Let's Talk About Prostate Cancer

No man wants to get it. But the vast majority will live—and thrive—after a diagnosis. We’ll tell you how.

by Matt McMillen Health Writer

We get how scary it can be to learn that you have cancer. And for men, the prostate is the most likely place where cancer is found. The good news? Advances in diagnosis and treatment have vastly improved the likelihood of surviving this all-too common disease. In fact, as you’ll soon discover, detecting prostate cancer early almost guarantees you’ll be OK. Even if your cancer is more advanced, you have options. That means a lot less fear, and a lot more hope. So, deep breath. We’ll explain everything here.

Prostate Cancer

Our Pro Panel

We went to some of the nation's top experts in prostate cancer to bring you the most up-to-date information possible.

Edmund Folefac, M.D.
Edmund Folefac, M.D.

Edmund Folefac, M.D.

Medical Oncologist

Ohio State University Comprehensive Cancer Center

Columbus, OH

Isla P. Garraway, M.D.
Isla P. Garraway, M.D.

Isla P. Garraway, M.D.

Associate Professor and Director of Research

Department of Urology, David Geffen School of Medicine at UCLA

Los Angeles

Daniel Ari Landau, M.D.
Daniel Ari Landau, M.D.

Daniel Ari Landau, M.D.

Medical Oncologist

Medical Oncology and Hematology Specialty Section, Orlando Health UF Health Cancer Center

Orlando, FL

Prostate Cancer
Frequently Asked Questions
Is there anything I can do to prevent prostate cancer?

Some risk factors can’t be helped, like your age or your race, and no diet or exercise plan can reduce your direct risk. However, both diet and exercise will help you achieve and maintain a healthy weight, which could reduce your risk of more advanced, deadlier prostate cancer.

What is the prostate cancer survival rate?

That depends on the stage of your cancer. About 95% of men diagnosed with prostate cancer learn they have the disease before it has spread beyond the prostate. Nearly all of those men—we're talking 99%—will live for at least five more years. However, fewer than a third of men whose cancer has spread, or metastasized, live that long—but enormous strides have been made in prostate cancer treatment in recent years, so don’t lose hope.

Who should treat my prostate cancer?

You will likely get care from several specialists, determined by the type of treatment you require. A urologist will perform surgeries, for example, while a radiation oncologist will lead your radiation therapy. Medical oncologists handle hormone therapy, chemotherapy, and immunotherapy.

How long will my prostate cancer treatment take?

This will depend on the stage of your cancer. Some men don’t require treatment. Others get multiple radiation treatments, chemotherapy, hormone therapy, and/or surgery.

What Is Prostate Cancer, Anyway?

Only men get prostate cancer, because only men have a prostate gland. Aside from skin cancer, it’s the most common type of cancer among men in the U.S. In fact, the American Cancer Society (ACS) estimates that nearly 200,000 cases of prostate cancer will be diagnosed in this country in 2020 alone.

However, exciting innovations in treatment and screening for prostate cancer have cut the mortality rate for this disease in half since 1993, which means your odds of survival are very, very good—close to 100% if your cancer has not yet spread. Still, only lung cancer has a higher mortality rate for men, because for those whose cancer has metastasized, or grown beyond the prostate, the five-year survival rate is closer to 30%. Which is why catching it early is so important. So, we’ll say it again: If a screening detects your prostate cancer in its first stages, you’ll very likely be cured of it.

Prostate cancer statistics including percentage of men who know someone with prostate cancer, men who haven't worried about prostate cancer, men who aren't familiar with signs of prostate cancer, men who are uncomfortable with rectal exam
Nikki Cagle

What, Exactly, Is the Prostate?

Here are some basics about the prostate:

  1. The prostate’s job is to produce fluid that, together with sperm cells, makes up semen. The muscles of the prostate then provide the force needed for ejaculation.

  2. Two smaller glands called the seminal vesicles are attached to each side of the prostate; they secrete the fluid that partly comprises semen.

  3. The prostate is the size of a walnut and weighs about an ounce.

  4. It can be found just below your bladder and in front of your rectum.

  5. It surrounds part of your urethra, a tube that runs from your bladder through your penis. Urine flows through your urethra when you pee.

Your prostate, then, plays an essential role in both sex and reproduction—it’s helping to deliver sperm in search of an egg along with a great orgasm. But things can go wrong with it. The cells in your prostate can start to grow out of control. As those abnormal cells accumulate, fed by male sex hormones like testosterone, they can clump together to form cancerous tumors.

As you get older, your chances of developing cancer of the prostate get higher. On average, men diagnosed with prostate cancer get the news at age 66. It’s rarely found in men under 40. Yet yearly one in 10 men will get a prostate cancer diagnosis at some point during his life. Unnerving as this sounds, know this: For most men, prostate cancer be such a slow-growing cancer that it never causes any real harm. This is such a truism, there’s actually a saying among prostate cancer specialists: More men die with prostate cancer than from it. That means you will die of other causes, like old age or heart trouble, rather than prostate cancer.

However, prostate cancer can sometimes be aggressive and fast-moving. It can spread beyond your prostate to other parts of your body. First, it may reach your prostate’s neighbors, like the seminal vesicles, the bladder, or your rectum. It can then move on to your lymph nodes, organs, and, commonly, your bones. Once it has traveled from the prostate, it becomes tougher to treat.

What Are the Types of Prostate Cancer?

Believe it or not, there’s more than one kind of prostate cancer. They differ in how quickly and aggressively they grow. Here’s the breakdown:

  • Nearly all prostate cancers are known as adenocarcinomas. This type of cancer develops in gland cells. And, more than nine out of 10 prostate cancers are acinar adenocarcinomas. They affect a type of cell called acini.

Other types of prostate cancer are rare. They include:

  • Small cell carcinoma, a very aggressive cancer which accounts for about 1% of prostate cancers

  • Urothelial carcinoma of the prostate, a deadly, difficult-to-diagnose cancer that accounts for 1% to 4% of prostate cancers

  • Ductal adenocarcinoma, which on its own accounts for less than 1% of prostate cancers, but it can occur with acinar adenocarcinoma

What Causes Prostate Cancer?

Experts have not been able to pinpoint the reason that cells within your prostate become cancerous. However, a number of factors appear to play some part in triggering the process.

Your cells have specific instructions regarding what they’re supposed to do: when to grow, when to divide and form new cells, and when to die. They get those instructions from your genes, which you inherit from your parents, and which are made up of DNA, a chemical within your cells. That DNA can be damaged, causing genes to send the wrong instructions to your cells. For example, genes that normally help prevent cells from growing out of control may stop working properly. And that may lead to cancer.

Why does this happen? In some cases, you inherit faulty genes from one or both of your parents, or you have a family history of other types of cancers.

  • If your father or a brother had prostate cancer, your risk of the disease doubles.

  • Your odds of getting prostate cancer is five times more likely if you have two immediate relatives who were diagnosed with the disease, such your father and a brother, or two brothers.

  • If your family history includes breast cancer or ovarian cancer, your risk for prostate cancer may be higher than normal, too. Two genes commonly associated with both breast and ovarian cancers, BRCA1 and BRCA2, appear to play a role. Normally, these genes help prevent tumors from arising in the first place. But if you inherit a faulty, or mutated, version of either of them, your risk of prostate cancer rises. That’s especially true of BRCA2. In one recent study, researchers report that men with a BRCA2 mutation are more likely to be diagnosed with aggressive prostate cancer than men who don’t carry that mutation. They also developed prostate cancer a few years earlier. BRCA1 appears to have a lower impact on prostate cancer risk but needs more study, the researchers concluded.

  • Several other genes may be responsible for prostate cancer, as well. Mutations in some genes, such as MSH2, MSH6, MLH1, and PMS2, are found in people with Lynch syndrome—also known as hereditary non-polyposis colorectal cancer (HNPCC), the most common cause of hereditary colorectal cancer, according to the Centers for Disease Control and Prevention (CDC)—which boosts your odds of prostate cancer and other cancers.

What Are the Other Risk Factors for Prostate Cancer?

But your gene pool is not the only possible trigger for prostate cancer. Other risk factors include:

  • Advancing age. Prostate cancer rarely occurs in men under 40. Once you turn 50, however, your risk begins to rise. Men over the age of 65 account for more than half of all prostate cancer diagnoses.

  • Race. In the U.S., African American men are about 60% more likely to be diagnosed with prostate cancer than white men, and they are two-to-three times more likely to die from it. It can also develop at a younger age. The reasons why are unclear. Genetic differences may account for some of the differences, according to the Centers for Disease Control and Prevention (CDC), as well as systemic disparities in healthcare, which can lead to less access to cancer care, including screenings for early detection.

You can’t change risk factors like your age or your race. But can your diet and other lifestyle habits change your level of risk?

  • Too much dairy. According to the ACS, eating a lot of dairy products may up risk for prostate cancer, and the same is true for men who get more calcium in their diet—through food or supplements—than they need. (However, studies have found no link between prostate cancer and getting the recommended amount of calcium.)

  • Obesity. According to a 2018 study in the journal Oncotarget, the link between obesity and prostate cancer remains unclear, but the study’s authors found that men with excess abdominal fat—think beer bellies—were at higher risk, especially for aggressive prostate cancer. Chronic inflammation and hormone imbalances caused by obesity may be culprits.

  • Sedentary lifestyle. One study shows a slightly elevated risk for prostate cancer among men who spend too much time watching TV or staring at screens. And recent research out of Vietnam reveals that study participants who engaged in regular physical activity had lower rates of prostate cancer.

What Are the Symptoms of Prostate Cancer?

Nearly all men diagnosed with prostate cancer learn they have the disease while it’s still in its early stages, before symptoms occur. Screening for prostate cancer, which we’ll get into next, picks up as many as nine out of 10 cases.

So, what happens when the cancer is not caught in early stages? More advanced prostate cancer can cause the following symptoms:

  • Frequent urination, especially at night

  • Difficulty urinating

  • Pain or a burning sensation when urinating

  • Pain when ejaculating

  • Weak stream when urinating, along with dribbling or interrupted flow

  • Blood in your urine or semen

  • Pain in your bones, where prostate cancer often first spreads

See your doctor if you have any of these symptoms. While they could signal cancer, some symptoms may arise from other conditions. For example, benign prostatic hyperplasia (BPH) causes your prostate to grow. It is a common and non-cancerous culprit of urinary difficulties in men over 50.

How Do Doctors Screen for Prostate Cancer?

The answer is complicated. While nearly all cases of prostate cancer are discovered during screening for the disease, you and your doctor first must decide if screening is right for you. Let’s start there.

First, what is prostate cancer screening? Screening tells your doctor whether or not you’re likely to have this disease. It’s not a diagnosis but rather helps guide the decision to undergo further testing, such as a biopsy, which will help determine whether you actually do have prostate cancer, how aggressive it is, and If treatment is recommended. The tricky part, as we’ll soon unpack in more detail, is that sometimes you can test positive for prostate cancer—and immediate treatment is not recommended.

Let’s first go over the initial tests you’ll likely have if screening is right for you:

PSA Test

The first step in screening is to take a PSA test. PSA stand for prostate-specific antigen, a protein made in your prostate. The higher it is, the higher your odds of prostate cancer may be. Here’s how the PSA test results break down:

  • Under 4 nanograms per milliliter (ng/mL) usually means there’s no cancer; however, about one in six men with a PSA at this level will be diagnosed with prostate cancer once they undergo further testing.

  • Between 4 and 10 ng/mL indicates a 25% risk of prostate cancer.

  • Above 10 ng/mL boosts the risk to above 50%.

Digital Rectal Exam (DRE)

During this procedure, your doctor will insert a gloved finger into your rectum and feel your prostate gland. A normal prostate is smooth and soft. If your doctor feels lumps or hard spots on the surface of your prostate, that could be cause for concern.

The problem is, neither test is 100% reliable. A high PSA, for example, could be caused by any number of things. Do you take supplements that affect your testosterone level? Have you had sex in the past 24 hours? Do you ride a bicycle? All of these and more could temporarily elevate your PSA results. Meanwhile, being obese or taking certain medications, like cholesterol-lowering statins or drugs used to treat BPH, can lower your PSA.

The main message is this: These screening tests offer important clues but are not definitive. A high PSA does not automatically mean you have cancer. The flipside is also true. And, if you have a low PSA, you may not be in the clear. This uncertainty may leave you anxious and with more questions than answers. The important thing to note is that a trend in your PSA results, rather than a onetime PSA test, is what's most relevant. Multiple PSA tests over time allow your doctor to determine whether your PSA is low or “normal,” trending upward to indicate a need for further testing, or trending downward to suggest no further testing is required at this time. That’s why there are guidelines for prostate cancer screening in place.

At What Age Should Men Be Screened for Prostate Cancer?

Here's what the American Cancer Society (ACS) says about when to pursue prostate cancer screening:

  • Beginning at age 50, the organization recommends that you discuss the pros and cons of screening with your doctor.

  • If you’re at higher risk of prostate cancer, this discussion should take place:

    • At age 45 for African American men, and for men who have a first-degree relative—meaning, a father or brother—who has or had prostate cancer.

    • At age 40 for men who have more than one first-degree relative diagnosed with prostate cancer, and for men with a family history of either breast or ovarian cancers linked to the BRCA gene mutations.

  • Men over 70, and those who are not expected to live more than 10 more years due their current health or age, should not be screened. Even if they have prostate cancer, the disease likely won’t cause symptoms during the remainder of their lives.

How Do Doctors Diagnose Prostate Cancer?

Ok, by now, you’ve been screened. Your PSA score and/or your DRE have raised concerns. What’s next?

  • Multiparametric magnetic resonance imaging (MRI). This useful imaging test produces different types of scans to give your doctor a fuller picture of your prostate. Your doctor can then target suspicious areas for biopsy and testing.

  • Transrectal ultrasound. Your doctor inserts a finger-sized probe into your rectum. The probe emits waves of sound that bounce off your prostate. Those waves create images, called sonograms, that help your doctor evaluate your prostate and spot abnormalities. This procedure is frequently done as part of a biopsy.

  • Biopsy. This procedure removes tissue from your prostate. Images from the multiparametric MRI are matched to images created by the ultrasound to pinpoint exact the spots that need to be tested.

Before your biopsy, your doctor will numb the area around your prostate so you don’t feel pain. However, you may experience some discomfort or feel pressure during the procedure. Then, a thin, hollow needle is inserted into your prostate to remove small tissue samples. It’s most often guided by an ultrasound probe that’s inserted into your rectum. The whole thing takes about 20 to 30 minutes.

Positive results mean that you have prostate cancer. Deep breath if you’ve just gotten this news. Remember, most cancers of the prostate are curable, and many require no treatment at all. Only 4% to 5% of men with prostate cancer have experienced spread beyond the prostate at the time of diagnosis. So the odds are very much with you.

What Is the Gleason Score?

So, how do you know where your biopsy stands? Your biopsy samples will be assigned what’s called a Gleason score, the most commonly used way to grade prostate cancer, which will help your doctor make treatment decisions.

It works like this:

  1. Your doctor compares each of the tissue samples taken during your biopsy to normal, healthy prostate tissue.

  2. He or she gives each sample a score, or grade, ranging from 3 to 5. (Scores of 1 or 2 are rarely used because they’re not considered cancerous.)

  3. The more abnormal your cells, the higher your grade. A 5 represents the most aggressive cancer.

  4. Once each sample has been graded, your doctor then takes the two most common scores from all the samples and add them together. These two numbers are then weighted for prevalence. This is your Gleason Score, which can range from 6 to 10, with 10 being the most aggressive cancer.

To make it super clear, let’s walk you through an example.

  1. Let’s say a man has a biopsy in which 12 tissue samples are removed from his prostate.

  2. After careful study in a lab, each tissue receives a score. Eight of the tissue samples score a 3, while the other four samples each receive a 4.

  3. His doctor then writes the two most common scores, 3 and 4, as the final score: 3+4=7. He writes 3 first because more of the slides were graded as a 3, thus giving these readings more significance.

  4. The total score of 7 indicates that the man has cancer that may not be slow-growing. However, because most of the samples scored as 3, most of the cancer may be low-grade. That’s good news. Treatment for non-metastatic prostate cancer may be more effective than it would be than if the two numbers were reversed. If the final score had instead been written as 4+3=7, that would have meant that most of the cancer was more aggressive.

What Is the Grade Group?

A new system called the Grade Group was introduced in 2014 to further clarify the Gleason Score. This is how it breaks down:

  • Grade Group 1: Gleason Score of 6 or less; indicates a slow moving cancer that may not require treatment.

  • Grade Group 2: Gleason Score of 7 (3+4); though not as slow growing as group 1, this indicates a likely positive outlook

  • Grade Group 3: Gleason Score of 7 (4+3); faster-moving but still less likely to spread beyond the prostate than groups 4 and 5

  • Grade Group 4: Gleason Score of 8; indicates a cancer that will likely grow and spread quickly.

  • Grade Group 5: Gleason Score of 9 or 10; cancers in this group are twice as likely as Grade Group 4 to grow and spread aggressively.

How Do Doctors Know if Prostate Cancer Has Spread?

If you are diagnosed with prostate cancer, you may need to undergo further testing to determine whether it has metasticized (spread) beyond your prostate to other parts of your body.

  • Computed tomography (CT) scans. This type of scan uses X-rays to create detailed images from multiple angles. It can be used to determine the size of tumors on your prostate. You also may undergo this if your doctor suspects that your cancer has spread beyond your prostate to nearby lymph nodes.

  • Bone scans. When it spreads, prostate cancer often affects the bones. To see if this has happened, you will be injected with a small amount of radioactive material that will allow a special type of camera to pick up signs of cancer in your bones.

  • Additional MRI scans. MRI images can help your doctor determine how far your prostate cancer has progressed, including whether it has spread beyond your prostate to other parts of your body.

How Are Prostate Cancer Stages Determined?

Once all testing has been completed, your doctor will tell you the stage of your cancer, or how much it has progressed and whether it has spread beyond your prostate. The stage will help your medical team decide which treatment is best for you. The higher the stage, the more advanced your cancer. The most common way to stage prostate cancer is the TNM system, developed by the American Joint Committee on Cancer, which hinges on three important factors:

  • T (for tumor): How much of your prostate the tumor affects

  • N (for node): Whether the cancer has spread beyond your prostate to nearby lymph nodes

  • M (for metastasized): Whether your cancer has metastasized, or spread far beyond your prostate to your bones, to nearby organs such as your bladder or rectum, or to more distant organs like your lungs, liver, or brain.

The TNM system also includes your PSA level and your Grade Group, based on your Gleason score. With your stage designated, which is labeled in a range of T1 to T4 (with T4 indicating metastatic prostate cancer, meaning the cancer has spread to tissues beyond the seminal vesicles), a treatment plan can be developed.

What Are the Best Treatments for Prostate Cancer?

Surgery, radiation, hormone therapy, chemotherapy—lots of treatment options exist for prostate cancer. And, in some cases, you may need no treatment at all. What’s right for you will depend several factors:

  • Your PSA level

  • Your Gleason score

  • Your current health and comorbidities (underlying health issues like heart disease, diabetes, and other chronic illnesses that become more common with age)

  • The stage of your cancer, particularly whether it remains confined to your prostate or has spread to other parts of your body

Now, let’s take a look at the different possibilities:

No Immediate Treatment

If you have Stage 1 or Stage 2 prostate cancer, your cancer likely does not pose an immediate threat. Therefore, you may not require treatment. Instead, your doctor may consider one of the two following approaches:

  • Active surveillance requires you to undergo regular PSA tests and digital rectal exams of your prostate to make certain that your cancer has not started to grow. You also may need to undergo additional biopsies, likely every one to three years. Your doctor will determine the best schedule for your exams, but expect a PSA test every six months or so and a DRE annually.

  • Watchful waiting involves less monitoring of your cancer, so you won’t have regular tests like biopsies.

These two mostly hands-off approaches are more often recommended for older men who are more likely to die of other causes before their prostate cancer affects their health. It spares them having to endure the potential side effects of treatments like radiation or chemotherapy. (More on both in just a moment.)

Surgery

If your prostate cancer has not spread beyond your prostate, surgery is an option if you have Stage 1 or Stage 2 cancer and have decided to undergo treatment. Most often, your entire prostate will be removed along with the seminal vesicles and other surrounding tissue. This procedure is called a radical prostatectomy, and it likely will cure your cancer. However, surgery has serious risks.

  • Urinary incontinence. You may experience leakage, trouble emptying your bladder, or sudden urgency to urinate. Though rare, surgery can lead to a complete lack of bladder control. these difficulties usually go away within several weeks or months of surgery.

  • Erectile dysfunction. Nerves that control your ability to have an erection can be found on either side of your prostate. Your surgeon will attempt to leave them intact, but if some or all of those nerves harbor cancer cells or cancer cells can be found close to them, they may have to be removed. This can leave you unable to get an erection. Even if the nerves remain intact, you likely will have at least temporary erection difficulties in the weeks after surgery.

  • Ejaculation. This is something every guy will want to consider no matter what his age: When your prostate and seminal vesicles are removed, you will lose your ability to ejaculate because you no longer produce semen. That does not mean you can’t enjoy sex. In fact, most men will still be able to have an orgasm, even if they can’t get an erection, though it will be what’s called a “dry” orgasm. According to the ACS, orgasms may be less intense after surgery for prostate cancer. For some men, they could be painful. Your doctor can help you understand what to expect when considering the option of surgery.

  • Fertility loss. Most men develop prostate cancer beyond the age at which they plan to father a child. However, if you’re not sure you want to give up this ability, especially if you’re still on the younger side, talk to your doctor about sperm banking to freeze and store your sperm.

Radiation Therapy

This type of therapy uses radiation to kill cancer cells or to damage them so that they can no longer grow and multiply. It may be used in all stages of prostate cancer. There are two main types.

  • External Beam Radiation Therapy (EBRT). Beams of radiation are projected from an external device at cancerous tissues inside your body. But first, your cancer will be mapped using imaging scans likes MRI and computerized tomography (CT, which uses rotating X-ray machines to create cross-sectional images of the body). Both create images your radiation specialist will use to plan where, exactly, to target the X-ray beams, as well as how high a dose you’ll need. Your medical team will determine how many sessions you will require. This can range from as few as five to as many as 45. EBRT is generally used for cancer caught in the early stages, though it also can relieve pain in your bones if the cancer has spread to your bones.

  • Brachytherapy. Rather than using an external device, this technique involves placing small amounts of radioactive material inside your prostate. This material emits radiation over a very small area in an attempt to kill cancer cells. Low-dose therapy is done with what are called ‘seeds,’ tiny radioactive pellets that are permanently implanted. The seeds kill your prostate cancer over several months. After a year, the seeds no longer emit radiation and become harmless.

    High-dose brachytherapy, done less frequently than low-dose, involves inserting small tubes called catheters into your prostate. These catheters are filled with a radioactive substance and are inserted into your prostate for one to four sessions, each lasting only 5 to 15 minutes over two days. On its own, brachytherapy is used to treat early, slow-moving cancers. It may be combined with EBRT to treat cancers that are likely to spread beyond the prostate.

    Radiation has many potential side effects, including diarrhea and irritation of the rectum, impotence, and fatigue—but all are usually temporary. If you have radioactive implants, you’ll have to avoid contact with children and pregnant women for more than five minutes at a time to protect them from the effects. You’ll have to keep this up for as long as the implants remain radioactive.

Hormone Therapy

You’ve probably heard of testosterone. It’s a male sex hormone, or androgen, which, among many other things, helps prostate cells grow. Normally, that’s a good thing, but not when you have cancer, as those cells can grow to become tumors. Hormone therapy controls your body’s testosterone production (as well as the production of the other main androgen, called dihydrotestosterone, or DHT) in order to deprive your prostate of the fuel it needs for cell growth.

Hormone therapy, a.k.a. androgen deprivation therapy, is most often used if your cancer has spread to elsewhere in your body, meaning it has metastasized. That means Stage IV cancers. However, it also may be used alongside radiation for early cancers. There are several different methods, but the goal of each is the same: to starve your cancer of testosterone. Hormone therapy does not cure prostate cancer, but it can help to slow its progression for a time.

  • Orchiectomy (surgical castration). This is the removal of your testicles, which produce most of your testosterone and DHT. It’s an effective treatment, but that does not mean it’s a welcome one for most men. Just the thought of losing your testicles, after all, could be emotionally overwhelming. And, in fact, most men opt for an equally effective medical alternative, discussed just below. A 2020 study found that only 6% of men undergo this permanent surgical procedure. However, surgical castration is the least-expensive option in the U.S., which may lead some men to make this choice.

  • LHRH (luteinizing hormone-releasing hormone) agonists. These medications, given as injections or as pellets implanted under the skin, are as effective as surgical castration for reducing the production of testosterone. Treatments may be given anywhere from once a month to once a year.

  • LHRH (luteinizing hormone-releasing hormone) antagonists. This is an injectable drug used for advanced prostate cancer. It also lowers testosterone production in the testicles.

Hormone therapy can share some common, and not very pleasant, side effects. We know how much they can affect your quality of life, mood, energy levels—everything. If you experience any of the following, talk to your doctor and ask for help:

  • Lower libido or lack of sexual desire

  • Erectile dysfunction

  • Shrinkage of both your penis and testicles

  • Hot flashes

  • Growth of breasts (called gynecomastia) and tenderness in breasts

  • Anemia

  • Loss of muscle

  • Weight gain

  • Fatigue

  • Elevated cholesterol

  • Depression

Additional Types of Therapy for Prostate Cancer

A few other treatments exist for advanced prostate cancer or prostate cancer that has stopped responding well to other forms of hormone therapy. They are usually taken with one of the therapies discussed above.

Chemotherapy. For cases of very aggressive prostate cancer, or when hormone therapy isn't effective, your doctor may recommend chemotherapy. This class of anti-cancer drug, taken by mouth or injected, fights cancers that have spread beyond the prostate to other parts of your body. The schedule of your treatment will depend on the specific drugs you require, but chemotherapy is typically given in cycles that last two to three weeks. Once you finish a cycle, the next cycle begins. The length of your treatment hinges on how well it works and whether you can cope with the side effects. Chemotherapy drugs are used to help you live longer. They rarely cure prostate cancer, according to the ACS, and can cause unpleasant side effects, including hair loss, nausea, and fatigue.

Immunotherapy. This type of treatment harnesses the power of your immune system to fight cancer. While it has been used successfully in several types of cancer, it hasn’t proved as effective in prostate cancer—yet. Researchers are working to discover the best ways to incorporate immune therapy into prostate cancer care, particularly for men whose cancer no longer responds to hormone treatment. In 2019, more than 100 such studies were underway.

Targeted therapy. This therapy involves drugs that home-in on cancer cells in order to block their growth and stop the disease from getting worse. They do this without harming the healthy cells around them. Two different drugs, Rubraca (rucaparib) and Lynparza (olaparib), both target prostate cancers that involve BRCA gene mutations. Like immunotherapy drugs, these are used for advanced cancers that no longer respond to hormone therapies. Research is underway to determine whether these drugs can be used effectively in combination with other prostate cancer treatments.

What’s Life—and Sex—Like With Prostate Cancer?

If you’ve completed treatment for prostate cancer, you’ll continue to be monitored to make sure your cancer doesn’t return. Regular PSA tests (generally conducted every six months for up to five years, then reduced to annual visits) are necessary.

That said, you’re probably wondering about the elephant in the room—what about sex? It’s true that treatment for this disease can radically change your sex life, but the good news is it does not have to end it. Different treatment options can trigger different side effects, and your age and health history all come into play, too. However, sexual side effects often go away, though perhaps not as soon as you would like. The Prostate Cancer Foundation says that most men see improvements within a year of surgery, for example, while the lack of sex drive that can accompany hormone therapy often resolves right after treatment ends. So remember: The road back to a healthy, active sex life is very frequently achievable.

Erectile Dysfunction

If you have trouble in the bedroom because your erections just don’t cooperate like they used to, you have options. They include:

  • Stress management. Having cancer, even if you don’t require treatment, causes stress. That’s a given. And stress can make getting—and keeping—an erection difficult. Exercise, meditation, and counseling can help you relax and get your groove back.

  • Medications. You probably already at least know the name Viagra (sildenafil citrate). Well, it and similar drugs, like Cialis (tadalafil), may be all you need to ensure you have an erection when you want it. It works by increasing blood flow to your penis. But don’t take these without getting the green light from your doctor. Injections of ED medications also work well, though understandably, you may not feel comfortable sticking a needle into the shaft of your penis. Discuss these options with your physician to see what will work best for you.

  • Penile implant. If you are not able to get an erection with the help of medication, you still have an option: an implant. There are two types: semi-rigid and inflatable. The first are flexible, silicone-wrapped metal rods made of wires or coils. You bend it upwards when you want to have sex and bend down when you want it out of the way. Inflatable implants are a bit more complicated. A pouch filled with a saline solution is implanted in your abdomen. It’s connected by a tube to cylinders placed in your penis. When you want to have an erection, you use a pump that’s been implanted in your penis to draw fluid from the pouch to the cylinders.

Is a Healthy Lifestyle Important After Prostate Cancer?

Sex may be a primary concern but it’s not your only one. Once you’ve had any kind of cancer, taking good care of yourself is 100% part of your recovery plan—and overall lifestyle going forward.

Exercise

The Prostate Cancer Foundation recommends regular exercise. Take brisk walks or go jogging, swimming, biking, or other exercise that boosts your rate and makes you break a sweat. Some evidence suggests that exercise may help prevent the return of cancer.

Diet

Recent research, including a 2020 randomized study in JAMA, has found that nutritious diets do not slow the progression of prostate cancer. However, getting the right nutrition through fruits, vegetables, whole grains, and other good for you foods will help with your overall health.

Remarkable strides have been made in prostate cancer screening, treatment, and care over the past 25 years. Even so, a cancer diagnosis of any sort can feel daunting—as can some of the possible side effects from treatments like hormone therapy or certain surgeries. If you need help, don’t hesitate to talk to your doctor, and consider visiting the American Cancer Society’s virtual resource to learn more about prostate cancer counseling and support groups in your area or online.

Matt McMillen
Meet Our Writer
Matt McMillen

Matt McMillen has been a freelance health reporter since 2002. In that time he’s written about everything from acupuncture to the Zika virus. He covers breaking medical news and the latest medical studies, profiles celebrities, and crafts easy to digest overviews of medical conditions. His work has appeared, both online and in print, in The Washington Post, WebMD Magazine, Diabetes Forecast, AARP, and elsewhere.