Prostate cancer is not a single disease but a range of tumour types that originate in the prostate gland. While the most common form is acinar adenocarcinoma, other, less common subtypes exist. Each type can differ in terms of aggressiveness, symptoms, and treatment options. Understanding these differences allows patients, families, and healthcare providers to make informed decisions that best suit an individual’s circumstances.
Acinar adenocarcinoma
Acinar adenocarcinoma is by far the most common type of prostate cancer, accounting for the vast majority of cases. It arises from the gland cells (acini) of the prostate that produce prostatic fluid.
Characteristics: Typically grows slowly, especially in its early stages. Often found through PSA (Prostate-Specific Antigen) testing, digital rectal examinations (DRE), or incidentally when investigating other urinary symptoms.
Treatment Options:
Active surveillance (for low-risk cancers)
Focal therapy (for suitable localised cancers)
Surgery (radical prostatectomy)
Radiotherapy (external beam or brachytherapy)
Hormone therapy (for more advanced cases or in combination with other treatments)
Ductal adenocarcinoma
Ductal adenocarcinoma is less common and originates from the ducts of the prostate rather than the acini. As ductal adenocarcinoma can sometimes be detected at a more advanced stage, close monitoring and prompt treatment are key to managing this subtype effectively.
Characteristics: More aggressive than acinar adenocarcinoma.
Treatment Options:
Surgery (radical prostatectomy)
Radiation therapy (external beam, brachytherapy)
Combination therapy (due to its more aggressive nature)
Transitional Cell Carcinoma
Transitional cell carcinoma, also called urothelial carcinoma, usually starts in the cells lining the urethra (the tube that carries urine from the bladder) or the bladder itself. It can sometimes spread to the prostate. This type of prostate cancer is rare and often requires a personalised treatment plan.
Characteristics: Arises from the transitional cells lining the prostatic urethra. May behave similarly to bladder cancer and can occur alongside bladder or urethral tumours.
Treatment Options:
Surgery (may include transurethral resection or more extensive surgery if needed)
Radiotherapy and chemotherapy (for more advanced disease)
Intravesical therapy (treatments placed directly into the bladder, like BCG) – if the cancer also affects the bladder lining.
Squamous Cell Carcinoma
Squamous cell carcinoma of the prostate develops from the flat squamous cells in the prostate. It's a very rare and aggressive form of prostate cancer.
Characteristics: Tends to be aggressive. May not produce PSA in the same way as adenocarcinomas, making early detection with standard PSA tests more difficult.
Treatment Options:
Surgery or radiotherapy (for localised disease)
Systemic treatments (chemotherapy) – often needed due to its aggressive nature.
Small Cell Carcinoma (Neuroendocrine Tumour)
Small cell prostate cancer is a type of neuroendocrine tumour and is one of the most aggressive forms of prostate cancer.
Characteristics: Made up of small, round cells that multiply rapidly. Often presents at an advanced stage with significant spread (metastasis). PSA levels may not always be elevated, making early detection challenging.
Treatment Options:
Chemotherapy (often the first-line treatment)
Radiotherapy (to help control local symptoms and may be combined with chemotherapy)
Hormone therapy (may be less effective than for typical adenocarcinomas)
Sarcomas
Sarcomas, which develop from connective or soft tissues, can occasionally occur in the prostate. Examples include leiomyosarcoma and rhabdomyosarcoma. These are extremely rare and tend to occur in younger men compared to adenocarcinoma.
Characteristics: Rapid growth and a higher chance of spreading beyond the prostate. PSA testing may not be as helpful in detecting sarcomas.
Treatment Options:
Surgery (may involve radical resection of the prostate and any affected tissues)
Radiotherapy (to reduce the risk of local recurrence or address any remaining disease)
Chemotherapy (certain sarcoma subtypes respond to specific chemotherapy drugs)
When Prostate Cancer Reappears
Recurrent prostate cancer refers to the return of cancer after initial treatment. This can occur within the prostate bed (local recurrence) or in distant organs and bones (metastatic recurrence).
Detection: Rising PSA levels are usually the first sign of recurrence. New symptoms, such as bone pain or urinary symptoms may also appear.
Treatment Options:
Hormone therapy (often effective if the cancer is still sensitive to hormonal manipulation)
Salvage radiotherapy (if the recurrence is localised, for example, after surgery)
Chemotherapy or newer targeted therapies (for advanced or hormone-resistant disease)
Focal therapies (HIFU or NanoKnife) – may be an option for local recurrence in carefully selected cases.
Frequently Asked Questions
What are the five types of prostate cancer?
While there are many subtypes, the main types of prostate cancer you might hear about are:
Acinar adenocarcinoma (the most common by far)
Ductal adenocarcinoma (a more aggressive subtype of adenocarcinoma)
Transitional cell carcinoma (usually starts in the bladder or urethra and spreads to the prostate)
Squamous cell carcinoma (very rare and aggressive)
Small cell carcinoma (a very aggressive neuroendocrine tumour)
Sarcomas (extremely rare).
What is the most common type of prostate cancer?
Adenocarcinoma is the most prevalent type, making up over 95% of cases.
What type of anaemia is associated with prostate cancer?
Anaemia (a low red blood cell count) can sometimes occur in men with advanced prostate cancer. This can happen if the cancer has spread to the bone marrow (where blood cells are made) and is interfering with normal blood cell production. It can also be a side effect of some treatments, like chemotherapy or long-term hormone therapy. It's not typically a sign of early-stage prostate cancer.
What type of cancer causes an enlarged prostate?
While prostate cancer can sometimes cause the prostate to enlarge, the most common cause of an enlarged prostate is benign prostatic hyperplasia (BPH), a non-cancerous condition that's very common in older men. BPH causes the prostate to grow, which can put pressure on the urethra and cause urinary symptoms.
Epstein JI, Amin MB, Reuter VE, Humphrey PA. Contemporary Gleason Grading of Prostatic Carcinoma: An Update With Discussion on Practical Issues to Implement the 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2017;41(4):e1-e7. doi:10.1097/PAS.0000000000000820
If you’ve got any questions about your prostate cancer diagnosis or want to know more about HIFU or NanoKnife, don’t hesitate to get in touch with our friendly, knowledgeable team.
