Prostate cancer is the most prevalent form of cancer among men in the United States, excluding skin cancer. It accounts for 25% of all new cancer diagnoses in this group (“Cancer Stat Facts: Prostate Cancer,” National Cancer Institute). Prognostically, early detection offers a promising outcome, with more than 2.8 million men in the United States currently classified as prostate cancer survivors. The incidence of prostate cancer exhibits racial disparities, with African Americans experiencing the highest rates of the disease while Asians have the lowest (Siegel et al., 2021). The U.S. Preventive Services Task Force recommends that men over the age of 55 consider screening for prostate cancer, particularly men with a history of prostate cancer in their families. For over four decades, I have treated prostate cancer patients and am committed to reducing the incidence of prostate cancer.

The pathogenesis of prostate cancer involves both genetic susceptibilities and environmental exposures, including dietary chemicals, toxins, hormones, and other epigenetic factors. The malignant transformation of prostate cells is characterized by uncontrolled growth, leading to the formation of tumors that may metastasize via lymphatic and hematogenous routes (“Genetic and Environmental Factors in Prostate Cancer Progression,” BMC Cancer). Chronic stress is also implicated as a risk factor for various health conditions, including prostate cancer, due to its systemic impacts on physiological functions (Cole et al., 2010). Mindfulness and stress management techniques, such as meditation, have been shown to reduce these risks by enhancing the body’s resilience (Goyal et al., 2014).

Advanced cancer that has spread may be found before or later than the main tumor. Most patients diagnosed with advanced prostate cancer have had biopsies and treatment in the past. 

Metastatic Prostate Cancer (mPCa) is when cancer cells spread from the prostate to other parts of the body, commonly affecting lymph nodes, bones, and other organs, such as the liver &/or lungs. Initial diagnosis of metastatic disease is uncommon but possible, necessitating proactive, comprehensive diagnostic strategies for early detection and management. Our foundation is working to reduce the number of people with metastatic prostate cancer when first diagnosed.  Earlier is always better. 

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC), also known as metastatic castration-sensitive prostate cancer (mCSPC), describes a state where the cancer, despite spreading, remains responsive to hormonal therapy aimed at reducing androgen levels to inhibit tumor growth. Male sex hormones, like testosterone, can be reduced to slow down cancer growth. Unchecked, these male sex hormones “feed” the prostate cancer cells to let them grow. Hormone therapy, like androgen deprivation therapy (ADT), may be used to reduce the levels of these hormones and thus starve the cancer cells. 

Castration-resistant prostate Cancer (CRPC) is hormone-insensitive. It signifies the progression of prostate cancer despite the reduction of testosterone to deficient levels. This is disease progression despite medical or surgical castration. A subset of non-metastatic CRPC (nmCRPC) indicates no visible spread on scans. However, a rising PSA level indicates active disease.

People with advanced prostate cancer may or may not have any signs of sickness. Symptoms often depend on the size of the new growth and where the cancer has spread to in the body. Advanced prostate cancer may manifest with nonspecific symptoms such as urinary retention, hematuria, and systemic fatigue. Bone pain can occur when the cancer metastasizes to skeletal structures. Diagnostic approaches include PSA testing, digital rectal exams (DRE), imaging techniques such as MRI, CT, and PET scans, and biopsies for histological analysis. These diagnostic tools are crucial for staging and guiding treatment planning and prognosis assessment. Patients should inform their healthcare team about any pain or other symptoms anywhere.

The following tests are used to diagnose and track prostate cancer.

Blood tests: The PSA blood test measures a protein called the prostate-specific antigen in your blood. Only the prostate and prostate cancers make PSA. Results for this test are in nanograms of PSA per milliliter (ng/mL) of blood. The PSA test is used to stage cancer, plan treatment, and track treatment progress. A rapid rise in PSA may be a sign that something is wrong. If PSA drops with treatment, it usually means the treatment is working. In addition, your healthcare team will test the testosterone level in your blood. When a PSA level doubles within several months, this is also recorded as PSA doubling time (PSADT). If your PSA increases after surgery, your healthcare team will measure how fast it is rising, as this may be a sign of cancer or spread.

Digital Rectal Exam (DRE) is a physical exam that assesses for changes in your prostate. The healthcare provider puts a lubricated, gloved finger into the rectum for this exam. During this test, a healthcare team member feels for an abnormal shape, consistency, nodularity, or thickness of the prostate gland. This finger test may also screen for cancer staging or track treatment progress. 

Imaging and Scans help your healthcare team learn more about your prostate. For example,

• Magnetic resonance imaging (MRI) is a scan that can show the prostate and whether cancer has spread into the seminal vesicles or nearby tissue. To see details, a contrast dye is often injected into a vein before the scan. MRI scans use radio waves and strong magnets instead of X-rays.

• Computed tomography (CT) scans view cross-sectional views of tissue and organs. They combine X-rays and computer calculations for detailed images from different angles. CT scans can show solid versus liquid structures, so they are used to diagnose masses in the urinary tract. CT scans are only sometimes as useful as MRI to see the prostate gland but are good at evaluating surrounding tissues and structures.

• Positron emission tomography (PET) scan may better see where and how much the cancer is growing. A particular drug (called a tracer) is given through your vein, or you may inhale or swallow the drug. Your cells will pick up the tracer as it passes through your body. The scanner helps better see where and how much the cancer is growing as cancer cells take up the tracer more than normal cells, leading to a hot spot.

• Bone scans help show if cancer has reached the bones. If prostate cancer spreads to distant sites, it often goes to the bones first. In these studies, a radionuclide dye is injected into the body. Over a few hours, images are taken of the bones. The dye helps to make cancer images show up more clearly as the cancer cells take up the dye more than normal bone cells, leading to a hot spot.

• Biopsy: A biopsy is a tissue sample taken from your prostate or other organs to look for cancer cells. There are many approaches to prostate biopsies. These can be done through a probe placed in the rectum, through the skin of the perineum (between the scrotum and rectum), and may use a specialized imaging device, such as MRI. The biopsy removes small pieces of tissue for review under a microscope. The biopsy takes 10 to 20 minutes. A pathologist (an expert in classifying disease) looks for cancer cells within the samples. If cancer is seen, the pathologist will “grade” the tumor. People diagnosed with advanced prostate cancer from the beginning will get a prostate biopsy. It is also used to grade and stage cancer. Most folks diagnosed with advanced prostate cancer have had a prostate biopsy in the past, meaning the cancer was suspected earlier. When a new tumor is found in someone treated before, it is usually recurrent cancer that has spread. 

• Grading and Staging: Prostate cancer is grouped into four stages, defined by how much and quickly the cancer cells grow. The stages are defined by the Gleason Score and the T (tumor), N (node), and M (metastasis) Score.

Gleason Score

If a biopsy shows cancer, the pathologist grades it. The most common grading system is called the Gleason Score, which measures how quickly cancer cells can grow and affect other tissues. Lower grades are given to samples with small, closely packed cells, and higher grades are given to samples with more spread-out cells. The Gleason score is set by combining the two most common grades in a biopsy sample.

The Gleason score will help your healthcare team understand whether the cancer is low, intermediate, or high risk for recurrence after treatment. Generally, Gleason scores of 6 and below are low-risk cancers. Gleason scores of around 7 are intermediate/mid-level cancers. Gleason scores of 8 and above are high-risk cancers. Some of these high-risk tumors may have already spread by the time they are found.  Even if you have already been diagnosed with prostate cancer, your healthcare provider should observe changes over time. 

Staging: The  Tumor, Nodes, and Metastasis (TNM) staging system is used for tumor staging. The T, N, and M Scores measure how far prostate cancer has spread in the body. The T (tumor) score rates the size and extent of the original tumor. The N (nodes) score rates whether the cancer has spread into nearby lymph nodes. The M (metastasis) score rates whether the cancer has spread to distant sites.

Tumors found only in the prostate are more successfully treated locally than those that have metastasized (spread) outside the prostate. Tumors that have metastasized are incurable locally and require hormones or chemotherapy to treat the whole body.

Prostate Cancer Stage Groupings

Prostate cancer is staged as follows:

• T1: Health care provider cannot feel the tumor

• T1a: Cancer present in less than 5% of the tissue removed and low grade (Gleason less than 6)

• T1b: Cancer present in more than 5% of the tissue removed or is of a higher grade (Gleason greater than 6)

• T1c: Cancer found by needle biopsy done because of a high PSA

• T2: Health care provider can feel the tumor with a DRE, but the tumor is confined to the prostate

• T2a: Cancer found in one half or less of one side (left or right) of the prostate

• T2b: Cancer found in more than half of one side (left or right) of the prostate

• T2c: Cancer found in both sides of the prostate

• T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles

• T3a: Cancer extends outside the prostate but not to the seminal vesicles

• T3b: Cancer has spread to the seminal vesicles

• T4: Cancer has spread to nearby organs

• N0: There is no sign of the cancer moving to the lymph nodes in the area of the prostate (becomes N1 if cancer has spread to lymph nodes)

• M0: There is no sign of tumor metastasis (becomes M1 if cancer has spread to other parts of the body)

Even if you have already been diagnosed with prostate cancer, your healthcare provider should observe changes over time.

Prostate cancer’s risk factors include age, genetic predispositions, and racial/ethnic backgrounds, with significantly higher risks observed in African American men and those with familial histories of the disease, including inherited mutations like BRCA1 or BRCA2 (Klein et al., 2021). Future research is directed toward understanding the molecular underpinnings of prostate cancer to develop targeted therapies and improve screening protocols. Your healthcare team may suggest gene testing because of your family history or because you have aggressive prostate cancer.

To learn more, talk to your healthcare team about inherited (genetic/germline) and acquired (biomarker/genomic/somatic) tests, as these may reveal other ways to treat prostate cancer.

Prostate cancer is the second-leading cause of cancer deaths among men, behind lung cancer, according to the American Cancer Society. While one in eight men will develop the disease during their lives, it will lead to death in roughly one in 44 cases. Being obese increases the risk of fatality, as the hormonal and metabolic changes and high levels of cholesterol and inflammation associated with causing the excess weight can lead to a person acquiring a more aggressive form of cancer.  Your risk for prostate cancer rises as you get older, have a family history of prostate cancer, are African American, or have inherited mutations such as the BRCA1 or BRCA2 genes.

• Age: Prostate cancer risk increases with age. About 6 in 10 cases of prostate cancer are found in those older than 65. Prostate cancer is rare in those under the age of 40.

• Race/Ethnicity: People who are African American and those who are Caribbean of African ancestry face a higher risk of being diagnosed with prostate cancer. They are also more likely to be diagnosed with prostate cancer at younger ages. It is not clear why prostate cancer affects African Americans more than other racial/ethnic groups.

• Genetic Factors: The risk of prostate cancer more than doubles in those with a family history of prostate cancer in their grandfathers, fathers, or brothers. Having family members with breast and ovarian cancer also raises the risk for prostate cancer. That is because some genes, including BRCA1 and BRCA2, increase the risk of breast, ovarian, and prostate cancers. If a man has a mutation in any of these genes, he should be screened earlier and/or more often for prostate cancer.

Your physician may suggest gene testing because of your family history or because you have aggressive prostate cancer. To learn more, talk to your healthcare team about inherited (genetic/germline) and acquired (biomarker/genomic/somatic) tests, as these may reveal other ways to treat prostate cancer.

ACS projects that by 2050, the number of people with cancer could rise by 77%. Estimates suggest that about 1 in 5 people who are alive now will develop cancer in their lifetime, and around 1 in 9 men and 1 in 12 women will die from the disease. This alarming warning increases the need to do all we can to prevent the incidence of cancer as soon as possible. 

Compared to many other cancers, prostate cancer is a “slower” cancer and more manageable when found early on. When an early-stage prostate cancer is found, it may be treated or placed on active surveillance (watching closely). Advanced prostate cancer is not “curable,” but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression and may help manage symptoms.

To treat prostate cancer, the complete surgical removal of the prostate — a radical prostatectomy — is the go-to procedure, often followed by radiation therapy. However, both treatments have serious risks of side effects that can impact a man’s ability to urinate and cause erectile dysfunction. Since the progression of prostate cancer tends to be very slow, many men put off treatment, often for years. As many as 60% of men diagnosed with prostate cancer will be on active surveillance for about five years before undergoing treatment.  Since the progression of prostate cancer tends to be very slow, many men put off treatment, often for years. As many as 60% of men diagnosed with prostate cancer will be on active surveillance for about five years before undergoing treatment. 

High-Intensity Frequency Ultrasound (HIFU) is an emerging treatment option for malignant tissues that has fewer side effects compared to more conventional approaches to cancer, such as invasive surgeries or chemotherapy. Research has found that the elderly face considerable risks in surgery, as people tend to grow more frail as they age. This morbidity and mortality risk must be weighed against the benefits of a given procedure. 

 HIFU is minimally invasive and uses ultrasonic waves and heat energy emitted by a wand to break up cancerous tissue while the patient is under anesthesia.

One can pinpoint the energy of the ultrasound to specific parts of the prostate, thereby avoiding many of the major side effects and the quality of impact that the traditional treatments cause.  Real-time intraoperative ultrasound determines the depth of tissue penetration of the energy and where to focus the energy. So, it’s a real-time image-guided treatment of prostate cancer cells.  HIFU is less painful than other therapies and can be a good option for “middle-risk” prostate cancer patients for whom “active surveillance” is not advised. Post-HIFU, some men may have problems with urination, but this usually clears up in a few days. The most uncomfortable part is using a catheter, which remains in place for a few days afterward.

Stress affects our physical and mental health in many ways. Chronic stress leads to problems including high blood pressure, heart disease, obesity, and diabetes. Research suggests stress also affects our urologic health. Therefore, living healthy with mindfulness meditation is essential to mitigate the impact of stress on our organs and cells. The benefit of yoga and other complementary practices is that they impact metabolic processes within our cells, leading to physiological resilience. 

Mindfulness has two main parts: attention and acceptance. First, focus on your breathing, thoughts, physical sensations, and feelings. Then, observe those feelings and sensations without judging them and let them go. Research has found that mindfulness-based therapy is especially effective in reducing stress, anxiety, depression, and pain. This then reduces the risk of chronic stress causing or worsening cancer.

Yoga teaches us to cure what need not be endured and endure what cannot be cured – BKS Iyengar.