What Are The Different Types Of Prostate Cancer, And How Are They Diagnosed?

Most prostate cancer types are confined to your prostate gland, grow slowly, and might not cause you any serious problems. Other types grow slowly and might only require minimal treatment or none at all. There are also aggressive types that spread quickly.

Types

Types of prostate cancer include:

Adenocarcinomas

These are the most common types of prostate cancer and are diagnosed in around 95% to 99% of all prostatic cancer cases¹.

Adenocarcinomas develop in your gland cells that produce prostate fluid. This fluid combines with your sperm, producing semen. If you develop cancer in these cells, you might have either acinar adenocarcinoma or ductal adenocarcinoma.

Transitional cell carcinoma (also called urothelial cancer)

This type might start either in your bladder or urethra and spread to your prostate. Or, in rare cases, it might begin in your prostate and spread to your bladder or urethra.

Soft-tissue prostate cancer (also called prostate sarcoma)

It develops in the soft tissue (nerves and muscle) of your prostate outside your prostate glands.

Small cell carcinoma

An aggressive type of prostate neuroendocrine cancer that develops in your neuroendocrine system's small round cells.

Neuroendocrine tumors (also called carcinoids)

These don't produce prostate-specific antigen (PSA). They appear in your gland and nerve cells that produce and release hormones into your bloodstream.

Squamous cell carcinoma

An extremely rare, quick-growing type of prostate cancer that starts in your flat cells covering your prostate glands.

Metastatic prostate cancer

If your prostate cancer starts spreading to other areas of your body, your doctor will likely tell you that your cancer has "metastasized" or that it's "metastatic."

Prostate cancer often spreads to the lymph nodes or bones. It commonly spreads to the lungs or liver as well. Rarely will it move to other organs, like the brain. Even if it spreads, it's still prostate cancer. 

So, for instance, if you have metastatic prostate cancer in a hip bone, you don't have bone cancer. You still have prostate cancer because it still has the original tumor's prostate cancer cells.

Metastatic prostate cancer is an advanced type of cancer with no cure. However, it can be treated and managed. Most men with this form of prostate cancer continue living normal lives for years.

Castration-resistant prostate cancer (CRPC)

This is where your prostate cancer continues to grow even when you have a very low testosterone level. 

Most prostate cancers in the early stages require normal testosterone levels to grow, but CRPCs don't. After you receive a diagnosis of this type of cancer, your doctor will check to see if it has spread and, if it has, how far. This is called the "staging" process. 

Stages

Your prostate cancer stage describes how much cancer you have in your body. It allows doctors to determine the severity of the cancer and the best method of treatment. 

When talking about survival rates, doctors will refer to the cancer stage.

The stage of your prostate cancer will be based on certain tests, including the blood PSA level, Gleason Score, and prostate biopsy.

Your doctor will most likely use your PSA test and Gleason Score results to determine what stage your prostate cancer is in and how advanced it is. It will help them decide on the right course of treatment.

Another tool in the staging process is the TMN staging system created by the American Joint Committee on Cancer (AJCC). Using this system, prostate cancer is staged based on: 

• The number of involved lymph nodes

• The extent and size of the tumor

• If the cancer has metastasized to other organs or areas

There are four stages of prostate cancer, with stage four being the most advanced.

Diagnosing prostate cancer

Undergoing prostate cancer screening will often depend on your personal preferences. This is because the PSA test results (often part of the screening process) could lead to a cancer misdiagnosis. Therefore, screening could lead to unneeded treatment and unnecessary worry.

The American Cancer Society (ACS) feels that men should be able to make their own informed decision with their doctor about whether they should receive a prostate cancer screening or not. 

They should first obtain information about the risks, uncertainties, and possible benefits of this screening before deciding. They shouldn't be screened until they receive this information.

The time for this discussion should take place when men have reached:

• The age of 50 and have an average risk of this cancer and have a ten year or more life expectancy.

• The age of 45 and have a high risk of developing this cancer, including men with a first-degree relative (brother or father) who received a prostate cancer diagnosis before turning 65 years old and African Americans.

• The age of 40 and have an even higher risk of this cancer and have more than one first-degree relative that developed this cancer at an early age.

If you and your healthcare provider feel a prostate cancer screen is beneficial for you, the doctor will discuss your health history and perform a physical exam. 

They'll also perform one or more of the following types of testing:

• Prostate-specific antigen (PSA) test: A blood test that detects your PSA level.

• Digital rectal exam (DRE): During this exam, the doctor will inspect your prostate by inserting a gloved finger up your rectum. They'll feel around to see if your prostate gland has any hard lumps on it that could be tumors.

• Prostate biopsy: The doctor might order this test to help them confirm the diagnosis of this cancer. For the exam, they'll remove a tiny piece of your prostate gland.

• Other testing: The doctor might also perform a CT scan, MRI scan, or bone scan.

They'll consult with you and share the results of any testing they performed and then discuss recommendations for any further necessary steps or treatment approaches.

The lowdown

When you compare prostate cancer with other types of cancer, it's somewhat unusual since many prostate tumors don't quickly spread to other areas of the body. 

Some cancers grow slowly and might not produce any problems or symptoms for years. Even if the cancer has spread to other areas of your body, it can usually be managed long-term.

However, if prostate cancer can't be managed well with existing treatments, it could cause symptoms like fatigue and pain and, in some cases, lead to death. 

An essential part of prostate cancer management is monitoring the cancer over time to see if it's slow or quick growing.

Your healthcare provider can decide which treatment option is best suited for your situation based on the growth pattern.

As any man ages, they can become at risk for prostate cancer, but the outlook is usually good if it's detected, diagnosed, and treated early. Therefore, as you age, you'll want to start having a conversation about your risk and screening for this type of cancer.  

If you're experiencing any symptoms that concern you and that cause you to suspect prostate cancer, don't hesitate to speak with your doctor.  

Even if you're not experiencing any symptoms, you should still talk with your doctor about adopting a healthy lifestyle to reduce your risk of this type of cancer.