What you need to know about prostate cancer
- Most prostate cancers cause no symptoms at early stages, making screening and conversations with a health care provider critical for early detection
- Prostate-specific antigen tests are the primary screening tool for and can help identify people who may need further testing
- When detected before it spreads, prostate cancer outcomes are excellent, with five-year survival rates exceeding 99 per cent for localized disease
The most common symptom of prostate cancer is no symptom at all.
Most people diagnosed with the disease feel completely healthy and have no warning signs that anything is wrong.
"If you wait until symptoms appear, it's often too late to cure the problem," says Dr. Nathan Perlis, a urologic oncologist at UHN's Princess Margaret Cancer Centre.
That reality underscores the importance of screening and conversations with a primary-care provider. While prostate cancer is the most common non-skin cancer among Canadian men, according to the Canadian Cancer Society, outcomes are typically positive when the disease is caught before it spreads.
What is prostate cancer?
The prostate is a small gland below the bladder that produces part of the fluid in semen.
Prostate cancer develops when cells in the prostate begin growing out of control, forming a tumour. As the cancer advances, it can spread beyond the prostate to other parts of the body.
What causes prostate cancer?
Researchers do not know exactly what causes most prostate cancers.
The disease becomes more common with age and is relatively uncommon before 50. According to a 2025 report by the Canadian Cancer Society, 98 per cent of prostate cancer cases are expected to occur in people over 50.
"We think it's just a side effect of having a long life," says Dr. Perlis. "Some of the cells in the organ can acquire mutations and then eventually become cancerous."
Risk factors include:
- Older age
- Family history of prostate cancer
- Certain inherited genetic mutations
- African ancestry
Smoking and diet have not been definitively linked to causing prostate cancer.
"There are a lot of studies that are exploring diet and prostate cancer, but no major large randomized studies have found any positive outcomes so far," says Dr. Perlis.
How can I help prevent prostate cancer?
There is currently no proven way to prevent prostate cancer. According to Dr. Perlis, living a healthy lifestyle is the best approach.
"I always tell my patients whatever is good for their whole body is good for their prostate too," says Dr. Perlis. "A well-balanced diet, exercise and a positive attitude."
Emerging evidence suggests that plant-based diets may help prevent prostate cancer, but more research is needed.
What are the signs and symptoms of prostate cancer?
Early prostate cancer usually causes no symptoms.
Symptoms are more likely to appear when the disease becomes advanced and may include:
- Blood in the urine
- Painful urination
- Unexplained weight loss
- Bone pain
- Fatigue
How is prostate cancer screened? What is a PSA test?
The primary screening tool is a prostate-specific antigen (PSA) blood test. It measures prostate-specific antigens, a protein produced by the prostate.
PSA levels naturally rise with age, but prostate cancer cells typically release more PSA than normal cells. Elevated PSA levels can also be caused by a large prostate, inflammation, infection or recent sexual activity.
"It's a very sensitive test," says Dr. Perlis. "If you have a high PSA, it doesn't mean you have prostate cancer, but it means you're going to need some more investigations."
Canadian Urological Association guidelines recommend discussing PSA screening with a health care provider for men aged 50 to 70 who have a life expectancy of at least 10 years. A physician or a nurse practitioner can refer you for a PSA test.
Men at higher risk may choose to start those conversations earlier.
Screening should involve a conversation about both the benefits and limitations of testing, he adds.
What happens if PSA results are high?
That depends on how elevated the result is.
Some patients may proceed directly to additional testing, such as imaging and a biopsy.
More commonly, physicians first order tests, such as a prostate MRI or high-resolution ultrasound, to determine whether a biopsy is needed and to help target abnormal areas more accurately.
Are prostate biopsies safe?
For some people, the idea of a prostate biopsy can be intimidating, but modern procedures are generally quick and safe.
The procedure typically takes about 20 minutes and involves collecting tissue samples from the prostate.
Most patients return to work the next day. Serious complications, such as infection or significant bleeding, occur in about two per cent of cases.
How is prostate cancer treated?
Treatment depends on whether the cancer is localized or metastatic, meaning it has spread to other parts of the body.
For low-risk cancers, patients may follow active surveillance, which involves regular PSA tests, imaging and sometimes repeat biopsies, with their physician.
For intermediate- and high-risk disease, treatment can include:
- Surgery
- Radiation therapy
- Hormone therapy
- Combinations of the above approaches
Researchers are also studying focal therapies that target only the cancerous portion of the prostate, potentially reducing side effects while preserving healthy tissue.
What are the survival rates for prostate cancer?
The outlook for patients diagnosed before the cancer spreads is excellent.
"For localized prostate cancer, five-year survival is greater than 99 per cent," says Dr. Perlis.
According to the Canadian Cancer Society,
survival rates decline by nearly half once the disease becomes metastatic.
"The whole idea is to try to diagnose and treat to prevent metastasis."
How is UHN advancing research into prostate cancer care?
Researchers and clinicians at UHN's Princess Margaret Cancer Centre are leading more than 30 studies exploring new ways to diagnose and treat prostate cancer.
Among the advances are Prostate-Specific Membrane Antigen (PSMA) PET scans, which have improved doctors' ability to detect cancer that has spread or returned after treatment.
UHN researchers are also investigating targeted radioligand therapies, image-guided focal treatments and genetically tailored treatment approaches through clinical trials.
