I started this post a long time ago, but found so many other things to write about that were easier to deal with than cancer. Cancer still is the ultimate disease, and we as a human race fear it probably more than any other. Any organ of the body can be affected, and for men, the prostate is the most common. In the United States, 11% of all men are diagnosed with this cancer over their lifetime, with increasing prevalence with age. In fact, it is estimated 80% of men will have prostate cancer by the age of 80. Luckily, this cancer is slow growing and remains at a low-grade for a long time. At the same time, 35,500 men each year die of this cancer, with 268,490 diagnosed cases.

Risk factors for this type of cancer include age, ethnicity (more common in African descendents in the US), family history including genetic factors, diet (high animal fat, red meat), smoking, hormone levels and obesity, and certain carcinogens.

How do we detect this cancer? Screening for prostate cancer used to involve a rectal exam. Now, after studies have shown that this is not very efficacious, the PSA (prostate specific antigen) blood test is used along with personal history to determine risk starting in the 40’s or early 50’s. Screening has been a controversial topic lately because of the slow nature of most cancers and the high rate of biopsies that have been done, with often more harm than good accomplished for the patient. The test can be very useful when used with an educational conversation with your primary care provider to determine the best age to start testing, the interval of testing, and the meaning of the results based on risk factors and assessment findings. This is called ‘shared decision making’ and is very helpful in coming to grips with the limits of testing but also the benefits.

Even more common is benign prostate hypertrophy which is what causes men in their 50’s typically to urinate at night or more frequently. This is not cancer nor is it associated with cancer, but has many of the same symptoms. This can make diagnosis confusing. The problem is that a fast growing and changing BPH is associated with cancer, and often with a high grade type, which means more dangerous risk.

Most prostate cancer is asymptomatic, and then with progression, it may start causing urinary symptoms like frequency, urgency, nighttime, urination, or possibly blood in the urine. If suspected from PSA tests, symptoms, history and evaluation, then the standard for diagnosis is a biopsy of the prostate performed by a urologist. This may be ordered with an MRI of the pelvis to further aid the process.

If diagnosed, the cancer will then be staged, which represents the size and proliferation of tumor, if lymph nodes are involved, and if metastatic, which means spread to other organs. Then a grade will be given, which is indicated by a Gleason score, which determines the aggression of cancer cells.

Prostate cancer is treated with surgery (prostatectomy), radiation, hormone therapy, chemotherapy, immunotherapy, and targeted therapy with radiopharmaceuticals. Now is a better time then ever due to the range of treatment options, which have lowered the mortality rates of this cancer.

If you have a prostate, and are in your 40’s, consider with your primary care provider whether you should get a baseline PSA. It’s a simple blood test that can be done with your yearly labs, like cholesterol, to track changes that could indicate the need for further investigation.

There is much more to learn, as I just gave you the basics. The most important take home point is to consider screening tests to track your PSA numbers, and not to just let chance rule. Then continue with healthy lifestyle habits!

Resources:

• The CDC: https://www.cdc.gov/cancer/prostate/basic_info/index.htm
• American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer.html
• The Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087