By Alexander P. Vukasin, M.D.
One in nine.
That’s how many men will be diagnosed with prostate cancer during his lifetime, according to the American Urological Association.
And while September is recognized as Prostate Cancer Awareness Month in the United States, men should discuss prostate cancer screening with their doctor at any time.
Risk Increases with Age
The prostate is a walnut-shaped gland that sits below the bladder and surrounds the urethra. It is part of the male reproductive system and is responsible for the production of prostate fluid, one of the components of semen.
As men age, their risk for developing prostate cancer increases. Other risk factors include:
- Ethnicity. African American men have the highest rate of the disease.
- Family history. Men who have a father or brother with prostate cancer have a two to three times higher risk of developing the disease.
- Smoking. Studies show prostate cancer risk may double for heavy smokers, according to the American Urological Association.
- Weight. Being obese or overweight is linked to a greater risk of death from prostate cancer.
The American Urological Association estimates that 164,000 men will be diagnosed with prostate cancer this year.
A Personal Decision
Though most prostate cancers are slow growing and take many years to progress, others can grow rapidly and be life-threatening.
The decision to screen for prostate cancer is a personal one that begins with a conversation with your doctor about your risk for the disease. The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer.
According to the ACS, this discussion about screening should take place at:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer.
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
The U.S. Preventive Services Task Force recommends that men between the ages of 55 to 69 talk to their physicians about the pros and cons of prostate cancer screening.
Prostate cancer typically does not exhibit any signs or symptoms unless it is in an advanced stage. If you have symptoms such as urinary frequency or urgency, talk to your doctor. Often, they are associated with other benign health conditions, including an enlarged prostate.
Screening is First Step
Diagnosing prostate cancer begins with a blood test to screen for abnormal levels of prostate specific antigen (PSA), a protein found in the prostate. A low score is a sign of prostate health, while a high score or a score that rises rapidly over time is a sign of potential disease.
In addition, a digital rectal exam, a physical test to feel the prostate for problems, may also be used as a screening tool.
Neither a PSA nor a digital rectal exam is a diagnostic tool, and if abnormalities are found, further testing is necessary for a definitive diagnosis.
Historically, a biopsy of the prostate gland would almost always be recommended.
However, in recent years, newer testing methods have evolved to help reduce the number of unnecessary biopsies, including certain blood tests that identify specific biomarkers for aggressive cancer. Additionally, doctors are using MRI to identify and locate cancer in the prostate gland.
If cancer is still suspected, a biopsy remains the only method for making an accurate diagnosis. Advances in technology are enabling doctors to use MRI and ultrasound together to perform more precise biopsies and find aggressive cancers sooner.
Treatment Varies
If prostate cancer is diagnosed, it will be assigned a “Gleason Score,” which is a measure of how quickly the cancer is likely to grow and spread. The score will help determine appropriate treatment. Treatment options include:
- Active surveillance. Some small, slow growing prostate cancers may never substantially progress, and therefore can be followed with regular close observation using PSA blood tests, digital rectal exams and biopsies.
- Surgical removal of the prostate (radical prostatectomy). Most prostate surgeries today are performed robotically through small incisions in the abdomen. At Penn Medicine Princeton Medical Center, surgeons typically use the da Vinci Xi Surgical System for radical prostatectomy. This minimally invasive approach helps spare surrounding nerves affecting urinary control and sexual function, resulting in a better recovery and quality of life.
- Radiation. Radiation can be administered in a variety of different ways, including internal radiation through radioactive “seeds” placed in the prostate, external beam radiation, or proton therapy. Radiation can be a treatment option instead of surgery or in addition to surgery if the cancer is not entirely removed.
- Hormone therapy. Hormone therapy reduces the body’s production of testosterone, which stimulates the growth and progression of prostate cancer. This treatment can be used in combination with radiation for localized prostate cancer or for advanced prostate cancer that has spread to other parts of the body. Hormone therapy is not curative but slows the progression of prostate cancer.
- Chemotherapy. Metastatic or advanced prostate cancer has traditionally been treated with chemotherapy. However, certain medications may delay the time until chemotherapy is necessary.
There is no one-size-fits-all approach to diagnosing and treating prostate cancer, making it even more important to talk with your doctor about screening and an approach to prostate health that is right for you.
To find a physician with Penn Medicine Princeton Health call (888) 742-7496 or visit www.princetonhcs.org.
Alexander P. Vukasin, M.D., is board certified in urology and is the Chief of Urology at Penn Medicine Princeton Medical Center.