Prostate cancer basics: risks, symptoms, tests, and treatment

TL;DR:

Prostate cancer is the most diagnosed cancer in men in many countries.
Age, family history, ancestry, and obesity raise risk.
PSA blood tests can help, but also cause false positives and overdiagnosis.
Most low risk cases are watched, not treated right away.
Ask your doctor about risk-adapted screening and side effects.

What is prostate cancer

Prostate cancer starts in the prostate, a small gland below the bladder that makes seminal fluid. Most cases grow slowly. Some are aggressive and spread to lymph nodes and bones.

Globally, prostate cancer is among the top cancers in men, and the burden is rising as populations age. International data show it is the most frequently diagnosed cancer in men in many countries, with large differences by region.

How common is it

In the United States in 2025, the American Cancer Society estimates about 313,780 new cases and 35,770 deaths. Rates vary worldwide due to access to testing, records, and genetics. Countries with limited access may undercount cases.

Symptoms to watch

Early prostate cancer often has no symptoms. When symptoms appear, they may include:

Weak urine stream or frequent urination, especially at night.
Trouble starting or stopping urine.
Blood in urine or semen.
Pain in the back, hips, or chest if cancer has spread.
These signs can also come from benign prostate enlargement or infection. See a clinician if you notice changes.

Main risk factors

Age: Risk rises after 50.
Family history: A father, brother, or son with prostate cancer raises risk. BRCA1 or BRCA2 mutations raise risk and may make disease more aggressive.
Ancestry: Men of African ancestry have higher risk and worse outcomes in many settings.
Obesity and lifestyle: Obesity links to higher risk of advanced disease.
Geography and access to care: Where you live affects testing and diagnosis.
Large studies and global registries support these patterns, though exact risk sizes differ by study.

Screening basics

Screening aims to find cancer before symptoms. Two common tests are:

PSA blood test: Measures prostate-specific antigen.
Digital rectal exam (DRE): A clinician feels the prostate for changes.

Screening has benefits and harms. PSA can find cancers early, but it can also flag slow-growing cancers that may never cause harm. This can lead to extra tests and side effects from treatment that may not be needed. Evidence reviews highlight small mortality benefits for some age groups and clear risks of overdiagnosis and overtreatment.

Age to consider screening

Guidance varies by region. In the United States, the USPSTF advises shared decision-making for men 55 to 69 years. It recommends against routine screening at 70 years and older. European guidance favors risk-adapted screening based on a baseline PSA and personal risk. Talk to a clinician who knows your history and local guidelines.

What risk-adapted screening means

Risk-adapted programs use your first PSA, age, family history, ancestry, and sometimes genetic or MRI tools to set when to retest. Men with a very low baseline PSA often retest less often. Men with higher risk retest sooner and may get MRI before biopsy. This approach aims to cut needless biopsies and still catch significant cancers.

If your PSA is high

A single high PSA does not equal cancer. Steps may include:

Repeat PSA after a few weeks, avoid ejaculation and intense cycling before the test.
Free-to-total PSA, PSA density, or risk calculators to refine risk.
Multiparametric prostate MRI to look for suspicious areas.
Biopsy if risk remains high. Many centers use MRI-targeted plus systematic cores.

Your team will also check other causes of high PSA, like infection or benign enlargement.

Diagnosis, grade, and stage

Gleason score / Grade Group: Pathologists grade patterns from the biopsy. Grade Group 1 is low grade. Grade Group 5 is high grade.
Stage: Imaging and pathology show how far the cancer has spread.
Risk category: Low, intermediate, or high risk, based on PSA, Grade Group, and stage. Risk guides treatment choices.

Treatment options by situation

Very low and low risk, localized

Active surveillance is common. You get regular PSA tests, repeat MRI, and periodic biopsies. The goal is to avoid or delay treatment side effects while staying safe.

Favorable intermediate risk

Active surveillance for some men.
Surgery to remove the prostate.
Radiation therapy, often with short-term hormone therapy.

Unfavorable intermediate and high risk

Surgery plus pelvic lymph node assessment in selected patients.
Radiation with longer-term hormone therapy.
Clinical trials if available.

Locally advanced or node positive

Radiation to prostate and nodes plus multi-year hormone therapy.
Surgery for select cases in expert centers.

Metastatic disease

Hormone therapy is the backbone.
Add androgen receptor pathway inhibitors for most patients.
Some patients benefit from docetaxel chemotherapy.
If tumors carry DNA repair gene mutations like BRCA1/2, PARP inhibitors can help, often combined with hormone therapy. Large trials in the last few years support these combinations. Ask about genomic testing if disease is advanced.

Side effects to discuss

Urinary: Frequency, urgency, leakage.
Sexual: Erectile dysfunction, dry climax after surgery.
Bowel: Looser stools, bleeding after radiation.
Hormone therapy: Hot flashes, fatigue, weight gain, loss of bone density.
Most side effects can be managed. Ask about pelvic floor rehab, penile rehab, and bone health plans.

Diet and lifestyle

Keep a healthy weight.
Exercise most days.
Eat a diet rich in vegetables, whole grains, beans, and fish.
Limit processed meat and alcohol.
These habits support general health and may help treatment tolerance.

What to ask your doctor

What is my risk category, grade, and stage?
Do I qualify for active surveillance?
If I need treatment, which option fits my goals?
What side effects matter most to me, and how will we prevent them?
Should I have MRI, genomic testing, or both?
How often will I follow up?

Quick checklist

Step	What to do	Why it helps
1	Know your family history and ancestry	Refines your risk and screening plan
2	Discuss PSA screening at 55 to 69, sooner if high risk	Balances benefits and harms
3	If PSA is high, repeat test and consider MRI before biopsy	Cuts unnecessary biopsies
4	If low risk, ask about active surveillance	Avoids avoidable side effects
5	If advanced, ask about genomic testing for BRCA and more	Can open PARP inhibitor options
6	Plan for side effect prevention early	Better quality of life

Why it matters

Prostate cancer is common and outcomes improve with smart use of testing and treatment. A risk-adapted plan catches dangerous disease, while many low risk cases avoid heavy treatment. Understanding your options helps you live well during and after care. Large agencies and guideline groups updated materials through 2024 and 2025 that support this balanced approach.

Sources:

American Cancer Society, Key Statistics for Prostate Cancer, https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html, accessed 2025-10-10.
National Cancer Institute, Prostate Cancer Screening (PDQ), https://www.cancer.gov/types/prostate/hp/prostate-screening-pdq, updated 2025-04-08, accessed 2025-10-10.
International Agency for Research on Cancer, GLOBOCAN Cancer Today and World Fact Sheet, https://gco.iarc.fr/today and https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf, accessed 2025-10-10.
U.S. Preventive Services Task Force, Prostate Cancer Screening Recommendation, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening, published 2018-05-08, accessed 2025-10-10.
University College London trial news via The Times, PARP inhibitor niraparib plus hormone therapy reduces progression in advanced prostate cancer, https://www.thetimes.co.uk/article/prostate-cancer-drug-trial-news-0kzs0dgt0, published 2025-10-07, accessed 2025-10-10.
European Association of Urology Guidelines, Diagnostic evaluation and risk-adapted early detection, https://uroweb.org/guidelines/prostate-cancer/chapter/diagnostic-evaluation, accessed 2025-10-10.