September is Prostate Cancer Awareness Month, and there is no better time to remind men that screening is important for early detection and treatment of all cancers, particularly cancer of the prostate. If you know me, you know I’m all about preventative care.
Prostate cancer—what is it?
The prostate is a gland that surrounds the posterior part of the urethra in the male, just under the bladder. It helps by producing fluid that carries sperm during ejaculation. As men get older, it is common for the prostate to enlarge in a way that isn’t cancerous. However, prostate cancer is the second leading cause of cancer death in men, so it is important to have the discussion about screening with your physician when it is time and for many men to opt into screening.
About 1 in 8 men will be diagnosed with prostate cancer in his lifetime; for Black men, this number is 1 in 6. About 1 in 41 men will die of prostate cancer; that means every 15 minutes, an American man dies of prostate cancer. The latest data for Black men indicate these numbers are 1 in 26.
Risk factors: What are they?
Data shows that you are at increased risk if you have a family history of prostate cancer. This is generally a first degree relative (father or brother), or multiple relatives with the diagnosis. Certain chemical exposures are also thought to be risk factors. Race is also a factor; as previously discussed, Black men are of significantly increased risk.
The American Cancer Society also recommends that in general, you live an active lifestyle, not smoke, dip, or vape tobacco products, try to maintain a healthy weight, and limit alcohol to healthy limits to decrease your risk of cancer.
Own your health: Know the Recommendations
The American Cancer Society recommends all men aged 50 and over who have a greater than 10-year life expectancy have an individualized conversation with their health care provider about screening for prostate cancer with a prostate specific antigen blood test (PSA) with or without a digital rectal exam (DRE) during the complete physical exam. For men who are at increased risk, such as men of African descent and with the other risk factors discussed above, this discussion should begin at age 45.
No organizations offer recommendations for all men who are of average risk for prostate cancer to be screened due to concern of risk of harm due to overdiagnosis and treatment. However, recent data modeling suggests that screening African American men aged 45-69 could reduce mortality up to 29% while not increasing overdiagnosis in this population. Even with current recommendations, in recent years, we are seeing that about one-third of the men who should be screened are being screened, which has resulted in an increase in higher grade cancers, and a reduction in the decrease in mortality from prostate cancer seen in previous years.
PSA normals vary by lab, age and man, although generally less than 3 is considered normal. Based on what we see clinically, if you opt to screen, it is best to do so yearly. This is because it is best to have a baseline, and track what is known as a PSA velocity. This is how quickly your PSA is changing over time. Some men will have a PSA in normal range but have had much lower PSA values which suddenly begin to jump, and this can be a sign of something that needs to be evaluated.
Other reasons for elevated PSA include enlarged prostate, infection, or inflammation, so having a high PSA does not mean that you have cancer. Repeat testing and further evaluation by a urologist is indicated.
Signs and Symptoms:
Prostate cancer is normally without symptoms when caught. However, prostate cancer that has become far advanced can cause symptoms. Some include:
- Changes in urination, including a slow or weak urinary stream, trouble emptying the bladder, or urinating more often, particularly in the evenings or overnight.
- Blood in the urine or semen, or painful ejaculation.
- Problems getting an erection
- Pain in the hips, back (spine), chest (ribs), or other areas
- Weakness or numbness in the legs or feet, or loss of bladder or bowel control
While any of these symptoms could be from several causes such as normal aging, infection or arthritis, you should be evaluated by your physician, and a PSA should be a part of that evaluation, particularly if there is not another good explanation for them, and they are new symptoms.
Treatment
Even if you find you have an abnormal evaluation with a urologist, sometimes, it is reasonable to watch and wait, since prostate cancer is often very slow growing, and won’t cause many problems. Of note, African American men are more at risk to have aggressive cancers that require treatment, and more likely to have poor outcomes. Black men are over twice as likely to die of prostate cancer.
Active treatment options usually include surgery, hormonal suppression, chemotherapy, and radiation. These modalities can be used alone, or in combinations depending on the presentation of the cancer. It is important that men know the right information about their bodies, to ensure they get the proper recommendations. Survival rate is up to 96% if caught early enough, so again, early detection is key.
Age is important
Prostate cancer tends to affect men later in life. While some younger men develop prostate cancer, the median age for diagnosis is 66.
Talk to your doctor
Don’t be afraid to discuss your questions and concerns with your doctor. Your health is important, so it is important that you understand your options and make an informed decision that is best for you.
Educate a friend
Do not keep your knowledge about the impact of prostate cancer screening to yourself. This is so important, you should want your loved ones to be aware as well, so make sure you spread the news about what you have learned. Online resources are available at www.cancer.org/cancer/prostate-cancer.html, www.pcf.org, https://www.cdc.gov/cancer/prostate, www.zerocancer.org.
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Resources:
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21718