Get the Facts On Prostate Cancer: Screening, Diagnosis, Treatment

What do you know about cancer? For starters, it’s the most common cancer among men, except for skin cancer. An estimated 191,930 American men will be newly diagnosed with prostate cancer this year.

On the positive side, “the outlook for men who have prostate cancer is fantastic,” says David Key, urologist with Dayton Physicians Network and Premier Health. “We have so many things we can offer patients, especially men with advanced cancer.”

Prostate cancer rarely occurs before age 40. The majority of prostate cancers grow slowly, reducing the number of deaths from the disease. Dr. Key explains that often, “you are more likely to die with the disease than die of the disease.”

How To Know If You Have Prostate Cancer

The prostate is a gland in men, about the size of a walnut, located below the bladder and in front of the rectum. As part of the male reproductive system, it makes fluid that mixes with sperm to become semen.

“The majority of men who have prostate cancer have no symptoms or complaints,” Dr. Key says.

Your risk of getting this cancer is higher if you have a father or brother who has prostate cancer. If you are an African-American man, you also have a higher risk of developing prostate cancer. It also may be a more aggressive form and occur at a younger age.

If symptoms are absent, screening becomes important to identify the disease. Dr. Key notes two screening tools that are the “gold standard” for prostate cancer detection: prostate-specific antigen test (PSA) and a digital rectal exam.

The PSA test measures the level in your bloodstream of the PSA protein made by the prostate gland. A high level could be a sign of prostate cancer. It also can be a sign that you have an enlarged prostate, infection, or inflammation of the prostate. So, further testing may be needed.

Dr. Key recommends that men follow the American Urologic Association guidelines for PSA screening, by age:

• Under 40. No screening needed
• 40 to 54. Get a PSA if you are at risk due to being African-American, having a family history of prostate cancer, or a family history of BRCA1 or BRCA2 gene defects, which are linked to increased occurrence of breast, ovarian, and prostate cancer
• 55-69. Get a baseline PSA level, after which you and your doctor will discuss whether you should have a follow-up test in a year or two, based on your overall risk and preferences
• 70+. No routine screening is recommended. However, some men age 70+ who are in excellent health may benefit from prostate cancer screening. “We don’t want to over-diagnose insignificant cancer or put people through diagnostic procedures (like biopsies) that have risks in themselves and don’t lead to better overall medical care,” Dr. Key says.

See Your Doctor For These Symptoms

Sometimes, prostate cancer does cause symptoms. If you experience any of the following issues, see your primary care physician or urologist to evaluate whether it is a sign of cancer or another condition:

• Problems with starting to urinate
• Urine flow that is weak or that stops and starts
• Frequent urination, especially at night
• Problems with emptying your bladder completely
• Pain or burning sensation when you urinate
• Blood in your urine or semen
• Pain in your back, hips, or pelvis that doesn’t go away
• Painful ejaculation

Diagnosis For Prostate Cancer

If you have an elevated PSA level or abnormal digital rectal exam, your doctor is likely to recommend a biopsy – removal of a small tissue sample from the prostate for study. Most commonly, the physician uses a transrectal ultrasound to guide the biopsy removal.

If greater precision is needed to locate a tumor or area of concern, the urologist may use magnetic resonance imaging (MRI). A combination of MRI and transrectal prostate ultrasound can be used to biopsy the abnormal area on the MRI.

Genomic testing also can be performed on a tissue biopsy. This test can help predict how cancer cells will grow and behave. Identifying genomic markers is important in early stage prostate cancers to decide whether to take action to treat the cancer or carefully monitor the cancer to see if it grows. Monitoring is called active surveillance.

Treatment For Prostate Cancer

There are several options for managing or treating prostate cancer:

Active surveillance. If your cancer is confined to your prostate and slow-growing, your doctor may recommend carefully monitoring it and not actively treating it. Dr. Key says genetic markers help determine if you are a candidate for active surveillance. You will need regular checkups to make sure nothing changes.

“Up to 40 percent of men with prostate cancer can be managed this way initially without any treatment,” Dr. Key says. “If something changes, we can move into potentially curative options.”

Potentially curative options. If found early, before it has spread, prostate cancer is often curable. You will likely have one of these treatment options:

• Surgery. A robotic-assisted prostatectomy removes the prostate entirely. This requires a brief hospital stay.
• Radiation therapy. Radiation beams of intense energy are aimed precisely at the tumor from outside the body. The beams travel to the tumor site with minimal or no harm to the skin and surrounding tissue. Often, a hydrogel substance can be injected between your prostate and rectum to spare your rectal area from the radiation beams.

Medical treatment for advanced cancer. A number of options are now available to treat prostate cancer that has spread:

• Androgen deprivation to stop the production of the male hormone testosterone
• Oral oncolytics, which is chemotherapy in pill form
• PARP inhibitors, a targeted cancer therapy that is taken by mouth
• Provenge immunotherapy, which is a cancer infusion treatment that activates your immune system to fight the cancer cells
• IV chemotherapy
• Access to national research study protocols, such as those offered through Premier Health’s affiliation with the MD Anderson Cancer Network®

“We can use these medications to delay the onset of metastases [cancer spread] and provide a longer quality of life,” Dr. Key says.