September is National Prostate Cancer Awareness Month. According to the American Cancer Society, prostate cancer is the most common cancer in American men after skin cancer. The risk of prostate cancer is about 1 man in 8 will be diagnosed in their lifetime. It's important for men to be screened for prostate cancer in order to catch it in early, more treatable stages.
What is Prostate Cancer?
Before I discuss prostate cancer, let me explain some anatomy. The prostate gland is part of the male reproductive system. It’s located between the bladder and the urethra. Its function is to produce some of the components of semen. Prostate cancer begins when cells in the prostate gland start to grow uncontrollably.
Prostate cancer is the second most common cancer in men (behind skin cancer) and about one in 7 men will be diagnosed with prostate cancer in his lifetime. Prostate cancer almost always affects men over the age of 55; however, some men younger than that are also at risk.
Prostate cancer can be detected early, which improves both survival rates and treatment outcomes.
Prostate Cancer Screening Guidelines
There are two components to prostate cancer screening: PSA and DRE.
- A PSA is a blood test that detects elevations of prostate specific antigen, which can be a sign of prostate cancer.
- A DRE is a digital rectal exam, which is an exam where a physician inserts a gloved index finger into a man’s rectum, feeling the prostate gland for any abnormalities.
Various medical and government entities provide recommendations for when and how to use these screening tests. In recent years, their recommendations have changed and no longer exist as one shared opinion. When the PSA was first introduced, within only a few years, the death rate from prostate cancer dropped by 50%; however, many men were also being diagnosed with lower-risk (not as aggressive) prostate cancers that may not have required treatment.
The net benefit of PSA screening, overall, was small, with about 2 deaths per 1,000 men prevented with screening; this is similar to other cancer screenings. After learning this new information, some groups continued to advocate for regular screenings while other groups advocated for fewer screenings. Now, the PSA recommendation is based on a consideration of both risks of not diagnosing prostate cancer early, as well as recognizing the harms of “overtreating” a less-aggressive cancer.
For prostate cancer screening, I follow the guidelines of the American Urological Association, the AUA, of which I’m a member.
Here are the screening recommendations I follow and share with my patients:
- Men aged 55-69 should discuss with their doctor the risk and benefits of PSA screening and whether or not it is right for them.
- Men older than 69 or younger than 55 who have risk factors for prostate cancer, including family history, African American heritage and any known genetic mutations should talk with their doctor about earlier and continued screenings.
- Anyone with a PSA greater than 3, or with an abnormality on the digital rectal exam, should meet with a urologist.
The AUA's complete screening recommendations are available on their website
Prostate Cancer Treatment Options
Once a man has been diagnosed with prostate cancer, there are three primary treatment categories:
- Active surveillance. If a man’s cancer has been determined to be a “lower risk” type of prostate cancer, he will have regular testing and visits to monitor for any changes.
- Surgical removal of the prostate. Urologists often use robotic technology for this procedure.
- Radiation treatment performed by a radiation oncologist; either external radiation beams or radioactive implants.
Because each patient and case is unique, I work with men, their families and their primary care physician to determine what treatment(s) are best for each patient.
If you would like to learn more about prostate cancer, I can recommend the following websites:
The American Urological Association
The Urology Care Foundation
Please share this information with the men in your life to help them make good choices related to their health.