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Prostate Cancer

September is Prostate Cancer Awareness Month.

Understanding Prostate Cancer. Learn about the symptoms of prostate cancer and the screening procedures used to detect it.

In the United States, prostate cancer is the most common cancer found in men, after skin cancer. Even though prostate cancer is fairly common, often it can be slow growing and may not cause health problems. In the early stages, there may be no symptoms.

Risks for prostate cancer
Certain factors may increase a man’s risk of developing prostate cancer:

  • 1. Getting older. The risk increases for men 50 years of age or older.
  • 2. Being African-American. This raises the risk for prostate cancer being diagnosed at an earlier age and also raises the risk of a more aggressive disease.
  • 3. Having a family history of prostate cancer. This includes a father, brother or son who had prostate cancer.
  • 4. Eating a high-fat diet. Some research shows that eating a diet high in animal fat may increase a man’s risk of developing prostate cancer.
 

Symptoms of prostate cancer
Prostate cancer often causes no symptoms and is diagnosed before any symptoms appear. If you have any of the following symptoms, it’s a good idea to check with your doctor:

  • 1. Difficulty starting or stopping the flow of urine
  • 2. Increased urination at night or having to urinate more frequently
  • 3. Inability to urinate
  • 4. Interrupted flow of the urine or decrease in force of the urinary stream
  • 5. Burning or painful urination
  • 6. Blood in the urine or semen
  • 7. Pain in the low back, pelvis or upper thighs
  • 8. Swelling in the lower legs
 

Some of these symptoms can result from a benign enlarged prostate or other noncancerous conditions. These may include infections of the bladder or prostate. In later stages, cancer can spread beyond the prostate gland and may cause symptoms in other parts of the body, including lower back pain and weight loss.

Talking about prostate cancer screenings
Doctors and other health experts do not recommend that all men be screened for prostate cancer. Instead, every man needs balanced information about the pros and cons of prostate cancer screening.

Screening is not recommended in symptom-free men, of any age, according to the U.S. Preventive Services Task Force (USPSTF). The American Cancer Society (ACS) suggests that most men start a discussion with their doctor at age 50 if ataverage risk. Talk about and consider the risks and benefits of prostate cancer screening.

The bottom line is that it’s important for a man to make an informed decision with his doctor about the choice to screen or not screen. For men who are at high risk, such as African-American men or men who have a family history of prostate cancer, the ACS suggests they talk to their doctor as early as age 45 about the risks and benefits of prostate cancer screening.

Screening tests for prostate cancer
Your doctor will talk with you about your medical history and do a physical exam. Along with this evaluation, he or she may use the two tests listed below (which are most often done together for the screening).

Digital rectal exam (DRE): The location of the prostate gland is near the rectum and allows for the prostate to be felt through the rectal wall. The doctor will feel the prostate gland through the rectum using a gloved, lubricated finger to note lumps or other abnormalities.

Prostate-specific antigen (PSA) blood test: This blood test measures for a protein that is only created by the prostate gland. Small amounts are normally found in the blood. The PSA is used with the DRE for prostate cancer diagnosis. PSA levels may vary and there is no specific level that indicates a cancer diagnosis. Ideally, the PSA is done before the DRE since the rectal exam of the prostate can elevate the PSA level in the blood.

Keep in mind, PSA screening may not be appropriate for certain men. The American Urologic Association (AUA) recommends against PSA screening in men ages 40 to 54 at average risk. Routine PSA screening is also not recommended for most men ages 70 and older or any man with less than 10 to 15 years life expectancy.

According to the AUA, if you are a man of average risk ages 55 to 69, PSA screening may be appropriate following an informed discussion. Similarly, men ages 40 to 54 at high risk for developing prostate cancer, African American men and men who have a first-degree relative, such as a father, brother or son who has had prostate cancer are considered high risk. These men should begin a discussion with their doctor about screening.

Other tests or exams may be required to help your doctor understand the reason for your symptoms. These may include X-rays and ultrasound. A biopsy will be used to confirm if cancer is present.

Treatment overview
There are several factors to consider when deciding the treatment options for prostate cancer:

  • 1. Overall health
  • 2. How quickly the cancer seems to be growing
  • 3. The size of the tumor
  • 4. If it has spread and how the treatment may impact a man’s quality of life
 

The more common treatment options for prostate cancer may be used in combination or alone:

  • 1. Active surveillance. Close monitoring or testing is done to watch for growth of the tumor.
  • 2. Watchful waiting. This approach is considered less intensive than Active Surveillance. Often, a person’s symptoms determine next steps in diagnosis or treatment.
  • 3. Surgery. There are different types of surgery options to treat prostate cancer. A choice is usually made based on the status of the patient’s cancer, patient preferences and the experience of the surgeon.
  • 4. Radiation therapy. May be used instead of surgery or following surgery to kill any remaining cancer cells
  • 5. Cryotherapy. Also known as cryosurgery, it freezes the tumor to kill the cancer cells.
  • 6. Hormone therapy. Helps reduce or block the male hormone that causes the prostate cancer to grow. There are several new forms of hormonal therapy that are frequently very effective.
    • Chemotherapy. Uses certain drugs to kill the cancer cells. The drug
  • 7. Chemotherapy. Uses certain drugs to kill the cancer cells. The drug is given through the vein with a thin needle.
  • 8. Immunotherapy. This treatment customizes a vaccine to each man by using immune cells from his own blood.
  • 9. Radiopharmaceuticals. These are radiation-emitting or radiation-delivering drugs that may be used to get radiation to the bone involved with prostate cancer. The purpose of this radiation is to relieve pain
 

Working with your primary care doctor and other specialists may help you gain an understanding of the risks and benefits with each treatment option. Similar to the decision of screening for prostate cancer, the options for treatment require careful consideration. Be sure to consider how the treatment will help and how the treatment could cause problems.

By Louis Neipris, MD, Contributing Writer

Sources:

  • 1. Centers for Disease Control and Prevention. Prostate cancer screening: A decision guide. Accessed: 06/02/2015
  • 2. American Cancer Association. American Cancer Society recommendations for prostate cancer early detection. Accessed: 06/02/2015
  • 3. National Cancer Institute. Prostate cancer. Accessed: 06/02/2015
  • 4. U.S. Preventive Services Task Force. Screening for prostate cancer. Accessed: 06/02/2015

 

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