Prostate Cancer Awareness Month was created to increase awareness and prevention and to educate men on all aspects of this topic, from screening to diagnosis and treatment options.
Prostate cancer occurs in the prostate, a walnut-shaped gland in the male reproductive system. The prostate is located underneath the bladder and surrounds the upper part of the urethra, which carries both urine and semen out of the body.
In many cases, prostate cancer is slow-growing and takes years to become sizeable enough to be detectable. It takes even longer for the cancer to spread beyond the prostate.
Prostate cancer is the most common cancer in the U.S., after skin cancers, affecting one in eight men. In fact, studies have revealed that most men over age 70 have some form of prostate cancer. However, most of these men do not die from the disease.
Diagnosis and Tests
Screening for prostate cancer might include the tests below; however, only a biopsy can confirm the diagnosis.
- Digital rectal exam (DRE) – This exam is done by a doctor, who inserts a gloved finger into the rectum to examine the prostate. Any abnormalities in the shape, size or texture of the gland may indicate the need for further tests.
- Prostate-specific antigen (PSA) test – This is a blood test to analyze PSA, a substance naturally produced by the prostate gland. A higher than normal level of PSA in the bloodstream may indicate a number of things, including prostate inflammation, infection, enlargement or cancer.
If the DRE or PSA tests detect any abnormality, further testing may be recommended. These tests include, but are not limited to:
- A transrectal ultrasound to create a picture of the prostate gland
- A tissue sample of the prostate. These are cells collected to perform a biopsy.
- MRI fusion, an advanced technology that “fuses” detailed MRI scans with live, real-time ultrasound for enhanced images of the prostate. This MRI allows doctors to narrow down a precise suspected area for a biopsy, much like a GPS.
When Should Men Begin Testing and How Often?
When and whether to test is a controversial topic. There is disagreement from medical organizations on the issue of screening, and whether or not it is beneficial. The American Cancer Society’s (ACS) recommendations include making an informed decision in conjunction with a healthcare provider about screening for prostate cancer. This discussion should occur according to the ASC guidelines below:
- At age 50 for those at average risk of prostate cancer, and who are expected to live at least 10 more years.
- At age 45 for men at high risk of developing prostate cancer. This category includes African-American men and those with a first-degree relative diagnosed with the disease when younger than age 65. First-degree relatives include a father, brother or son.
- Age 40 for those with more than one first-degree relative diagnosed with prostate cancer at an early age. This constitutes an even higher risk.
For those screened with no finding of prostate cancer, the timing between future screenings may be every two years, or yearly, depending on the results of the PSA blood test.
One complication, however, is that a small percentage of men have more rapidly growing aggressive forms of prostate cancer. As it is difficult to determine which prostate cancers will be slow-growing or aggressive, it may complicate the decision on testing and treatment.
In all cases, men should discuss these issues with their healthcare providers.
Prostate cancer in its early stages may be asymptomatic (without symptoms). Additionally, many of the symptoms listed below are likely to have a cause other than prostate cancer. However, any of these symptoms should be discussed with one’s healthcare provider.
- Urinary problems, including weak urinary stream and the need to go more often, especially at night
- Blood in the urine or semen
- Erectile dysfunction (ED); trouble getting an erection
- Hip, back or chest (rib) pain, or pain any areas in which cancer has spread to the bones
- Numbness or weakness in the legs or feet, in which case cancer could be pressing on the spinal cord. This may also result in loss of bladder or bowel control.
Treatment for prostate cancer depends on the individual case. According to the American Cancer Society, options for treatment may include:
- Watchful waiting
- Active surveillance
- Radiation therapy
- Hormone therapy
- Vaccine treatment
- Bone-directed treatment
According to the Prostate Cancer Foundation, approximately 90 percent of all prostate cancers are detected in early stages. Thus the cure rate is high. Nearly 100 percent of men diagnosed and treated at early stages will be disease-free after five years. However, prostate cancer is still a deadly disease.
At Partners In Urology, we are experts in the screening, diagnosis and treatment of prostate cancer and in other urologic conditions. With over 25 years of experience, we put our patients first, treating them with the utmost respect, care and compassion.