Prostate cancer

Prostate cancer is one of the most common cancers affecting men worldwide.[1] Understanding early symptoms, diagnostic options, and prostate cancer treatment pathways can be life-saving. In this guide, we’ll explain:

• The warning signs of prostate cancer;
• How prostate cancer is diagnosed and staged;
• The role of advanced diagnostic tools like prostate MRI for cancer. 

If you're seeking clarity about prostate health, keep reading

What Is Prostate Cancer?

Prostate cancer occurs when cancerous cells form in the tissues of the prostate. It is a different condition than enlarged prostate (BPH), although the two conditions can have similar symptoms. 

Prostate cancer is second only to skin cancer as the most commonly diagnosed type of cancer in the US. According to the American Cancer Society, 1 in 8 men in the USA will be diagnosed with prostate cancer at some point in their lives.[1] 

The risk for prostate cancer can vary based on age, family history, race/ethnicity, genetic mutations (such as mutations in the BRCA2 gene, Lynch syndrome, or HNPCC), and other factors. Prostate cancer risk is highest in African American men and in Caribbean men of African ancestry.[1]

Prostate cancer is often slow-growing over many years.[2] Prostate cancer survival rates are high, with the Centers for Disease Control and Prevention (CDC) stating that 97% of prostate cancer patients survive 5 years later.[3] It has one of the best survival rates when detected early and promptly treated. Over the past two decades, thanks to improvements in screening, early detection, and treatment, prostate cancer mortality rates dropped by over 40% (from 89.87 per 100,000 in 1999 to 52.92 in 2020).[4] 

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How common is prostate cancer? 

Prostate cancer incidence increases with age. It is rare in men under 40, and nearly 60% of all prostate cancers are diagnosed in men over the age of 65. The average age of men when they are first diagnosed is about 67.[1] 

While the chances of a man dying from prostate cancer are generally low,[1] it should be noted that prostate cancer is the second leading cause of cancer death among men in the US, with 94 men dying from it every day.[5]

It is important to catch prostate cancer early, and treatment success rates are high compared with many other types of cancer. According to the Prostate Cancer Foundation, the 5-year prostate cancer survival rate for men diagnosed in early stage (1 or 2 ) in the USA is greater than 99%.[5] 

Prenuvo’s whole body MRI is one way to identify prostate cancer, even in the early stages of prostate cancer (stage 1 / 2), through a non-invasive process that is often more accurate than X-rays or CT scans.[6] MRI can also help distinguish between enlarged prostate (BPH) and prostate cancer.[7] Prenuvo’s imaging of the prostate gland is equivalent to a dedicated MRI of the prostate, with the added benefit that Prenuvo doesn’t administer intravenous contrast, which means no needles.

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Symptoms and Stages

Early prostate cancer symptoms

Prostate cancer causes a range of symptoms, the earliest of which are similar to those of an enlarged prostate (BPH). Both can cause issues with urination, including: 

• Difficulty urinating, including pain, and/or a weak or interrupted stream;
• Increased frequency of urination, especially at night;
• Urinary incontinence;
• Less commonly, blood in the urine or semen.

Advanced Prostate Cancer Symptoms

As prostate cancer progresses, additional symptoms may include:

• Erectile dysfunction (ED);
• Pain in the hips, spine, ribs, or other areas, from cancer that has spread to the bones;
• Weakness or numbness in the legs or feet;
• Urinary and/or fecal incontinence, from cancer in the spine pressing on the spinal cord;
• Weight loss;
• Increased fatigue.

It is important to speak with your healthcare provider if you experience any symptoms. And a Prenuvo Whole Body MRI can help your provider make a proper diagnosis about your prostate-related symptoms.

Prostate Cancer Stages

If you have received a prostate cancer diagnosis, your healthcare providers will assign it a Gleason score or Grade Group, both of which assign numerical values to the cancer. 

Learn more about the Gleason Score and Grade Group from the American Cancer Society.

TNM Staging System

Your cancer care team will also assess your cancer using a staging system, which refers to how far your cancer has spread. According to the American Cancer Society, the most widely used staging system for prostate cancer is the TNM system, which was most recently updated in 2018 by the American Joint Committee on Cancer (AJCC).

H4: The TNM system for prostate cancer considers 5 key pieces of information:

• The extent of the main (primary) tumor (T category)
• Whether the cancer has spread to nearby lymph nodes (N category)
• Whether the cancer has spread (metastasized) to other parts of the body (M category)
• The PSA level at the time of diagnosis
• The Grade Group (based on the Gleason score), which is a measure of how likely the cancer is to grow and spread quickly, which is determined by the results of prostate biopsy (or surgery).

H4: Prostate Cancer Stage Rating System

T1 – Cancer present, but not detectable in DRE or on imaging.

• T1a – Found incidentally, Less than 5 percent of sample malignant and low-grade.
• T1b – Found incidentally, More than 5 percent of sample malignant and/or not low-grade.
• T1c – PSA elevated, not palpable, found in needle biopsy.

T2 – Tumor is palpable in DRE; organ confined.

• T2a – Confined to half or less than half in one of the prostate’s two lobes.
• T2b – Confined to more than one half of one lobe of gland but not both.
• T2c – The tumor is in both lobes but within the prostatic capsule.

T3 – Locally extensive cancer.

• T3a – Penetration of the prostate capsule on one or both sides.
• T3b – Invasion into the seminal vesicle.

T4 – Tumor extension to other organs.

• T4a – Cancer that has invaded the bladder neck and/or rectum and/or external urinary sphincter.
• T4b – Cancer that involves other areas near the prostate.

N – Lymph node involvement.

• NO – No cancer detected in the lymph nodes.
• N1 – Cancer spread to one or more lymph nodes measuring less than 2cm.
• N2 – Cancer spread to one or more lymph nodes measuring 2-5cm.
• N3 – Cancer spread to one or more lymph nodes measuring more than 5cm.
• M – Metastasis to distant sites other than lymph nodes (cancer spread).

MO – Cancer that is confined to the prostate, surrounding tissues and pelvic lymph nodes.

M1 – Cancer that has spread beyond the pelvic area to bones, lungs, etc.

According to a recent study published by Prostate Cancer Free Foundation, a Prostate Cancer TNM Stage of T2B or higher can indicate intermediate or high-risk prostate cancer.

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How Is Prostate Cancer Diagnosed?

Prostate cancer is usually diagnosed by screening, such as a Prenuvo MRI or a PSA test. If your healthcare provider suspects that you have prostate cancer based on results of screening tests or the appearance of symptoms, additional testing may be required, and you may be referred to a urologist. 

PSA Testing

Prostate-specific antigen (PSA) is a protein created by cells in the prostate gland. 

PSA blood testing can be used to screen for prostate cancer in men without symptoms. It’s also one of the first tests done in men who have symptoms that might be caused by prostate cancer, or in those with a family history of prostate cancer.

The higher the PSA score, the more likely the chances are of prostate cancer. If your PSA level is high, your healthcare providers may determine that you need additional testing to confirm or rule out prostate cancer. 

In men who have been diagnosed with prostate cancer, the PSA level continues to be monitored to determine the efficacy of treatment for prostate cancer, the stage of the cancer, the cancer’s risk group, and possible recurrence of the cancer after treatment.

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Digital Rectal Exams

During a physical exam, your provider may perform an examination of your prostate through a digital rectal exam (DRE). They might also check for an enlarged bladder, urethral discharge, and/or enlarged or tender lymph nodes in your groin.

It is important to note that the DRE is not a completely accurate test for prostate cancer. Your healthcare provider won’t be able to feel the whole prostate, and someone with a prostate that feels normal may still have prostate cancer.

MRI

There are different types of medical imaging, including MRI.

MRI scans can help your healthcare providers identify tumors, and they are very good at finding and pinpointing certain types of cancer. While MRI images can sometimes tell your provider whether or not a tumor is cancerous, they are often used in conjunction with a biopsy to confirm whether someone has prostate cancer.[8] 

MRIs can also be used to monitor treatment efficacy and whether cancer has spread. MRIs are especially helpful for healthcare providers in planning cancer treatments, such as surgeries or radiation.[8]

According to the American Cancer Society, MRIs are very useful in a variety of ways: 

• MRI can help determine whether a man with an abnormal screening test or possible prostate cancer symptoms should get a prostate biopsy;
• MRI might be done in preparation for a biopsy to help locate and target areas of the prostate that are most likely to contain cancer;
• MRI can be used during a prostate biopsy to help guide the needles;
• If prostate cancer has been found, MRI can be done to help determine the extent of the cancer, and whether it has spread outside the prostate.

Prenuvo’s imaging of the prostate gland is equivalent to a dedicated MRI of the prostate, except that we do not administer intravenous contrast.

PSMA-PET

Another new imaging technique used in diagnosing prostate cancer is radiolabelled Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET).[9] New guidelines from the European Association of Urology recommend using MRI for the primary diagnosis of prostate cancer, with PSMA-PET used for staging, especially in cases of high-risk localized disease or locally advanced disease.[10] PSMA-PET is also recommended for detecting biochemically relapsed disease after radical prostatectomy. [11]

Biopsy

If PSA, DRE, or other testing suggest prostate cancer, you will most likely need a prostate biopsy, in which small samples of the prostate are removed for laboratory examination. 

The biopsy is usually performed by a urologist, and your healthcare provider will likely use imaging (such as an MRI or ultrasound) to guide the procedure. You will be given antibiotics before and after the biopsy to reduce the risk of infection. You will receive a local anesthetic to numb the area being examined. According to the American Cancer Society, biopsies usually cause only brief discomfort. 

Post-biopsy, you may experience some soreness in the area and possible blood in your urine. There might also be light rectal bleeding, especially if you suffer from inflamed hemorrhoids. Many men note blood in their semen, possibly up to several weeks after the biopsy.

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Treatment Options

There are several treatment options for prostate cancer, and the stage or severity of the cancer will likely dictate the course of treatment. Not all cancers are the same, and cancers can grow at different rates. Your healthcare professional and you can discuss the severity of your cancer and severity of your symptoms when planning treatment options. 

It’s important to note that prostate cancer is often a slow-growing cancer, and that with early detection and prompt treatment, prostate cancer survival rates are quite high and mortality rates have dropped by +40% since 1999. As noted by the CDC, 97% of prostate cancer patients survive 5 years later.[3] 

Active Surveillance and Observation

For men with slow-growing prostate cancers, especially older men or those with other serious health problems, healthcare professionals may recommend active surveillance or observation (also known as watchful waiting).

Active surveillance involves monitoring the cancer closely with ongoing PSA testing, digital rectal examinations (DRE), and prostate biopsies and imaging testing at a rate based upon risk factors. 

Observation (or watchful waiting) describes a less intense follow-up with fewer tests, and relies more on changes in symptoms to decide if and/or when additional treatment is needed. This is often a path used for older men and/or those with other serious health problems.

According to the National Cancer Institute, active surveillance rates more than doubled between 2014 and 2021, to almost 60% of US men diagnosed with low-risk prostate cancer.[12] 

Surgery and Radiation Therapy

Surgery is often used when ‌prostate cancer is localized within the prostate gland. In a radical prostatectomy, the surgeon removes the prostate gland and some of the surrounding tissues, including the seminal vesicles. Lymph nodes are often removed as well.

Radiation therapy uses radioactive rays or particles to target and kill cancer cells. It is often used:

• As the first treatment for lower-risk group cancer that is localized to the prostate gland;
• In conjunction with hormone therapy for higher-risk group cancer that is localized to the prostate, or for cancers that have spread into tissues immediately surrounding the prostate; 
• If surgery doesn’t completely remove the cancer, or if the prostate cancer recurs;
• For advanced prostate cancer stages, or if it spreads to the bones or other areas, and to help prevent or relieve symptoms.

Hormone Therapy, Chemotherapy, and Immunotherapy

Hormone therapy, also known as androgen deprivation therapy (ADT), seeks to reduce levels of androgens in the body to stop or slow them from fueling prostate cancer cell growth. Hormone therapy may be used:

• In conjunction with radiation therapy as the first treatment for higher-risk group cancer that is localized to the prostate, or for cancers that have spread into tissues immediately surrounding the prostate; 
• To shrink the cancer in advance of radiation treatment with the goal of increasing the effectiveness of radiation treatment;
• Post-surgery or radiation therapy if the cancer comes back or spreads;
• When the cancer has spread too far to be cured by surgery or radiation.

Chemotherapy, or chemo for short, uses oral or intravenous anti-cancer drugs to reach cancer cells throughout the body. Chemo can be used to treat advanced prostate cancer, especially if there is also cancer outside the prostate gland. It can be used in conjunction with hormone therapy, or by itself if hormone therapy is no longer working. 

Immunotherapy uses medicines to stimulate the immune system to recognize and destroy cancer cells more effectively. Immunotherapy involves a special type of vaccine that is made specifically for each patient. It is made by drawing white blood cells from the blood and mixing them in a lab with a protein called prostatic acid phosphatase (PAP). The resulting fusion is a cancer vaccine called Sipuleucel-T (Provenge), which is then administered to the patient through an IV. 

According to the American Cancer Society, while immunotherapy has not been shown to cure prostate cancer, studies suggest this type of treatment may help men live an average of several months longer.[13] 

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Emerging Treatments and Clinical Trials

As researchers learn more about prostate cancer, new drugs and therapies are being developed and tested through clinical trials.

Some of the latest therapies in development involve targeted drugs used in very specific cases, such as PARP inhibitors, ​​Rucaparib (Rubraca), Olaparib (Lynparza), Talazoparib (Talzenna), and Niraparib plus abiraterone (Akeega). Click here for more details on these emerging therapies.

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Is Prostate Cancer Curable?

When diagnosed early and promptly treated, prostate cancer is often curable.[14] Many who are treated when the cancer is contained to the prostate go on to live cancer-free lives. 

How the Prenuvo scan can impact care

Prostate cancer is a serious but treatable condition when detected early. Recognizing symptoms, understanding the stages, and knowing your diagnostic and treatment options are crucial. Prenuvo’s advanced MRI scans detect hundreds of conditions and play a vital role in early detection and monitoring so you can proactively manage your health. Additionally, Prenuvo’s imaging of the prostate gland is equivalent to a dedicated MRI of the prostate, with the added benefit that it does not require intravenous contrast to be injected. 

Schedule your Prenuvo MRI today for peace of mind

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Sources

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1. Key Statistics for Prostate Cancer. Cancer.org. Accessed January 28, 2025. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
2. If You Have Prostate Cancer. Cancer.org. Accessed January 28, 2025. https://www.cancer.org/cancer/types/prostate-cancer/if-you-have-prostate-cancer.html 
3. U.S. Cancer Statistics Prostate Cancer Stat Bite. CDC.org. Accessed January 28, 2025. https://www.cdc.gov/united-states-cancer-statistics/publications/prostate-cancer-stat-bite.html 
4. Aziz N, Nabi W, Khan M. Trends and Disparities in Prostate Cancer Mortality in the United States (1999–2020). Clinical Genitourinary Cancer. 2025: 23(2). doi: 10.1016/j.clgc.2024.102298.
5. Prostate Cancer Survival Rates. PCF.org. Accessed January 28, 2025. https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-cancer-survival-rates/ 
6. MRI is more accurate than a PSMA PET/CT scan for prostate cancer diagnosis. Cancer. 2022: 128: 3906-3906. DOI: 10.1002/cncr.34525.
7. Prostate MRI. RadiologyInfo.org. Accessed January 28, 2025. https://www.radiologyinfo.org/en/info/mr_prostate 
8. MRI for Cancer. ACS.org. Accessed January 25, 2025. https://www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/mri-for-cancer.html 
9. Cereser L, Evangelista L, Giannarini G, Girometti R. Prostate MRI and PSMA-PET in the Primary Diagnosis of Prostate Cancer. Diagnostics (Basel). 2023: 13(16): 2697. DOI: 10.3390/diagnostics13162697. 
10. EAU Guidelines: Prostate Cancer. April 2024. uroweb.org. Accessed February 21, 2025. https://uroweb.org/guidelines/prostate-cancer 
11. Wang, Y., Galante, J.R., Haroon, A. et al. The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer. Nat Rev Urol: 2022: 19: 475–493. DOI: 10.1038/s41585-022-00618-w
12. Advances in Prostate Cancer Research. Cancer.gov. Accessed January 25, 2025. https://www.cancer.gov/types/prostate/research 
13. Immunotherapy for Prostate Cancer. ACS.org. Accessed January 25, 2025. https://www.cancer.org/cancer/types/prostate-cancer/treating/vaccine-treatment.html 
14. Prostate Cancer. ClevelandClinic.org. Accessed January 25, 2025. https://my.clevelandclinic.org/health/diseases/8634-prostate-cancer 

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