When thinking about prostate cancer, you may think there’s only one type or kind of prostate cancer. The truth is, there are a few different prostate cancer types with some more common than others. The term type when it comes to prostate cancer can refer to what type of cells are involved or where the cells came from in or around the prostate. 

This is different from stages which refers to how much a person’s prostate cancer has grown or spread. Today’s article will go over the different types of prostate cancer and how they can impact treatment decision making. 

In the Inspire Prostate Cancer Community, members share their personal experiences of living with prostate cancer and how to find support. This content should not be used as a substitute for professional medical advice, diagnosis, or treatment. As always, consult with your doctor before trying any new treatments or medications.

The most common type of prostate cancer

Prostate cancer cells that start in the cells found in the prostate gland are considered adenocarcinoma and are the most common prostate cancer type. You may have heard of other types of cancers being considered adenocarcinomas and that’s because this term is often used to describe cancer that starts in any type of gland. Other areas where you have glands include digestive tract, breast tissue, and in other organs. 

Another name for adenocarcinoma of the prostate is glandular prostate cancer. Most men diagnosed with prostate cancer will have adenocarcinoma of the prostate. This prostate cancer type is further divided into two categories: acinar adenocarcinoma (conventional adenocarcinoma) and prostatic ductal adenocarcinoma (PDA). 

Acinar adenocarcinoma accounts for almost all of prostate cancer adenocarcinomas. This type of prostate cancer starts in the acini cells which line the prostate gland. Prostatic ductal adenocarcinoma (PDA) is much more rare and starts in the small tubes or ducts of the prostate gland. 

Symptoms of adenocarcinoma of the prostate include:

• frequent urination

• painful urination

• painful ejaculation

• finding blood in semen

How common is adenocarcinoma of the prostate?

Adenocarcinoma of the prostate is so common that 1 out of every 9 men will be diagnosed with it at some point in their life. Sixty percent of adenocarcinoma of the prostate cancer diagnoses occur in men over 66 years old making it more common in older men than in younger men. It also affects African American men more commonly. 

Adenocarcinoma as well as other prostate cancer types are differentiated by examining prostate cancer cells under a microscope after a biopsy has been made. 

Transitional cell carcinoma of the prostate

While adenocarcinoma of the prostate starts within the prostate gland and ducts, transitional cell carcinoma begins within the urethra. The urethra is a small tube that carries urine from the bladder and through the penis. Transitional cell carcinoma can start in the urethra or it often starts in the bladder and spreads to the prostate. 

Only 2%-4% of prostate cancer diagnoses are considered transitional cell carcinoma making it much less common than adenocarcinoma. Since transitional cell carcinoma involves the urinary tract system, the most common symptoms are urinary in nature and can include painful urinating or blood in the urine. A person’s prostate specific antigen (PSA) is often not elevated when someone has transitional cell carcinoma. 

Other prostate cancer types

There are other types of prostate cancer that are even less common than adenocarcinoma and transitional cell carcinoma. Squamous cell carcinoma of the prostate begins in the flat cells covering the prostate and generally grows and spreads more aggressively than the common adenocarcinoma. Small cell prostate cancer also tends to grow rapidly and can be more challenging to treat. 

Other rare prostate cancers include sarcoma, which originates from connective tissues, and lymphoma, a cancer of the lymphatic system that can sometimes affect the prostate. These rarer types often require specialized treatment approaches. 

Prostate cancer types versus Gleason score

Prostate cancer types focus on where a person’s prostate cancer began while the Gleason score focuses on the aggressiveness of their prostate cancer. The Gleason score ranges from 6 to 10, with higher scores indicating more aggressive prostate cancer. The score is determined by examining prostate tissue samples under a microscope, looking at how much the cancer cells differ from normal prostate cells. 

A Gleason score is a sum of two ‘grades’ which are the scores of the two most common prostate cancer cell arrangements found in the tissue. The grades range from 1 to 5. These grades are then added together to make the Gleason score. The higher the score, the more aggressive the prostate cancer is. For example, a Gleason score of 6 (3+3) suggests a less aggressive form of prostate cancer, while a score of 8 (4+4) or higher indicates a more aggressive form. When prostate cancer is considered more aggressive it has a higher chance of spreading. 

Doctors use the Gleason score to help guide treatment decisions and predict outcomes, providing essential information for managing prostate cancer effectively.

Treating prostate cancer types

Treatment for most prostate cancer types is fairly similar and depends more on a person’s prostate cancer stage, Gleason score or grade, as well as the patient’s overall health. Common treatment options include:

• active surveillance: for low-risk prostate cancer, doctors may recommend regular monitoring rather than immediate treatment. This involves frequent PSA tests, biopsies, and imaging to track the cancer’s progression.

• surgery: the primary surgical option is radical prostatectomy, which involves removing the prostate gland and some surrounding tissue.

• radiation therapy: this option uses high-energy rays to target and kill cancer cells and can include external beam radiation and brachytherapy, where radioactive seeds are implanted directly into the prostate.

• hormone therapy: also known as androgen deprivation therapy, this treatment reduces levels of male hormones like testosterone that fuel prostate cancer growth.

• Chemotherapy: used primarily for advanced prostate cancer, chemotherapy involves drugs that kill fast-growing cancer cells

• Immunotherapy: this newer approach boosts the body's immune system to target cancer cells more effectively. It’s typically used in specific cases or advanced stages.

Sources

• https://www.cancer.org/cancer/diagnosis-staging/tests/biopsy-and-cytology-tests/understanding-your-pathology-report/prostate-pathology/prostate-cancer-pathology.html

• https://www.cancercenter.com/cancer-types/prostate-cancer/types

• https://www.ncbi.nlm.nih.gov/books/NBK571329/

• https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/types

• https://radiopaedia.org/articles/urothelial-carcinoma-of-the-prostate?lang=us

• https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/types

• https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gleason-score

• https://my.clevelandclinic.org/health/diagnostics/22087-gleason-score

• https://www.cancer.org/cancer/types/prostate-cancer/treating/by-stage.html

Disclaimer

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.