What Percentage of Prostate Biopsies Are Cancer?

Prostate cancer often causes no symptoms in the early stages. As the cancer progresses, symptoms may include: 

• Problems with urination
  • Slow or weak urinary stream 
  • Urinary urgency, especially at night
• Blood in urine or semen
• Difficulty getting an erection (erectile dysfunction, or ED)
• Weakness or numbness in the legs or feet
• Loss of bladder or bowel control if the cancer presses on the spinal cord
• Pain in the hips, back (spine), chest (ribs), or other areas from cancer that spreads to bones

The cause of prostate cancer is unknown but it may be due to inherited or acquired genetic changes. 

Risk factors for developing prostate cancer include: 

• Age: increased risk in men after age 50
• Family history
• Genetic changes
• Geography: most common in North America, the Caribbean islands, northwestern Europe, and Australia
• Race/ethnicity: more common in African-American men and Caribbean men of African ancestry than in men of other races
• Other factors that might increase the risk of developing prostate cancer — though these links are less clear and have not been conclusively proven — include: 
  • Obesity
  • Smoking
  • High consumption of dairy products 
  • Prostatitis (inflammation of the prostate gland) 
  • Sexually transmitted diseases, such as chlamydia or gonorrhea 
  • Vasectomy
  • Certain chemical exposures, such as Agent Orange

Prostate cancer is diagnosed with a patient history and physical examination, which includes a digital rectal examination in which a doctor inserts a gloved finger into the rectum to examine the prostate.

Other tests to diagnose prostate cancer include: 

• Blood test to check prostate-specific antigen (PSA) levels
• Prostate health index (PHI) blood test 
• Prostate cancer urine test
• Imaging test of the prostate gland
  • Magnetic resonance imaging (MRI) (such as multiparametric MRI) 
  • Transrectal ultrasound (TRUS)
• Biopsy of the prostate 

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if the cancer has spread (metastasized) to other parts of the body, and the age and overall health of the patient. Treatment may include one or more of the following:

• Watchful waiting (active surveillance)
• Surgery: removal of the entire prostate and some nearby tissue
• Radiation therapy
  • Brachytherapy (internal radiation)
  • External beam radiation
• Cryotherapy (also called cryosurgery or cryoablation), which uses very cold temperatures to freeze and kill prostate cancer cells and most of the prostate
• Hormone therapy
  • Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made in the testicles
  • Orchiectomy (surgical castration)
  • Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles (also called medical castration)
  • LHRH antagonists
• Chemotherapy 
• Immunotherapy 
  • Cancer vaccine (doesn’t stop prostate cancer from growing, but may help men live several months longer)
  • Immune checkpoint inhibitors
  • PD-1 inhibitor
• Targeted therapy 
  • PARP (poly(ADP)-ribose polymerase) inhibitors
• Treatments for prostate cancer spread to bones
  • Surgery
  • Pain medicines