Did you know there are different types of prostate cancer (PCa)? That’s because cancer starts when the genes in a healthy cell mutate, causing it to behave abnormally. Since the structure of the prostate gland is composed of distinct types of cells, the kind of PCa is determined by the kind of cell from which it originates.

Basically, the prostate is composed of glandular cells (the cells that produce seminal fluid, and the small ducts or tubes that carry the fluid to the urethra), muscles to help push fluid through ducts into the urethra, and connective tissues that shape the architecture of the prostate zones.

Here are the main types of PCa that doctors encounter:

1. Acinar adenocarcinoma – Begins in gland cells, and is the most commonly diagnosed type of PCa (90-95% of all cases).
2. Ductal adenocarcinoma – Much less common than acinar adenocarcinoma. Starts in the cells that line the ducts, and behaves more aggressively than acinar adenocarcinoma but may not cause a rise in PSA. It can spread to the body, but will often spread to the penis and testicles first.
3. Transitional cell carcinoma (also called urothelial carcinoma) – Occurs in the cells that line the urethra, most often originating in the bladder itself, but it can begin in the prostate and spread to the bladder. It is estimated that 2-4% of PCa is this type, but 90% of cases are associated with bladder cancer.
4. Small cell PCa – A rare kind of PCa that begins in certain prostate cells that have a hormonal function and don’t produce PSA. Since this type does not cause a rise in PSA, it tends to be diagnosed when it has already spread in the body. It represents less than 2% of PCa cases.
5. Squamous cell carcinoma – Arises in flat cells that cover the prostate and is considered quite aggressive, with no definitive treatment though surgery, radiation, and chemotherapy have been applied. Survival averages 14 months after diagnosis. Fortunately, this type of PCa is very rare (less than 1% of cases).

There are even rarer types of PCa (sarcoma, lymphoma) that are not discussed here.

Treatment plan depends on type and stage

Finding out you have PCa is never welcome news, but acinar adenocarcinoma is the most likely diagnosis. This means that a suspicious PSA blood test will be the earliest warning sign, and it is further definable by multiparametric MRI obtained on a powerful 3T magnet (3T mpMRI). An experienced radiologist can interpret the findings, assign a PI-RADS score, and conduct an in-bore MRI-guided targeted biopsy if needed.

The tissue from the biopsy is essential for diagnosis since the cells themselves can be analyzed. Also, genomic testing can be done if it appears warranted based on factors such as PSA level, imaging results, family history of cancer (including prostate, breast, ovarian and pancreatic cancers).

Treatment decisions are made on the basis of matching the treatment to the cancer. This includes not just the type of cancer, but the stage (size and location). Since acinar adenocarcinoma is usually diagnosed when it is still localized, and is relatively nonaggressive, treatment success rates are high. It may be amenable to a focal treatment using Focal Laser Ablation, MRI-guided Focused Ultrasound (MRgFUS) or TULSA-PRO. Depending on a patient’s clinical factors, Active Surveillance may also be an option.

We can’t emphasize enough the importance of early detection. For any type of PCa, the sooner it is diagnosed, the wider range of treatment options are available. We also highly recommend obtaining a 3T mpMRI following an abnormal PSA test, in order to determine if a biopsy is necessary. While no one ever wants to be diagnosed with cancer, “Your treatment was a success” will be the sweetest words you can hope for.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.