Prostate cancer is the second most common cancer among men in the U.S., after non-melanoma skin cancer, according to the Centers for Disease Control and Prevention. Fortunately, it’s also one of the most treatable.
September is Prostate Cancer Awareness Month, a good time for men to take a closer look at screening, risk factors, symptoms and treatment options. That’s especially important in our area: D.C. has the highest mortality rate for prostate cancer, with 27.5 deaths per 100,000 residents, according to the American Cancer Society. (Mississippi is second, with 24.8 deaths per 100,000.)
A recent MedStar Health survey sheds more light on prostate cancer’s prevalence here. Forty-one percent of respondents said they either know someone who has been diagnosed with prostate cancer or have been diagnosed themselves. Yet 69% of men forgo screenings and many ignore symptoms, including pain (59%), the report states.
Know When to Start Screening
The prostate is a small gland in men that affects urinary and sexual function. As men age, paying attention to it becomes increasingly important.
The American Cancer Society recommends that men begin yearly prostate cancer screening at age 50. For men at higher risk, that starting point drops to 45. That group typically includes men whose father or brother had the disease before age 65 or African American men, who are 1.7 times likelier than white men to develop the disease. Men with more than one first-degree relative who had prostate cancer at an early age should start screening at 40.
“About 60% of prostate cancers are diagnosed in men over the age of 65, and right around late 60s, early 70s is the peak in terms of the most common age that men are diagnosed with this,” says Nadim Nasr, a radiation oncologist at VHC Health. “It’s extremely uncommon to see it in someone younger, especially younger than 40.”
Screening involves two steps. One is a digital exam in which a healthcare provider uses a finger to feel the prostate for enlargement or hard nodules. Both can signal problems. But suffice it to say this exam isn’t popular among patients. According to MedStar’s report, 30% of men ages 55 and older haven’t had one.
Shyness may be one reason, says Jonathan Hwang, chair of urology at MedStar Washington Hospital Center. “Many men still are either embarrassed or they just feel very uncomfortable undergoing a digital exam,” he says.
The second form of standard screening is a PSA blood test, which measures the amount of prostate-specific antigen (PSA), a protein produced by the prostate gland. Any score higher than 4 nanograms per milliliter is considered elevated and warrants monitoring. But 39% of men 55 or older have not had the test, the survey found.
“Men are often too scared to come to see their doctors for prostate cancer screening,” says Hwang, who is also a urology professor at Georgetown University School of Medicine. “They do have inherent fear about potential treatment and side effects,” such as incontinence and a diminished libido.
That fear may be understandable, but prostate cancer isn’t one-size-fits-all. Its severity can vary widely, Nasr says.
“In many cases, men never need treatment for their prostate cancer,” Nasr says. “They live with it. They can certainly die of something else, but it’s not going to be prostate cancer.”
Understand Your Risk
Age is the biggest risk factor for prostate cancer, and the likelihood of developing it rises as men get older.
In fact, Hwang says that developing prostate cancer is practically unavoidable for men who reach old age. “International studies that have shown that if we were to do a biopsy in all men over the age of 80, about 80% of men will have some cells that are considered to be prostate cancer,” he says, “but [it will] never really grow or spread or impact men’s lifespan.”
Lifestyle may play a role, Nasr says, although studies have been inconclusive. Men who smoke, are obese or are HIV-positive may be at higher risk.
“You may not be able to change your personal risk of developing prostate cancer,” Hwang says, “but you can make yourself a better candidate for any treatment” by maintaining a healthy weight, avoiding tobacco use, minimizing alcohol consumption, and getting plenty of sleep and exercise.
Know the Warning Signs
Prostate cancer has typically advanced by the time it causes symptoms, Nasr says. Men should know what to look for.
According to the MedStar study, only 6% of men can identify all the symptoms, and many dismiss them. For instance, 79% ignore a change in appetite, 73% ignore feeling more tired than usual and 53% ignore dizziness.
Common symptoms of early-stage prostate cancer include blood in the urine or semen; needing to urinate more often, including waking up at night to go; and difficulty emptying the bladder. More advanced disease can also cause urinary leakage, bone pain, erectile dysfunction and exhaustion.
Many of those same symptoms can indicate benign prostatic hyperplasia (BPH) a noncancerous enlargement of the prostate gland. That’s why patient history and PSA testing are important.
“All men’s prostates get bigger as we get older,” Nasr says. “It’s just a physiologic thing. Urine flows through the middle of the prostate, and an enlarged prostate tends to put pressure on that bladder, and it causes all of those symptoms. Not everybody who goes to the bathroom a lot has prostate cancer.”
Tailor Your Treatment
A prostate cancer diagnosis doesn’t mean immediate treatment is necessary. The approach depends on how aggressive the disease is.
For low-risk prostate cancer that grows slowly, doctors may recommend observation, also known as active surveillance. Instead of jumping into treatment, patients undergo regular monitoring with PSA tests and imaging.
“The idea is that if the cancer is not changing, then you’re not putting these men through surgery or radiation, which could have a big impact on their quality of life: urine function, bowel function, sexual function, etc.,” Nasr says.
For the roughly 25% of men diagnosed with a more aggressive form of prostate cancer, Hwang says treatment may include surgery, such as a prostatectomy (removing the gland), radiation or focal therapies. Focal therapies are minimally invasive procedures that target tumors without affecting the surrounding healthy tissue.
The good news is that all treatment options can be highly effective, with similar survival rates, Nasr says. The primary differences lie in the side effects.
“A lot of times, we focus our discussion on not necessarily which treatment is going to work better for the patient because they’re all going to work about the same and they’re all going to do very well,” he says. “It’s really which set of side effects are going to be a more negative impact on the patient’s quality of life, and so how can we maximize our cancer outcome, but at the same time also maximize our quality of life long term.”
The takeaway is not to shy away from screening. “As long as we intervene early, it pretty much guarantees that [patients] will never die from prostate cancer,” Hwang says.
