Top Prostate Cancer Facts You Simply Can't Ignore
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 9, 2021.
Prostate Cancer is Common, But Not Usually Deadly
Prostate cancer results from the growth of abnormal cells in the prostate gland, usually occurs in older men, and is the most common (non-skin) cancer in U.S. men. The prostate gland produces fluid that makes up part of the semen and is about the size of a walnut. It is located below the bladder and in front of the rectum.
The National Cancer Institute estimates 248,530 new cases of prostate cancer in 2021 with about 34,130 deaths. However, because prostate cancer typically grows slowly, many more men die of other causes while they have prostate cancer than die as a result of the cancer itself.
In fact, almost 100% of men diagnosed with local or regional prostate cancer will still be alive after 5 years. The 5-year survival rate for cancer that has spread at detection is 30%. For some men, prostate cancer may not be noticeable until an advanced stage.
What Are the Symptoms of Prostate Cancer?
Many men with prostate cancer have no symptoms at all. If the cancer grows and presses on the urethra (the tube that carries urine out of your body) or spreads to the bladder it can cause:
- a weak urine stream or the need to urinate more often
- pain during urination
- blood in urine or semen
- erection problems
- lower back pain
However, other conditions can lead to some of these symptoms, too.
Your doctor might suspect prostate cancer if you have any screening tests that are positive, but a positive test does not mean you have cancer.
A biopsy might be ordered for further diagnosis.
Enlarged prostates felt on digital rectal exams (DREs) and positive prostate-specific antigen (PSA) tests can also be due to benign prostatic hypertrophy (BPH), which is treatable with medication, and not prostate cancer.
Is Prostate Cancer Screening Needed?
Screening is when your doctor looks for cancer before you have any symptoms. This can help find cancer at an early stage when it may be easier to treat.
Two of the most frequently used screening tests used today include the digital rectal exam (DRE) and the prostate-specific antigen (PSA) test. Controversy has existed over if and when these tests should be used.
- The U.S. Preventive Services Task Force (USPSTF) updated their prostate cancer screening recommendations in May 2018. USPSTF, after reviewing evidence, is now recommending that men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening to determine if it is an appropriate preventive test in their case. (Grade level C).
- For men aged 70 and older, the USPSTF recommends against PSA screening. (Grade level D)
- Previously, in 2012, the USPSTF recommended against PSA screening for ALL ages.
Another group, the American Cancer Society, recommends men should be able to make an informed decision about screening for prostate cancer. They should be informed of the risks and benefits of screening, and then allowed to determine their preference. Early-detection screening should start at age 50 in men expected to live at least another 10-years, unless risk factors dictact earlier testing.
How are Screening Tests for Prostate Cancer Performed?
A digital rectal exam (DRE) is an exam of the rectum where the doctor inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or enlargement in the prostate gland.
A prostate-specific antigen (PSA) is a blood test. Some doctors might use PSA tests or DREs for screening because they believe these tests may help to detect cancer early and save lives.
Whether or not to be screened is a decision to make in concert with your doctor. If you are screened, PSA levels and a DRE will usually occur every 2 to 4 years starting at age 50 to 55 -- or possibly earlier -- based on risk factors. Also, check with your insurance to see if the tests are covered.
Avoid ejaculating and riding a bike for at least 48 hours before a PSA test. Two out of every three positive PSA tests end up being "false positives", meaning you may end up having further tests you do not need. Speak with your doctor about the risk of "false positives" with the PSA test.
In some cases, a prostate biopsy or imaging test like an ultrasound or magnetic resonance imaging (MRI) may also be used to rule out cancer.
What Increases My Chances of Having Prostate Cancer?
Roughly 1 out of every 9 men will be diagnosed with prostate cancer during a lifetime.
- Age over 50: Prostate cancer is rarely found in men younger than 50 years old. About 60% of prostate cancers are diagnosed in men older than 65 years of age.
- Black men have a greater risk of prostate cancer compared to white men.
- Family history of prostate cancer (father or brother) or BRCA gene breast cancer in a women who is a relative; a genetic abnormality (for example: BRCA1/BRCA2 gene) may be responsible for an increased risk in these cancers.
- Unhealthy diet: excess red meat, fried foods, high-fat dairy products or alcohol intake may increase risk. Lack of fruits and vegetables in diet.
Some men are concerned a vasectomy may increase the risk for prostate cancer. Results from a study in JAMA Internal Medicine showed that for men who have undergone a vasectomy, there is little evidence linking this to prostate cancer. The study looked at data from 53 studies conducted worldwide, involving a total of more than 14 million men.
What Treatments Are Used for Prostate Cancer?
There are options for cancer treatment. Prostate cancer is a complex disease, and doctor's opinions may differ on the best approach. Treatment will depend upon the stage of the prostate cancer and your decisions with your doctor. Your final decision should be followed after learning about these options.
- If the cancer is slow-growing, watchful waiting may be the best option, and no active treatment is started at this time. This may be appropriate for older men with other serious medical conditions.
- Actively watching is another option, which may involve regular PSA tests and prostate biopsies. If the cancer has spread just in the prostate area, watchful waiting, external beam radiation or brachytherapy can be used. In brachytherapy, small radioactive pellets are placed permanently into the prostate gland.
- Surgery to remove the prostate gland (prostatectomy) is another option, as is using anti-androgen drugs (hormone therapy) and chemotherapy in more advanced cases, either separately or together. Surgery to remove the testicles, the source of testosterone, is usually only used in advanced cases.
- But remember, while prostate cancer can be a serious disease, most men with this diagnose do not die from it, and there can be complications from invasive tests, medications, and surgery, too.
What if My Prostate Cancer Spreads?
There are many options you can discuss with your doctor. Your doctor will stage your cancer to determine if cancer cells have spread within the prostate or to other parts of the body.
If the cancer has spread beyond your prostate, doctors may prescribe anti-androgen therapy. Male sex hormones like testosterone can worsen prostate cancer, so anti-androgen therapy reduces the production or blocks the action of testosterone. This therapy is either injected or implanted under the skin.
These agents block androgens:
- Casodex (bicalutamide)
- Erleada (apalutamide)
- Nilandron (nilutamide)
- Nubeqa (darolutamide)
- Xtandi (enzalutamide)
- Zytiga, Yonsa (abiraterone)
What Other Treatment Options Are Available?
Prostate cancer can eventually become resistant to anti-androgen therapy, leading to castration-resistant prostate cancer. Other treatments available at this stage include:
These agents are chemotherapy drugs that act to kill cancer cells by disrupting DNA. These drugs are injected into the vein and are given in cycles of treatment and rest periods. A full cycle may be 3 weeks long, but it can also depend on the drug given.
Side effects of "chemo" can vary in severity and type, and include low blood cell counts, nausea/vomiting, diarrhea, hair loss, loss of appetite and mouth sores; however, these drugs may prolong survival in some patients. Speak with your doctor about side effects.
Provenge (sipuleucel-T) is an immunotherapy product that stimulates the immune system to help fight prostate cancer cells resistant to anti-androgen therapy. It is used in metastatic prostate cancer ans was approved in 2010.
- Provenge is mixed with certain immune cells drawn from the patient's blood, and the mixture is later injected back into the patient's body. This type of treatment is called autologous immunotherapy.
- In clinical trials, Provenge showed an increase in overall survival of 4.1 months. The median survival for patients receiving Provenge treatments was 25.8 months, as compared to 21.7 months for those who did not receive the treatment.
- In studies, the most commonly reported side effects were chills, fever, nausea, and headache, but they appear to be short-lived. More serious effects, reported in 25% of patients, might involve acute infusion reactions and rarely stroke.
Your insurance and the manufacturer (Dendreon Corporation) should be contacted to determine cost-assistance for this medication.
Jevtana Approved for Advanced Prostate Cancer
Jevtana (cabazitaxel) is Sanofi's microtubule inhibitor indicated in combination with prednisone for treatment of patients with hormone-refractory metastatic prostate cancer.
- Jevtana was FDA-approved in June of 2010 and is given via an intravenous (IV) infusion every three weeks. It is given in combination with oral prednisone.
- In clinical studies, a 30% reduction in risk of death was seen among patients taking Jevtana in combination with prednisone compared to those taking mitoxantrone and prednisone.
- Side effects can be severe and may include low red and white blood cell counts, diarrhea, fatigue, nausea/vomiting, constipation, and stomach pain, among others.
Xtandi Shows Clear Benefit in Advanced Prostate Cancer
In 2012, the FDA approved Astellas' oral Xtandi (enzalutamide) for use in men with metastatic castration-resistant prostate cancer (mCRPC). Xtandi is an anti-androgen hormone therapy.
Research studies were done in 1,199 patients with metastatic castration-resistant prostate cancer who had received prior treatment with docetaxel. The median overall survival (the length of time before death) for patients receiving Xtandi was 18.4 months, compared with 13.6 months for the patients who received placebo.
Xtandi was subsequently approved in 2018 for men with non-metastatic castration-resistant prostate cancer (CRPC). It's most recent approval came in 2019 for metastatic castration-sensitive prostate cancer (mCSPC), which is prostate cancer that still responds to androgen deprivation therapy (ADT) but has spread to other parts of the body.
Common side effects may include weakness or fatigue, back pain, diarrhea, and headache among many others. Seizures have been reported in roughly 0.5% to 2.2% of patients receiving Xtandi.
Patients should avoid activities where a sudden loss of consciousness could seriously harm you or someone else. Tell your doctor right away if you lose consciousness or have a seizure. Treatment should be permanently stopped patients who experience seizures while taking Xtandi.
Xofigo for Advanced Prostate Cancer with Bone Metastases
Xofigo (radium Ra 223) is a drug that contains a radioactive substance. It is injected into the blood to help fight advanced prostate cancer that has spread to the bones. Once the drug reaches the bone, it delivers radiation to kill the cancer cells.
- Xofigo, approved in May 2013, was evaluated in a clinical trial of 809 men with symptomatic castration-resistant prostate cancer. The study was designed to measure overall survival (length of time before death).
- Men receiving Xofigo lived a median of 14 months compared to a median of 11.2 months for men receiving placebo - or a median of 2.8 months longer. Studies have reported increased quality of life, too.
- The most common side effect with Xofigo is diarrhea.
Zytiga Use in Prostate Cancer
Zytiga (abiraterone) is Janssen Biotech's CYP17 inhibitor indicated for the treatment of metastatic castration-resistant prostate cancer and metastatic high-risk castration-sensitive prostate cancer. Zytiga decreases the production of testosterone, and is approved in combination with prednisone.
In studies in men with metastatic castration-resistant prostate cancer who had not received chemotherapy, patients had a median overall survival of 35.3 months compared with 30.1 months for those receiving the placebo. Progression-free survival (time alive without a worsening of the cancer) was also extended.
In February 2018, the FDA approved Zytiga to be used in combination with prednisone for the treatment of patients with metastatic high-risk castration-sensitive prostate cancer (CSPC), an earlier form of prostate cancer. In Phase 3 studies in patients with metastatic high-risk CSPC, Zytiga in combination with prednisone reduced the risk of death by 38% compared to placebo.
Common side effects include fatigue, joint swelling or discomfort, swelling caused by fluid retention, hot flush, diarrhea, high blood pressure, nausea and vomiting, low potassium, and headache, among others.
Erleada: Treatment for Non-Metastatic, Castration-Resistant Prostate Cancer
The FDA approved Janssen’s Erleada (apalutamide) in February 2018 for the treatment of prostate cancer that has not spread (non-metastatic), but that continues to grow despite treatment with hormone therapy (castration-resistant).
- Erleada blocks androgens such as testosterone, a hormone that can promote tumor growth.
- This approval is the first to use the endpoint of “metastasis-free survival”, measuring the length of time after starting treatment that tumors did not spread in the body or that death occurred.
- In Phase 3 studies with over 1,200 patients, the median metastasis-free survival for patients taking Erleada was 40.5 months compared to 16.2 months for patients taking a placebo.
Common side effects seen in studies with Erleada include fatigue, high blood pressure (hypertension), rash, diarrhea, nausea, and weight loss, among others. More serious adverse reactions included falls, bone fractures and seizures.
In September 2019, the FDA also approved Erleada for treatment of metastatic castration-sensitive prostate cancer (mCSPC). mCSPC is prostate cancer that still responds to androgen deprivation therapy (ADT) but has spread to other parts of the body.
Lynparza and Rubraca: PARP Inhibitors for mCRPC
Metastatic castration-resistant prostate cancer (mCRPC) is prostate cancer that no longer responds to medical or surgical treatment that lowers testosterone levels in the blood.
Lynparza (oloparib), approved in May 2020, is used to treat mCRPC in adults with certain inherited or acquired abnormal genes (HRR). Patients who are eligible for Lynparza have had continued disease progression with enzalutamide or abiraterone treatment. Lynparza is a targeted drug treatment, classified as an oral poly ADP ribose polymerase (PARP) inhibitor.
- Lynparza is used only if your cancer has a specific genetic marker. Your doctor will test you for this gene.
- The recommended dosage of Lynparza is 300 mg taken orally twice daily, with or without food. Do not chew, crush, dissolve, or divide tablet.
- Your treatment with Lynpara will continue until your have disease progression of the prostate cancer or the side effects become intolerable.
Rubraca (rucaparib), also approved in May 2020, is used to treat metastatic castration-resistant prostate cancer (mCRPC) in adults with certain inherited or acquired abnormal genes (BRCA), as determined by a test your doctor will give you. Rubraca is used in patuents who have been treated with androgen receptor-directed therapy and a taxane-based chemotherapy.
- Rubraca tablets are usually taken once every 12 hours, with or without food.
- If you take Rubraca for prostate cancer, you may also be treated with another medicine called a gonadotropin-releasing hormone, or GnRH. GnRH helps prevent the testicles from producing testosterone.
- Rubraca was approved based on response rate and how long patients’ responses lasted. Studies are ongoing studies to confirm the clinical benefit of Rubraca.
Orgovyx: First Oral GnRH Antagonist for Advanced Prostate Cancer
In December 2020, the FDA approved Orgovyx (relugolix), the first oral gonadotropin-releasing hormone (GnRH) receptor antagonist for men with advanced prostate cancer. Orgovyx blocks the GnRH receptor and reduces production of testosterone, a hormone known to stimulate the growth of prostate cancer.
- In the Phase 3 HERO study, treatment with Orgovyx led to sustained testosterone suppression to castrate levels (< 50 ng/mL) through 48 weeks in 96.7% of men, compared with 88.8% of men receiving leuprolide acetate injections, the current standard of care.
- Orgovyx is taken as 3 tablets on your first day of treatment. After that, take 1 tablet each day. Take the tablets at about the same time each day.
- Common side effects include hot flush, elevated glucose, triglycerides and ALT, fatigue, muscle pain, decreased hemoglobin, constipation, and diarrhea.
- Orgovyx is from Myovant Sciences.
Related: Orgovyx side effects (in detail)
Are There Ways to Prevent Prostate Cancer?
Eating a diet rich in fruits and vegetables and low fat foods may help to lower the risk of prostate cancer, and possibly other cancers. Avoiding fried and fast foods is important.
Studies have also been done with certain medications to see if they could help prevent prostate cancer.
One study published in the New England Journal of Medicine (Prostate Cancer Prevention Trial) involved nearly 19,000 men age 55 and older showed that Proscar (finasteride), a 5-alpha reductase inhibitor drug usually prescribed for benign prostatic hypertrophy (BPH). Proscar blocks the activity of 5-alpha reductase, an enzyme that affects the hormone testosterone and can provoke the growth of prostate tumors.
- Finasteride lowered the risk of low-grade prostate cancer by a third, but no effect on overall survival (extending life) was shown.
- Originally, Proscar was shown to increase the risk of developing high-grade cancers of roughly 17% compared to the placebo group (3.5% vs. 3%, respectively); however, this was a secondary finding of the study. Subsequent follow-up did not support evidence that 5-alpha reductase inhibitors increase the incidence of higher grade prostate cancer or increase the risk of death due to prostate cancer.
- Most clinicians do not suggest the use of 5-alpha reductase inhibitors to reduce the risk of prostate cancer; however, for some patients this option may be appropriate. There is always a concern of over-treatment, drug side effects, and added costs.
Data are also not supportive of supplements such as vitamin E or selenium for prostate cancer prevention.
Finished: Top Prostate Cancer Facts You Simply Can't Ignore
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- National Cancer Institute (NCI). Key Statistics for Prostate Cancer. Accessed Accessed February 9, 2021 https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html
- FDA Approves Erleada. Drugs.com. Accessed February 9, 2021 at https://www.drugs.com/newdrugs/fda-approves-erleada-apalutamide-non-metastatic-castration-resistant-prostate-cancer-4696.html
- National Cancer Institute (NCI). Prostate Cancer. Accessed February 9, 2021 at http://www.cancer.gov/types/prostate
- U.S. Preventive Services Task Force (USPSTF). Prostate Cancer: Screening Release Date: May 2018. Accessed February 9, 2021 at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening1?ds=1&s=prostate
- Hoffman R, et al. Patient education: Prostate cancer screening (Beyond the Basics). Up to Date. Accessed February 10, 2019 at https://www.uptodate.com/contents/prostate-cancer-screening-beyond-the-basics
- Dawson N, et al. Patient education: Treatment for advanced prostate cancer (Beyond the Basics). Accessed February 10, 2019 at https://www.uptodate.com/contents/treatment-for-advanced-prostate-cancer-beyond-the-basics
- Sartor A. Chemoprevention strategies in prostate cancer. Up to Date. Accessed February 9, 2021 at https://www.uptodate.com/contents/chemoprevention-strategies-in-prostate-cancer
- Barbee J, Shulman G, O'Neal-Scott A, et al. Prostate Cancer: Facts, Causes, and Treatments. Pharmacy Times. March 16, 2018. Accessed February 10, 2019 at https://www.pharmacytimes.com/publications/health-system-edition/2018/march2018/prostate-cancer-facts-causes-and-treatments