Prostate Cancer
Prostate Cancer is the most common cancer in American men after skin cancer. In the US, 1 in 8 men will be diagnosed with Prostate Cancer.
Symptoms:
Unfortunately, there usually are no any early warning signs for prostate cancer. The growing tumor does not push against anything to cause pain, so for many years the disease may be silent. That’s why screening is important.
In rare cases, prostate cancer can cause symptoms. Contact your doctor for an evaluation if you experience any of the following:
• A need to urinate frequently, especially at night, some- times urgently
• Difficulty starting or holding back urination
• Weak, dribbling, or interrupted flow of urine
• Painful or burning urination
• Difficulty in having an erection
• Blood in the urine or semen
• Pressure or pain in the rectum
• Pain or stiffness in the lower back, hips, pelvis, or thighs
Remember: urinary symptoms don’t necessarily mean you have cancer. Prostatitis or BPH(Benign Prostatic Hypertrophy, also known as enlargement of the prostate) are benign diseases which can cause similar symptoms and are very common.
When your doctor suspects you may have prostate cancer, what comes next is a careful series of tests and examinations that will confirm the diagnosis and assess the extent of the disease. Most prostate cancer cases are highly treatable, but first, your care team needs to know exactly what you’re dealing with.
The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease at an early stage when treatment may be more effective and potentially have fewer side effects. The PSA test may be done along with a digital rectal exam (DRE), in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.
What Does PSA Mean?
PSA, or prostate-specific antigen, is a protein produced by the prostate and found mostly in semen, with very small amounts released into the bloodstream. When there’s a problem with the prostate—such as the development and growth of prostate cancer—more PSA is released. Sometimes, a man’s prostate releases slightly high PSA for other reasons. Rising PSA eventually reaches a level where it can be easily detected by a blood test. During a PSA test, a small amount of blood is drawn from the arm, and the level of PSA, a protein produced by the prostate, is measured. A higher PSA means that there is a greater chance that you have prostate cancer. Your doctor will consider several factors when evaluating the results of your PSA test, including age (PSA rises with age) and race (black men tend to have slightly higher PSAs, on average). If you have had multiple PSA tests, your doctor will look at the trend.
Prostate size: A man with a larger-than-usual prostate may have a higher-than-usual normal PSA level.
Prostatitis: Prostatitis is a painful condition, often caused by bacterial infection in which the prostate is inflamed, swollen, and tender. Prostatitis can cause high PSA.
Benign urination or ejaculation difficulty, along with swelling, may cause a spike in PSA levels.
Urinary tract infection or irritation: An infection of the urinary tract, as well as irritation caused by medical procedures involving the urethra or bladder, may irritate the prostate and cause it to produce more PSA.
Prostate stimulation: many things, even a long bike ride, can cause temporarily high PSA.
Medications: Some medications, such as finasteride (Proscar or Propecia) or dutasteride (Avodart), can lower your PSA.
What if my PSA is High?
PSA screening is just the first step, alerting you and your doctor that more testing may be needed. If PSA is only slightly elevated, your doctor may recommend repeating the test a couple of weeks later. From there, other types of tests can help with the decision on whether you need a biopsy, including:
• complete physical exam
• Magnetic Resonance Imaging (MRI) of the prostate
Each time you see your doctor for a checkup, have a conversation about prostate health and prostate cancer screening. Cancer specialists recommend that you make a shared decision about PSA screening with your doctor, starting at age 45, or age 40 if you have a family history of prostate or other cancers or are black.
There are three well-established risk factors for prostate cancer:
- Age
- Family history (including genetics)
- Race
As men age their risk for prostate cancer increases considerably. About 60% of prostate cancer is diagnosed in men over age 65. That is why talking with your doctor about PSA screening for prostate cancer as you enter middle age is so important.
Genes for disease can run in families. Of all the major cancers, prostate cancer is the most heritable: 58% of prostate cancer is driven by genetic factors. Men who have a close relative with prostate cancer may be twice as likely to develop the disease, while those with 2 or more relatives may be nearly 4 times as likely to be diagnosed. The risk is higher if the affected family members were diagnosed before age 60.
As we unlock the genetic underpinnings of cancer, we see that men may also be at increased risk of prostate cancer if they have a strong family history of other cancers, such as breast cancer, ovarian cancer, colon cancer, or pancreatic cancer.
Other risk factors for prostate cancer diagnosis and worse outcomes are:
Social and environmental factors, particularly a diet that is low in vegetables and high in processed meat and saturated fat.
Overweight/Obese: Research has shown that obese men are at greater risk of developing an aggressive form of prostate cancer, recovery from surgery tends to be longer and more difficult, and the risk of dying from prostate cancer can be higher.
Tall height
Lack of exercise and a sedentary lifestyle
Very high calcium intake
Black race
Family history
Treatment is based on the test and staging of the cancer. It may include, surgery, radiation and chemotherapy.
What is Active Surveillance?
The concept of Active Surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate radical treatment for prostate cancer (surgery or radiation therapy).
Active Surveillance is based on the concept that low-risk prostate cancer is unlikely to harm you or decrease your life expectancy. Over 30% of men have prostate cancers that are so slow growing and “lazy” that Active Surveillance is a better choice than immediate local treatment with surgery or radiation. Of the top 10 most common cancers, prostate cancer is the only one in which so many patients have a slow-growing tumor that does not warrant aggressive immediate treatment.
Active Surveillance is not “no treatment,” but rather a strategy to treat you only if and when your cancer warrants treatment (some think of it as deferred treatment only if you need it). Your physician will discuss this option if you qualify in detail. Your staging and Gleason Score will be explained.
Call your physician for evaluation and screening.
Here is to your good health,
Cathy