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Prostate CancerMen's Health

Prostate Cancer 101: What You Need to Know, What to Do, and When to Do It

Prostate cancer is the second most common cancer in American men; roughly 1 in 8 men will be diagnosed with it. Dr. Brooks offers important, practical information, including screening, for men about this all-too-common disease.
December 2022 Vol 8 No 6
Nathan A. Brooks, MD
Director of Urologic Oncology–UPMC Urology of Central Pennsylvania
Harrisburg, Pennsylvania

Prostate cancer is the most common cancer in American men after skin cancer. About 34,500 men are estimated to die from prostate cancer in the United States in 2022, according to the American Cancer Society, and roughly 1 in 8 men will be diagnosed with prostate cancer in their lifetime.1

Make no mistake: prostate cancer is potentially deadly. However, most prostate cancers can be treated today, and most men don’t die from it. There are several actions you can take to help protect yourself from prostate cancer–related death by early detection of prostate cancer.

What Is Your Best Protection?

What is the best form of protection? Get screened. Men should be screened for prostate cancer based on the current guidelines; however, those guidelines can vary, depending on who issues the guidelines. As a rule of thumb, the majority of current guidelines say that men who are at an average risk of prostate cancer should start screening with a blood test called prostate-specific antigen, or PSA, around age 50 to 55.

For men who are at a higher risk of prostate cancer, including those with several first-degree or second-degree family relatives who have had early or aggressive prostate cancer, breast cancer, or ovarian cancer, PSA screening should start between the ages of 40 and 45.

African-American men are also at a higher risk for prostate cancer, and are therefore now recommended to start screening between the ages of 40 and 45, because the rate of prostate cancer is higher in African-American men than in white men.

The death rate from prostate cancer in African-American men is also higher than in white men; however, most of this increased risk can be attributed to the current lack of access to care and lack of appropriate screening among African-American men compared with white men.2

Genetic Mutations

Research is helping us to understand the link between some genetic mutations, or changes, and the hereditary (or “familial”) nature of prostate cancer. Specifically, the BRCA gene mutation, which is often involved in breast and ovarian cancer in women, has been shown to increase the risk for prostate cancer in men, although the reason for that is not fully understood.3

Men who have a family member who was diagnosed with breast cancer or ovarian cancer, which are often associated with the BRCA gene mutation, are at an increased risk for prostate cancer. So knowing your family history of cancer is important. In fact, men with known genetic mutations in the family, such as the BRCA1 or BRCA2 mutation, should get screened at an earlier age for prostate cancer, and also meet with a genetic counselor to discuss their potential risk for cancer.

And in all cases, it is recommended that you get a PSA screening every 1 to 2 years, depending on your level of risk, after a consultation with your physician.

What Is a Prostate?

Although prostate cancer is the second leading cause of cancer-related death in American men, many men don’t understand the basic facts about the prostate gland, prostate cancer diagnosis, and prostate cancer treatment. These are among the most frequently asked questions I get from my patients.

This may seem a basic question, but it is important for all men to understand the role the prostate plays in the body. The prostate is a small gland in the male body that is responsible for making the fluid component of semen.

Like the appendix, the prostate gland is relatively superfluous. We don’t really need the prostate for our daily function, but if there are cancer cells in the prostate, it is often better to know that these cells are there, so the cancer be treated appropriately.

Does Having Prostate Cancer Diminish Me as a Man?

Prostate cancer treatment, using radiation or surgery, is associated with the risk of erectile dysfunction and difficulty urinating, as well as incontinence in men who have surgery. However, modern treatments and techniques mitigate those risks. Also, most men will no longer ejaculate after prostate cancer treatment.

It is important to remember that many men who have prostate cancer identified via the PSA screening will not need to receive treatment right away, because it may be identified at an early stage, with regular screening. Usually, we can safely monitor most of these patients via active surveillance, by monitoring their PSA level, which can often continue for a significant amount of time.

It is also important for men who are on active surveillance or who are receiving active treatment for prostate cancer to seek out support—such as joining a support group—so that they can feel less isolated from their peers.

Discussing prostate cancer with your friends, family, and peers does not make you less manly. This is important for the individual with cancer, and it also offers support and advocacy for other men diagnosed with prostate cancer and for those who may be diagnosed in the future.

I Don’t Have Any Symptoms: Should I Still Get Screened?

Yes. Having symptoms often means that the cancer is in an advanced stage, when treatment is already necessary. The point of regular screening is to allow doctors to catch the cancer early, before any symptoms manifest.

So, if you say to yourself, “I don’t have any symptoms of prostate cancer,” that’s a good thing, and an excellent reason for you to get screened, when you reach the appropriate age.

What Is PSA, or Prostate-Specific Antigen?

I mentioned the PSA screening above, but it is important to understand exactly why it is important. PSA is a marker for prostate cancer, meaning it indicates the presence of prostate cancer, but the PSA screening is not perfect.

A PSA test result can be elevated for several reasons. Repeating the PSA test about 2 weeks or more after the first elevated test result is important in determining whether the patient’s PSA level is truly elevated or if this is just a temporary result. In fact, many men with elevated PSA levels don’t have cancer.

And although getting screened for cancer can be stressful, it is more important for men to know their PSA level than to live without knowing it and risk having cancer identified at a later stage.

Getting screened regularly is crucial to catching prostate cancer early and determining the optimal treatment course for the best possible outcome. Like most cancer, catching prostate cancer at an early state means there are more treatment options, even curing it.

“Man Up” and See Your Doctor

Finally, I’d like to share a few words of wisdom with men who fear going to their doctors, or who don’t listen to their advice. It is reasonable to feel fear when visiting your doctor. We are all human, and many of us naturally don’t want to hear that something is wrong.

Many men also fear that their physician is going to tell them what to do, and expect them to do it without question. I understand the reluctance, but I would argue that is not how medicine is typically practiced today.

By taking paternalism out of the practice, doctors prefer to have a conversation with their patients instead of simply telling them what to do. We are not looking to force our values on our patients, or get angry if patients don’t listen to our advice.

I would rather work with you, the patient, to understand your position, and make sure that you get care in a fashion that matches your goals. Therefore, I encourage you to have an open, honest dialogue with your physician, no matter how uncomfortable it may feel.

If your doctor includes something in the proposed care plan that you don’t want to do, let your doctor know that. As physicians, we will work with you to ensure that your care meets your wishes and your values.

As a man, I understand the perspective of my male patients. Having something wrong with you can feel like a personal weakness. In addition, the unknowns surrounding cancer can be devastating, even terrifying.

But consider what women go through every year with breast cancer screening. The fact is that prostate cancer screening is necessary to help you stay healthy, longer. That’s why I can’t stress strongly enough: “man up” and get screened!

References

  1. American Cancer Society. Key statistics for prostate cancer. Updated January 12, 2022. www.cancer.org/cancer/prostate-cancer/about/key-statistics.html#.
  2. Memorial Sloan Kettering Cancer Center. 3 things black men should know about prostate cancer. June 22, 2022. www.mskcc.org/news/things-black-men-should-know-about-prostate.
  3. Barnes DR, Silvestri V, Leslie G, et al. Breast and prostate cancer risks for male BRCA1 and BRCA2 pathogenic variant carriers using polygenic risk score. JNCI: Journal of the National Cancer Institute. 2022;114(1):109-122. https://academic.oup.com/jnci/article/114/1/109/6329642.

Key Points

  • Although prostate cancer is potentially deadly, most prostate cancers can be successfully treated today and most men don’t die from it
  • Getting screened is the best protection against prostate cancer, with a blood test called prostate-specific antigen, or PSA
  • PSA tests are generally advised for men aged 50-55
  • The rate of prostate cancer is higher in African-American men than in white men: African-American men are recommended to start screening at age 40-45
  • Overall, a man should get a PSA screening every 1-2 years, depending on his level of risk, after a consultation with his physician

Patient Resources

American Cancer Society
www.cancer.org/cancer/prostate-cancer/about/new-research.html

National Cancer Institute
www.cancer.gov/types/prostate

Prostate Cancer Foundation
www.pcf.org/patient-resources/patient-navigation/

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