t mean we shouldn’t take all the steps we can to try and prevent the cancer cells from triggering and metastasizing. Here are some steps you can take that may help push back a diagnosis:
- Healthy Diet: Eating certain foods like vegetables, fruits, and fish (which is high in omega-3 fatty acids, which are good fats) is recommended because it takes away from eating fatty foods, like pork, fried food, and cheese, which play a role in weight gain. People with higher body mass indexes (above 30) have been shown to have an increased risk of developing prostate cancer.
- Exercise: Related to healthy food helping maintain weight, exercising can be beneficial in terms of maintaining a healthy BMI. An increase in exercise, paired with a healthier diet, can help you drop weight quickly and get to proper BMI levels.
- Reduce stress: Stress has been shown to aid the progression of active cancer cells in your prostate. It also negatively affects your immune system, which is constantly fighting cancer cells when they’re present.
These preventative steps are also recommended for other types of cancers and diseases. While they may not explicitly reduce your risk of getting prostate cancer, following these steps won’t increase your chances of developing the disease. If you have any questions or concerns regarding a prostate cancer diagnosis—or think you may have the disease—contact your doctor immediately.
