Prostate Cancer

Prostate cancer develops when cells in the prostate gland—a walnut-sized organ located just below the bladder—begin to grow abnormally and out of control. The prostate produces seminal fluid that nourishes and transports sperm. Prostate cancer is the most common non-skin cancer in American men, accounting for roughly 30% of all male cancer diagnoses. In 2025, an estimated 313,780 new cases will be diagnosed in the United States, and approximately 1 in 8 men will receive a prostate cancer diagnosis during their lifetime.

The good news is that the vast majority of prostate cancers are found at an early, treatable stage. When detected before it has spread beyond the prostate, the five-year relative survival rate approaches 100%. More than 3.5 million men living in the United States today have been diagnosed with prostate cancer at some point—and are still alive. However, early detection is critical: cancers found at a later stage are more difficult to treat, and late-stage diagnoses have been increasing in recent years.

Risk Factors

The three most well-established risk factors for prostate cancer are:

• Age. Prostate cancer is rare before age 40. About 6 in 10 cases are diagnosed in men 65 or older, and the average age at diagnosis is 67.
• Race and ethnicity. Black men have a 67% higher incidence rate than White men and are twice as likely to die from the disease. Screening conversations should begin earlier—at age 40 to 45—for Black men.
• Family history and genetics. Having a father or brother with prostate cancer more than doubles a man's risk. Inherited mutations in genes such as BRCA2 and Lynch syndrome genes can further increase risk.

Other factors under study include diet, obesity, chemical exposures (such as Agent Orange), and chronic prostate inflammation (prostatitis), though their roles are less clearly defined.

Symptoms

Early-stage prostate cancer usually produces no symptoms at all—which is why screening is so important. When symptoms do occur, they can include:

• Difficulty starting or stopping urination
• Weak or interrupted urine flow
• Frequent urination, especially at night
• Blood in the urine or semen
• Pain or burning during urination
• Persistent pain in the back, hips, or pelvis (may indicate advanced disease)

Many of these symptoms overlap with non-cancerous conditions such as benign prostatic hyperplasia (BPH). If you are experiencing any of these symptoms, it is important to be evaluated by a urologist to determine the cause.

PSA Screening & Early Detection

Prostate-specific antigen (PSA) is a protein produced by the prostate gland that can be measured with a simple blood test. Elevated PSA levels can be an early indicator of prostate cancer, though other conditions—including BPH, prostatitis, and recent urinary tract procedures—can also raise PSA. According to the American Urological Association (AUA), PSA should be used as the first-line screening test for prostate cancer.

When to start screening: The AUA recommends that men ages 45 to 50 begin a conversation with their doctor about PSA screening. Men at higher risk—including Black men, those with a strong family history, and those with known genetic mutations—should discuss screening beginning at age 40 to 45. For men ages 50 to 69, screening is generally recommended every two to four years rather than annually, which reduces the risk of overdiagnosis while preserving the benefits of early detection.

If your PSA level is elevated, the next step is usually to repeat the test to confirm the result, and then consider additional evaluation such as a prostate MRI and/or biopsy. To learn more about what an elevated PSA means, visit our Elevated PSA page.

Prostate Biopsy & Diagnosis

A prostate biopsy is the only way to definitively diagnose prostate cancer. During the procedure, small tissue samples are taken from the prostate and examined under a microscope by a pathologist. Modern biopsy approaches are often guided by multiparametric MRI (mpMRI), which can identify suspicious areas within the prostate and allow for targeted sampling. This MRI-guided approach improves the detection of clinically significant cancers while reducing unnecessary biopsies for low-risk disease.

Gleason Grading & Grade Groups

When a biopsy confirms prostate cancer, the tissue is assigned a Gleason score—a number that reflects how aggressive the cancer cells appear under a microscope. The Gleason score combines the two most common cell patterns found (each graded 1 to 5), producing a total score between 6 and 10. Today, Gleason scores are also reported as Grade Groups (1 through 5), which are easier to understand:

• Grade Group 1 (Gleason 6): Low-grade cancer that tends to grow slowly. Often a candidate for active surveillance.
• Grade Group 2 (Gleason 3+4=7): Favorable intermediate-risk. Most cells are well-formed, with a smaller component of more abnormal cells.
• Grade Group 3 (Gleason 4+3=7): Unfavorable intermediate-risk. More abnormal cells are present, which may indicate a more aggressive cancer.
• Grade Group 4 (Gleason 8): High-grade cancer with a higher likelihood of growth and spread.
• Grade Group 5 (Gleason 9–10): The most aggressive form. Typically requires prompt, definitive treatment.

Your Grade Group, combined with your PSA level, clinical stage, and biopsy tumor volume, forms the basis for risk stratification and treatment recommendations. Dr. Radtke will explain exactly what your results mean and how they influence your options.

Staging

Prostate cancer staging describes how far the cancer has spread. The most widely used system is the TNM staging system from the American Joint Committee on Cancer (AJCC):

• Stage I: The cancer is small, confined to the prostate, and low-grade (Grade Group 1). It is unlikely to grow or spread quickly.
• Stage II: The cancer is still confined to the prostate but may be larger or higher-grade. It has not spread to lymph nodes or other organs.
• Stage III: The cancer has grown beyond the outer layer of the prostate and may have reached nearby structures such as the seminal vesicles, or the PSA level is very high.
• Stage IV: The cancer has spread to nearby lymph nodes, bones, or other distant organs.

For low- and intermediate-risk cancers, advanced imaging (bone scans, CT) is usually not needed. For high-risk disease, Dr. Radtke may order additional imaging—including bone scans, pelvic MRI, or molecular imaging—to determine whether the cancer has spread.

Treatment Options

Treatment for prostate cancer is highly individualized and depends on the cancer's grade, stage, your overall health, your age, and your personal preferences. The main options include:

• Active surveillance: For men with low-risk prostate cancer (Grade Group 1), active surveillance is the recommended approach. Rather than treating immediately, your cancer is closely monitored with regular PSA tests, repeat biopsies, and imaging. Studies show that active surveillance over 15 years carries a disease-specific mortality of only 0.1% to 1.5%. About 60% of men with low-risk cancer choose this approach. If the cancer shows signs of progression, definitive treatment can be pursued at that time.
• Robotic radical prostatectomy: Surgical removal of the entire prostate gland using a robotic-assisted, minimally invasive approach. This is the most common surgical treatment for prostate cancer in the United States. Compared to traditional open surgery, robotic prostatectomy offers less blood loss, smaller incisions, shorter hospital stays (typically one to two days), and faster recovery. Cancer-specific survival approaches 95% at 15 years for appropriately selected patients. Dr. Radtke is fellowship-trained in robotic surgery and performs this procedure regularly.
• Radiation therapy: High-energy beams are used to destroy cancer cells. This can be delivered externally (external beam radiation therapy) or internally using radioactive seeds placed directly in the prostate (brachytherapy). Radiation may be combined with hormone therapy for intermediate- and high-risk disease. Long-term survival outcomes are comparable to surgery for most patients.
• Hormone therapy (androgen deprivation therapy): Reduces testosterone levels to slow cancer growth. Often used in combination with radiation for higher-risk disease, or as a treatment for cancer that has spread beyond the prostate.

The landmark ProtecT trial, which followed over 1,600 men for 15 years, found that prostate cancer mortality remained very low regardless of whether men received active monitoring, surgery, or radiation therapy. However, radical treatment (surgery or radiation) resulted in a significantly lower risk of disease progression compared to monitoring alone. This underscores the importance of a thorough discussion with your urologist about which approach best fits your individual situation.

Dr. Radtke will walk you through every option, explain the benefits and risks of each approach, and help you develop a treatment plan that aligns with your cancer characteristics, your health, and your goals.