Prostate cancer is the second most common cancer in men in the U.S. and is mostly found in older men. Prostate cancer tends to grow slowly, and in most cases, it's found before it has spread to other parts of the body. In fact, some prostate cancers may not need to be treated right away—they can be watched and then be treated if it starts to grow. Robert Ellis, MD, associate professor of clinical and medical student education director, shares the importance of understanding prostate health.
When should I begin screening for prostate cancer?
The decision to screen for prostate cancer is difficult due to differing opinions from many organizations and experts. Unfortunately, the screening test for prostate cancer is not as accurate as those for other cancers, such as breast cancer or colon cancer. The test has frequent false positives and many of the prostate cancers that are found can be so slow-growing, that they will never be a problem. With that said, all organizations recommend taking an individual approach to deciding if and when to screen for prostate cancer. Men should discuss with their primary care doctor to determine the right course of action for them. Below are two major organizations’ updated prostate cancer screening recommendations:
- United States Preventive Service Taskforce (USPSTF) says “For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.”
- American Cancer Society (ACS) says that men should talk with their healthcare providers about the pros and cons of screening. They advise having this talk at age 50 for men at average risk who are expected to live for 10 years or more. Men who are Black, of African ancestry or who have a father or brother (first-degree relative) diagnosed with prostate cancer before age 65 are at high risk and should have this talk at age 45. ACS advises men to discuss screening at age 40 if they are at even higher risk—meaning having more than one first-degree relative diagnosed before age 65.
Stages of Concern: When to Start Thinking About Prostate Cancer
Stage 1: Prostate Cancer Risk Factors
Risk factors for prostate cancer should be the first stage of concern for men to start thinking about prostate health and the possibility of developing cancer. There are certain risk factors that are more common than others:
- Gender. Only men are at risk.
- Age. Men ages 50 and older are at higher risk. Most prostate cancers are found in men older than age 65.
- Race. Prostate cancer is more common in African American and Caribbean men of African ancestry than men of any other race, and it tends to happen when these men are younger. It's less common in Asian-American and Hispanic men than in non-Hispanic White men.
- Family history of prostate cancer. Having a father or brother with prostate cancer greatly raises a man's risk for the disease. The risk is even higher if more than one family member has this cancer, especially if at a young age.
- Chemical exposures. The U.S. Department of Veterans Affairs says that men who were exposed to Agent Orange during the Vietnam War are at higher risk for prostate cancer.
- Genes. Men with certain inherited gene changes are at higher risk for prostate cancer, but only a small amount of prostate cancer is strongly linked to gene changes.
Stage 2: Signs and Symptoms
Prostate cancer often causes no symptoms in its early stages, and by the time symptoms start, the cancer may have spread outside the prostate. Many of these symptoms may be caused by other health problems, so it’s important to see your healthcare provider if you have any of these symptoms.
Possible symptoms associated with prostate cancer:
- A need to urinate often, especially at night, or accidental urination.
- Weak or interrupted urine flow or trouble emptying your bladder.
- Trouble starting to urinate or being unable to urinate.
- Painful or burning sensation when urinating.
- Blood in your urine or semen.
- Loss of ability to have an erection.
- Pain or stiffness in your lower back, hips, ribs or upper thighs.
- Weakness or numbness in legs or feet.
“Most patients with prostate cancers don’t have any symptoms unless it is very advanced. Most of the symptoms that people think of for prostate cancer, such as urination problems, are much more likely due to other causes like benign prostatic hyperplasia (BPH), a urinary tract infection (UTI) or prostatitis,” Dr. Ellis said. “It is important for men to discuss these symptoms with their healthcare provider to determine the exact cause.”
Stage 3: What You Should Do If You Have Been Diagnosed with Prostate Cancer
- Understand you are not alone. It is normal to feel angry, scared or depressed after your diagnosis. Each man copes with a prostate cancer diagnosis in his own way but knowing the common feelings and concerns others have can help during this time.
- Talk about it. Do not be afraid to talk about it, as your diagnosis affects you and those around you. Talking about it with your partner and family will help you and your loved ones learn and cope with it.
- Designate an appointment buddy. Ask for someone to attend appointments with you. This person can help ask questions and take notes during your appointments. Keeping a notebook with a list of your appointments, tests and medications is one way to organize the large amounts of information that will come from your healthcare provider.
- Join a cancer support group. Consider going to a support group. Talking with other men who understand your concerns can lower your stress. Ask your healthcare provider about support groups in your area and consider taking your partner or a friend as your support.
Stage 4: Treatment options for Prostate Cancer
Due to the commonality of prostate cancer compared to other cancers, many different types of treatments have been created to improve outcomes for patients. Often an arsenal of treatments may be necessary to fully treat the cancer.
If prostate cancer is diagnosed early the active surveillance or watchful waiting stages, certain methods may be used to monitor the cancer to further determine if an invasive or highly involved procedure is needed.
There are a variety of treatment options available depending on the severity of the cancer that can be used. A type of hormone therapy called androgen deprivation therapy (ADT) may be used to cut the production of the androgen hormone, which is known to boost the growth of prostate cancer.
If you pursue treatment at an academic healthcare center, like the University of Cincinnati Cancer Center, you may have access to prostate cancer specialists that can administer focal therapies. These are a variety of therapies that use guided imaging techniques to target and treat prostate cancers that are confined to a small area of the prostate. These therapies include high-intensity focused ultrasound (HIFU), focal irreversible electroporation and focal cryotherapy.
In cases where the cancer has spread, is growing quickly or other treatments are not working, chemotherapy will often be the next step. Chemotherapy uses anticancer medicines that attack and kill cancer cells throughout the body, as opposed to a cancer that is confined to the prostate or smaller area.
Keep Calm, Get a Second Opinion
Treatment options make a difference. Learning about your diagnosis and the risks and benefits of each treatment option can help you understand how each may affect your life. No two men will have the exact same diagnosis, so it is important to talk with an expert before worrying or trying any at-home remedies. Getting a second opinion can also help in researching all treatment options available. Your healthcare provider understands getting a second opinion and they can help you in this process.
University of Cincinnati Cancer Center provides access to a variety of treatment options lead by prostate cancer specialists who can offer an increased chance of a positive outcome.
Primary care physicians, like Dr. Ellis, are accepting new patients—and they offer in-person visits as well as virtual visit options. To schedule an appointment with UC Health Primary Care, call 513-475-8001.