Understanding and Improving Your Prostate Cancer Prognosis

By: Pranav D. Parikh M.D.

Many men know that prostate cancer risk increases with age — and that when detected early, it is highly treatable.

But if you are among the more than 850 U.S. men expected to be diagnosed with prostate cancer every day in 2025, these facts can easily be crowded out by one big unknown: What is my prostate cancer prognosis?

In general, the outlook is encouraging: most men diagnosed with prostate cancer survive and go on to enjoy long, full lives after treatment.

Which means your complete prostate cancer prognosis is partially in your hands, through healthy lifestyle practices and self-care, including knowing when to get your first or follow-up prostate specific-antigen (PSA) blood test.

These factors matter. Consider this: An estimated one-third of early prostate cancer deaths in men with high genetic risks could have been prevented with healthy lifestyle habits, according to a 2024 study in JAMA.

Keep reading to learn what your prostate gland needs to be healthy, and why.

Before a Prostate Cancer Prognosis, It’s a Busy Little Gland

The average prostate weighs less than an ounce (about half a Hershey bar) but it has a heavy influence on your sexual and urinary health. This is due to its job and location: It produces the fluid that nourishes sperm, and it encircles the urethra, through which urine travels. So any changes in the prostate, including cancer, can interfere with urination and reproductive health.

Prostate cancer develops when the gland’s tissue cells multiply too fast and do not die off when they should, due to DNA abnormalities. Eventually, these excess cells form a tumor that, if undetected, can slowly spread to other body tissue.

Some changes in your urinary or sexual health can signal a problem with the prostate. Symptoms to watch for include:

• An increased need to urinate, particularly at night
• Trouble holding back urine flow
• Blood in your urine or semen
• Pain in the lower back, hips, and bones
• Difficulty making bowel movements

Your prostate cancer prognosis can depend on how quickly you act on these symptoms.

Measures that Can Determine Your Prostate Cancer Prognosis

Doctors often estimate prostate cancer prognosis using two key measures: the Gleason score, which describes how aggressive the cancer cells look under a microscope, and the tumor stage, which shows how far the cancer has advanced.

The Gleason score determines the aggressiveness of the cancer cells and ranks them on a scale of 2 to 10, with 10 being most aggressive. The tumor stage describes how the cancer was detected, such as through an image test or biopsy, and how far it has advanced.

The stages of prostate cancer and five-year survival rates, according to the American Cancer Society, are:

Stage I: The cancer is contained within the prostate. The prognosis for survival is more than 99%.

Stage II: The tumor is larger, but still in the prostate. The prognosis for survival does not change.

Stage III: The cancer has spread to tissue directly surrounding the prostate, including the seminal vesicles, bladder, rectum, sphincter, and pelvis. The five-year survival rate becomes 95%.

Stage IV: The cancer has spread beyond the prostate to the lymph nodes, bones, and other organs, making it more complex to treat. The prostate cancer prognosis for five-year survival falls to 37%.

Fortunately, 92% of prostate cancer cases are detected in Stages I through III, contributing to an average 10-year survival rate of 98%, and a 15-year prognosis for surviving of 95%.

Risks and Issues that Can Worsen a Prostate Cancer Prognosis

These numbers are highly encouraging, but some men do die from prostate cancer. Among the risks and issues that can alter a prostate cancer prognosis:

1. Prostate cancer runs in the family. Men whose fathers or brothers are diagnosed with prostate cancer carry more than double the threat of developing the disease, with brothers passing on a greater risk. The chances climb if they are young at detection.
2. Race and ethnicity. African American men are about 76% more likely to develop prostate cancer than white men, and more than twice as likely to die from it. Men under 50 in this group should be especially aware of symptoms.
3. Inherited gene conditions. Some parents pass on gene mutations, such as Lynch syndrome, that could expose their male children to cell abnormalities that can develop into prostate cancer. You can ask your doctor about genetic testing for cancer.
4. The year you were born. Men who are older than 80 and – counterintuitively – younger than 50 have the highest prostate cancer mortality rates, WebMD reports. Death rates among younger men are due to them being less likely to get tested, so the cancer spreads.
5. Your “normal” PSA reading. The PSA prostate test quantifies the antigen, a cancer-marking protein, in your blood. A “normal” reading, generally, is 4 nanograms of antigen per milliliter of blood. However, what counts as “normal” can vary from man to man, so yours could be higher or lower. An increase in this annual reading can be a warning sign of cancer.

What You Can Do to Optimize Your Prostate Cancer Prognosis

Each man’s prostate cancer is specific to him, and no one knows your body as well as you. You can help your prostate cancer prognosis through the following:

• Walk away from cigarette smoke. Those who smoke have a higher risk of prostate cancer spreading.
• Exercise four or more days a week. While exercise might not prevent prostate cancer, it does improve your overall health and manages weight. Ask your doctor for guidance.
• Eat more low-fat, plant-based foods. Fill your plate with a variety of vitamin-rich fresh fruits, vegetables, whole grains, and lean meats. Cut back on processed foods, animal fats, and red meat.
• Don’t delay a PSA test if it’s due. Men over 50 — or younger men at higher risk — should ask their doctors about screening. Research shows that PSA testing prevents one prostate cancer death for every 11 to 14 men screened.

While your prostate cancer prognosis depends on many factors, remember that you don’t have to face it alone — your care team is here to guide and support you at every step.

At MidLantic Urology, our physicians and advance practice providers are well-versed in treating advanced prostate cancer. Find a convenient location to schedule an appointment here.