Prostate Cancer

This article describes the basic screening factors and impact on men’s health that prostate cancer has.  Prostate cancer should be a concern to all men because it is the most common cancer found in men in the United States, after non-melanoma skin cancer.  Non-melanoma skin cancer refers to lesions such as basal cell carcinoma which generally is very slow growing and more of a cosmetic concern than cancer risk.  These cancers account for less than 0.1% of cancer deaths and very rarely spread.  In contrast, prostate cancer is the second leading cause of cancer death for men in the United States.  There are about 240,000 men diagnosed with prostate cancer each year and about 27,000 deaths from prostate cancer each year.  This does NOT mean that more than 10% of those diagnosed die from it, these statistics refers to the millions of men with the cancer that are already diagnosed with it from previous years.

Analogous to breast cancer, the incidence (number of diagnosed each year and rate) has been increasing each year.  This does not necessarily mean that more men get prostate cancer each year, it more likely refers to the increased ability to detect prostate cancer at earlier states.

As with most cancers, early detection of prostate cancer allows the best possible outcomes even cure.  One of the frustrating things with prostate cancer is that it can be present for some time without any symptoms.  This is concerning because a cancer that is present, yet undetected, has a chance to grow and spread to other areas of the body.  When cancer spreads this is called metastases and it generally implies (with a few exceptions) that the cancer is not curable.

Early detection of prostate cancer is often done solely with an elevated PSA level.  PSA (prostate specific antigen) is a blood test that can be elevated with prostate cancer but it is not extremely specific for prostate cancer.  Other conditions such as infection, swelling or trauma can increase the PSA level also.  Having an elevated PSA level does NOT diagnose prostate cancer.  When the PSA is elevated, it should be further investigated with a physical exam, ultrasound and often biopsy to definitively diagnose prostate cancer.  There is debate about what cut off or level of PSA indicates elevation.  The PSA level normally rises as men get older and has ethnic differences as well.

In the days before the PSA test, prostate cancer was usually diagnosed after it was far advanced and caused severe symptoms.  Symptoms of prostate cancer include:

  • Urgency: Having an abnormal pressured sensation to urinate without much warning
  • Nocturia: Having to urinate several times at night
  • Frequency: Having to urinate multiple times a day, often only in vary small amounts
  • Hesitancy: Feeling the urge to urinate but being unable to initiate the urine stream
  • Abnormal kidney function testing (not a symptom per se, but a finding nevertheless)
  • Examination feeling a hard “knot” on the prostate gland with digital rectal exam

The conundrum with the above symptoms (the first four specifically) is that they are also common symptoms of prostate enlargement without cancer, prostate infection, or bladder infection.  Whether these symptoms are present with or without cancer, the underlying cause still requires treatment to both improve the quality of life and prevent complications of any of these which can cause serious health problems such as kidney failure.

Which men are at an increased risk for prostate cancer?  If we live long enough (e.g. late 80’s-90’s) almost all men will have at least a little prostate cancer but they are much more likely to die with the disease than from it.  It would more helpful to know which younger men are at an increased risk for prostate cancer.  In contrast to breast cancer, there is not as much evidence to establish firm risk factors.  Risk factors for prostate cancer appear to have both a genetic and familial component.  Having several close (i.e. first-degree) relatives with prostate cancer increases the risk, with a higher risk being associated with more affected relatives.  For example, if your brother has prostate cancer you have a 3x increased risk to get prostate cancer compared with the average man.  If your brother and father have prostate cancer, your risk is increased to 5x compared with the average man.  There is not a reliable, affordable or accurate genetic test to determine risk for prostate cancer.  Some have thought that infections of the kidneys or prostate increase the risk for prostate cancer but research has not established this relationship.

Fortunately there is a wide range of treatment options for early prostate cancer.  Selecting your treatment option should only be done after a thorough discussion with your doctor about the benefits and potential drawbacks of each treatment option.  Treatment options for prostate cancer include:

  • Surgery to remove the prostate (also called prostatectomy – there are several ways this can be done)
  • Radiation therapy with external beam
  • Radiation therapy with implanted radioactive beads known as brachytherapy
  • Hormone blocking therapy (mainly aims to block testosterone like hormones)
  • Watchful-waiting strategy (basically observation or “doing nothing” since sometimes doing something creates more trouble than the disease is causing or is likely to cause)

Often some combination of the above treatment strategies is used.

REFERENCES:

  1. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18thed.  Chapter 77.  New York, NY: Saunders.
  2. www.cancer.gov/cancertopics/types/prostate
  3. seer.cancer.gov/statfacts/html/prost.html
  4. Wein, AJ: (2007) Wein: Campbell-Walsh Urology, 9th ed.  Chapter 95. Philadelphia, PA: Saunders Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.