The Importance of Regular Screenings
Other than skin cancer, prostate cancer is the most common form of cancer in American men. It’s so prevalent, in fact, that 1 in 9 men will be diagnosed with the disease in their lifetime. “The numbers are strikingly similar to women with breast cancer,” says Dr. Lee Jackson, a surgeon with CHI Memorial Robotics for Prostate Cancer. With just under 165,000 new cases expected to be diagnosed in 2018, and just under 30,000 associated deaths presumed, its significance cannot be overstated. Fortunately, if caught early, it’s treatable.
The prostate is a gland about the size of a walnut located below the bladder, just in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder. Its primary function is to carry seminal fluid from the testicles as part of the male reproductive system.
When a cancerous tumor develops on the prostate, it will typically grow slowly. Most men won’t notice any signs or symptoms that suggest there is a problem, since the tumor doesn’t cause pain. In rarer cases, the cancer cells may be more aggressive and spread to other areas, which can lead to side effects like painful or burning urination, a need to urinate frequently, blood in the urine, a weak or interrupted flow of urine, and pain or stiffness in the lower back, hips, pelvis, or thighs. However, many of these side effects can also be associated with benign prostatic hyperplasia, the natural enlargement of the prostate that begins around age 40 for many men. Dr. Joseph Veys, a urologist with North Georgia Urology Center, explains, “Prostate cancer often has no symptoms unless it’s really advanced. You can have an aggressive disease and not know until it spreads and causes other problems.”
Prostate cancer is initiated by a mutation in the DNA of normal prostate cells. When these cells mutate, the affected DNA can interrupt the process of two separate sets of genes. First, it will turn on oncogenes, the genes that help cells grow, divide, and stay alive. It will also turn off tumor suppressor genes, which are genes that can repair DNA mistakes and keep cell growth under control. These abnormal cells continue to divide and grow until a tumor develops. In more aggressive types of prostate cancer, the cells may metastasize, migrating and spreading to other areas of the body.
Clearing Up Misconceptions
While many men may have heard that sexual activity, alcohol consumption, or vasectomies can increase the risk of developing prostate cancer, clear links have not been established. At this time, doctors don’t consider them to be causative.
Age: Age is the biggest risk factor for prostate cancer. The likelihood of developing the disease significantly increases as men grow older. Less than 1% of men under the age of 50 will be diagnosed with prostate cancer, while 6 in 10 cases are found in men 65 and older. Only 1 in 10,000 men in the U.S. will develop prostate cancer before age 40.
Race: Though researchers don’t know why, African-American men are more likely to develop prostate cancer. In fact, men of African descent are 73% more likely than white men to develop prostate cancer and 2.4 times more likely to die from it. However, the disproportionate death rate has been shown to be due, in part, to inequality in access to health care. Hispanic/Latino men and Asian-American men are at the lowest risk for prostate cancer.
Family History: The genetic mutations that lead to prostate cancer are often inherited. For men whose father or brother has been diagnosed, the risk of developing prostate cancer is more than doubled. The risk is even higher if multiple relatives have been diagnosed, especially if their relatives were young when diagnosed. The American Cancer Society recommends that any man with a family history of prostate cancer discuss screening options with their doctor around age 40.
Diet: Though not quite as clear, it is believed that diet may play a role in one’s risk of developing prostate cancer. Men who routinely eat red meat and high-fat dairy products may be at a higher risk. Increased fat consumption can promote production of testosterone and other hormones that can speed the growth of cancerous tumors. These men also tend to eat fewer fruits and vegetables, which could be related. More research is needed in this sector, but eating a well-balanced diet is always a good idea.
Factors that may increase the risk of developing an especially aggressive form of prostate cancer include obesity, sedentary lifestyle, and smoking.
With genetic risk factors such as age, race, and family history, prostate cancer may seem unpreventable. But that’s not entirely the case. Doctors recommend taking care of your overall health to aid in cancer prevention. This includes eating a healthy diet low in fat and high in fruits and vegetables and maintaining a healthy weight. Dr. Veys shares, “Reduce your intake of foods that spike insulin, such as white bread, pasta, potatoes, and white rice. Higher levels of insulin are correlated with inflammation, which is linked to different forms of cancer.” Exercise has also been linked to a reduced risk of developing prostate cancer. Aim to exercise at least three to four days a week to control weight and reap other health benefits, such as a reduced risk of heart disease and other cancers.
While there is no exact consensus on how often men should get screened for prostate cancer, a well-accepted rule of thumb is that men with any risk factors should get a baseline PSA (prostate-specific antigen) blood test in their 40s, along with a DRE (digital rectal exam). Men with no risk factors should get the same tests done by age 50. The results of the tests will determine when a follow-up exam is needed.
PSA blood tests measure the levels of PSA, a protein made in the prostate. “We become suspicious that a man may be at risk for prostate cancer when he has risk factors and an elevated PSA level,” explains Dr. Jackson. Levels between 4 and 10 indicate a 1 in 4 chance of prostate cancer, while PSAs over 10 increase risk to 50%. These tests are not used to diagnose, however, as 15% of men with a PSA below 4 can still have prostate cancer, and high levels can be indicative of another problem.
A newer blood test, called the Prostate Health Index (PHI), can also be a useful tool in measuring the likelihood of a patient having prostate cancer. It is typically performed for those with abnormal PSA levels. However, the only way to confirm diagnosis is through a prostate biopsy.
Treatment options for prostate cancer depend on several factors including a man’s age, the stage and grade of his cancer, treatment-related side effects, and other medical conditions. “Management strategies are determined by a prostate cancer’s risk of progression during life expectancy,” Dr. Jackson explains. There are generally three main treatment options: active surveillance, surgery, and radiation.
Active surveillance might be appropriate for elderly men, cancers that don’t cause symptoms, or patients with other serious health conditions that might make treatment more difficult. Under active surveillance, patients will do regular follow-ups to monitor signs of progression and take blood tests to monitor PSA levels.
Surgery involves removing the prostate gland and surrounding lymph nodes. Modern techniques are robot-assisted with a surgeon guiding the instruments through several small incisions in the abdomen. Alternatively, surgeons will manually remove the prostate through an incision in the abdomen.
Finally, radiation may be used to treat the disease. This method utilizes high-energy X-rays to kill cancer cells. It can be used in conjunction with other treatments depending on the cancer’s grade, and if it has spread or not.
Other treatment options include cryotherapy, which involves freezing tissues to kill cancer cells, and more systematic therapies like chemotherapy or hormone therapy. “These options are typically used in cases where the cancer is advanced and has spread,” says Dr. Veys.
Although prostate cancer is prevalent and can be fatal, the prognosis is greatly improved with early intervention. Men should pay attention to risk factors and talk to their doctor about what screening and prevention methods are right for them.