Prostate Cancer: Risks, Screenings, & Treatment Info

Amar Singh, M.D., Urological Oncologist of Academic Urologists at Erlanger provides expert advice on the side of effects of prostate cancer surgeryAbout one in six men are diagnosed with prostate cancer. Yet if caught early, the cancer is treatable, and most importantly, survivable.  

By Rashad J. Gober

The prostate gland in males is one of the key physiological differences between men and women. Located right below the bladder near the rectum, the walnut-sized gland is responsible for producing seminal fluid to nurture and transport sperm. But in addition to serving an essential role in the male reproductive system, it can also be the location of one of the most widespread forms of cancers affecting men: prostate cancer.

Aside from certain forms of skin cancer, prostate cancer is the most common type of cancer in men—about one in six men are diagnosed with it on average. But thankfully, most prostate cancers grow slowly with about 91% of all cases confined either to the prostate or nearby.

Despite its prevalence, the amount of awareness and research dedicated to prostate cancer is disproportionate to that of other prominent cancers. For example, there has been only one major drug developed for prostate cancer in the past decade, while there have been several therapies discovered for breast cancer and kidney cancer. It seems that patient advocacy has been slow going as well—most men would rather not talk about such a disease.

How do I know if I am at risk of getting prostate cancer? 

Age is the strong risk factor in developing prostate cancer as it primarily occurs in older men. The average age at the time of diagnosis is 67—two out of three prostate cancers are found in men over the age of 65. It’s very rare before age 40.

Family history also plays a role in the risk of developing prostate cancer. For example, men who have a father or brother with the disease are twice as likely to acquire it themselves. The family history risk increases if the relatives were young at the time of diagnosis. Men who have multiple relatives with prostate cancer are almost guaranteed to get it themselves.

Ethnicity is also a factor when it comes to risk of prostate cancer. Prostate cancer is more common in African-American men than other ethnicities. African-American men are also more likely to be diagnosed late and are twice as likely to die of prostate cancer.

Aside from these uncontrollable variables, research suggests certain lifestyle habits may increase your risk of getting prostate cancer. Some studies show that men who eat a “Western” or “Cowboy” diet, which includes large amount of red meat and high-fat dairy products, may have an increased risk. Conversely, prostate cancer seems to be less common among vegetarians.

Lee Jackson, M.D., Urological Oncologist of Memorial Hospital provides expert advice on the best candidates for prostate cancer surgeryHow can I know if I have it?

Unfortunately, there are no observable symptoms of prostate cancer in its early stages, making it difficult to diagnose early. Symptoms usually arise as the cancer advances, which makes it all the more important to see a doctor if any worrisome signs occur.

Common indications of prostate cancer usually appear when the tumor causes some degree of urinary blockage. These symptoms include difficulty in starting and/or stopping the urinary stream. Other less common symptoms of prostate cancer include blood in the urine or semen or pain while ejaculating. Men experiencing any of these symptoms should see a physician as soon as possible.

Should I get screened? 

The short answer is yes—if you are of a certain age or risk level. In addition to seeking medical advice when symptoms arise, men 50 and older, and younger, at-risk men should consider being screened for prostate cancer. The initial steps of prostate cancer screening include the prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE).

PSA test: High levels of PSA, a substance produced by cells in the prostate gland, can indicate prostate infection, inflammation, enlargement, or cancer. PSA can be measured by analyzing a blood sample taken from your arm. However, since factors other than prostate cancer may affect levels, an increased volume is not a guaranteed diagnosis.

DRE: In this exam, a physician inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas that may be cancerous. Though the exam can be uncomfortable, it is relatively quick and painless.

If these two initial screening tests or certain symptoms suggest that you may have prostate cancer, your physician will conduct a biopsy to make a certain diagnosis. In this procedure, the doctor inserts a very thin, hollow needle into the wall of the prostate, extracting a small sample of tissue a few times. This sounds painful, but it really only takes around 10 minutes, is done in office, and most doctors will inject a local anesthetic alongside the prostate. It’s a small discomfort to pay for testing that may save your life.

Frank Kimsey, M.D., Radiation Oncologist of Erlanger Health System provides expert advice on the CyberKnife radio-surgery systemHow serious is it? 

That will depend on the results of your prostate biopsy, which are reported using the Gleason grade and the Gleason score. These assessment tools tell the patient how aggressive the cancer is by grading tumors on a scale of 1-5, with the two main grades added together. Scores between 6 and 7 are most common, but higher scores suggest that the cancer has spread beyond the prostate.

Drawing from this score, prostate cancer is staged according to how far it has spread within the prostate, whether the cancer has spread to lymph nodes near the prostate, and whether the cancer has spread to other organs.

Though difficult to catch early, the outlook for those with prostate cancer is generally positive. According to the American Cancer Society, 100% of men live at least 5 years after initial diagnosis, 98% live at least 10 years, and 93% live at least 15 years, though many live longer.

Is prostate cancer painful? 

Pain is not usually a major effect of localized prostate cancer, though it does often occur in more advanced stages, particularly when metastasized to the bone. More common side effects of prostate cancer and its treatments include incontinence and erectile dysfunction. Incontinence is likely to improve over time, but is also treatable with medications and catheters. Erectile dysfunction due to prostate cancer or its treatment is also treatable with medications or surgery.

How is prostate cancer usually treated?

Choosing from among different treatment options for prostate cancer can be complicated because every man is different and every case of prostate cancer is different. There is a wide range of different treatment options, and each has its pros and cons. Also, physicians must consider which options will prolong life for certain populations (e.g. the elderly or those with serious health problems). In making a treatment decision, men should consider the probability of eradicating the cancer completely along with possible side effects. Three different approaches are currently the norm for treating prostate cancer: active surveillance (or watching waiting), curative treatments, and palliative treatments.

Lee Jackson, M.D. Urological Oncologist of Memorial Hospital provides expert advice on the importance of screening for prostate cancerActive surveillance: Active surveillance, or watchful waiting, is frequently an option for older men (those over 70) who want to avoid or postpone the potential side effects of treatment. For example, it may be recommended to someone with a low Gleason score whose cancer is confined to a small area within the prostate. Active surveillance involves active monitoring, meaning repeat PSA testing, biopsies, and scans for any signs of spreading.

Curative treatments: Curative treatments aim to remove all of the cancer. This approach is common among men with more aggressive cancer as well as those with small, slow-growing cancers who are healthier and younger (particularly those under 60). The most common curative treatments are surgery and radiation therapy.

Surgery: Surgery, which involves the removal of part or all of the prostate, is the most common option for men under 70 whose cancer is confined to the prostate. Studies show that up to 75% of men who undergo surgery never experience a recurrence. In recent years, technological advancements in surgical techniques for prostate cancer—such as minimally-invasive surgery (laparoscopic) and robotically-assisted surgery—have led to smaller incisions, and shorter recovery times.

Radiation Therapy: Radiation therapy kills cancer either through external radiation therapy, in which a machine outside the body sends radiation to the cancer, or internal radiation therapy (brachytherapy), in which tiny radioactive seeds are implanted in the cancer. External radiation can also be used to control disease that recurs after a surgical treatment. Today, new computer programs are allowing doctors to better plan the radiation doses and approaches for both external radiation therapy and brachytherapy.

Palliative treatments: Palliative treatments for prostate cancer aim to treat symptoms and slow cancer growth rather than cure it altogether. They include hormone therapy and chemotherapy, among others. Typically, hormone therapy works to starve cancer cells by using drugs that inhibit testosterone production. For advanced cancers that don’t respond to hormone therapy, chemotherapy, or the use of powerful toxic drugs to kill rapidly growing cells, may be an option.

Aside from active surveillance, many of these treatment options may be more harmful than the cancer itself, specifically for elderly men. Any treatment decisions should be talked through extensively with doctors and loved ones.

Get Support Today!

Despite the lack of media coverage on prostate cancer, there are many resources out there to help and encourage men dealing with prostate cancer. Here are a few good ones:—The largest volunteer men’s cancer support group on the web.—A collection of cancer communities offering free support.

Man to Man—An American Cancer Society program for prostate cancer patients and their loved ones. Contact (423) 778-5119 for more information.