In today’s article we will review 5 important things to discuss with your doctor regarding prostate cancer. Before we do that, let’s do a quick review of what the prostate is. The prostate gland is located below the bladder, is about the size of a walnut, and your urethra passes through it. The prostate is essential for reproduction, as it produces fluid that helps transport and protect sperm cells. Prostate cancer develops when abnormal cells grow in the prostate gland, creating tumors. Prostate cancer is the second most common cancer in the United States for men but highly treatable when caught in the early stages.
What Are the Symptoms of Prostate Cancer?
Understanding the symptoms of prostate cancer can help you know when to seek medical attention, so be sure to ask your doctor what you should watch out for. Prostate cancer is often asymptomatic in the early stages which is why screening is important. When symptoms do occur, they may initially present as urinary tract symptoms. You may notice you have to urinate more often, have difficulty with urination, or a weak urinary stream. New onset erectile dysfunction and blood in the urine can also occur.
It is important to understand that there is a crossover between prostate cancer symptoms and symptoms of non-cancerous conditions of the prostate such as benign prostatic hypertrophy (BPH) and prostatitis. If you experience symptoms, the best thing you can do is discuss them with your doctor as soon as possible. Your doctor can then perform an evaluation to determine if your symptoms are from prostate cancer or something else.
When Should I Start Screening for Prostate Cancer?
There is not a one-size-fits-all approach to prostate cancer screening. Screening should be personalized based on the individual’s age, overall health, and risk factors. The American Cancer Society recommends a discussion about screening take place at:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
For men dealing with several serious health problems, and who have a life expectancy of less than 10 years, prostate cancer screening may not be recommended. This is because prostate cancer often grows slowly, and aggressively treating prostate cancer may do more harm than good. Overall health status, not age, is the most important factor when making decisions about screening.
How Often Should I Get Screened?
A yearly screening test is recommended for most patients eligible for PSA (prostate-specific antigen levels) testing. If your doctor has determined you are at low risk of prostate cancer, screening every 2 years may be an option. The time between future screenings may also be guided by the results of the PSA blood test. Screening is often done yearly for men whose PSA level is 2.5 ng/mL or higher. Men who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years. Ultimately screening is up to you. As things change, you may want to change your screening intensity.
What does screening look like, and What Do The Results Mean?
Prostate cancer screening consists of testing the blood for PSA, and a digital rectal exam (DRE). PSA is a substance from the prostate that is released into the bloodstream. Many things can cause an increase in PSA levels, including a tumor. A DRE means the doctor will put a gloved, lubricated finger into the rectum to feel for tumors on the prostate gland. These tests are usually performed together, with the PSA done first because the digital rectal exam can temporarily increase PSA levels.
Generally, the higher the PSA, the more likely it is to have prostate cancer. The suggested normal ranges of PSA based on age:
Age 40 to 49: 0 to 2.5ng/mL
Age 50 to 59: 0 to 3.5ng/mL
Age 60 to 69: 0 to 4.5ng/mL
Age 70 to 79: 0 to 6.5ng/mL
However, it is very important to understand these specific ranges do not apply to all men. Many men with high levels of PSA do not have prostate cancer. And some men have naturally low PSA levels, so the 4.0 ng/mL cut-off would not apply to them and would miss an elevation of PSA caused by a tumor. Some medications can lower the PSA levels even when a tumor is present. Conversely, vigorous exercise before a PSA test can temporarily raise PSA levels.
But the PSA is still a useful test, especially when used to monitor what the prostate is doing over time. Ideally, an initial PSA should be obtained to establish his baseline number. The PSA should then be retested periodically to assess for changes. A significant rise in PSA from one test to the next would mean that prostate cancer is a possible cause, and you may need additional testing. Usually, confirming an elevated PSA requires two separate tests done 8 weeks apart. This is because 25% to 40% of men with an elevated PSA level will have normal levels on a recheck, meaning it was not likely to be caused by cancer and they can be spared the expense and inconvenience of further testing.
If your second PSA test is also elevated, your doctor may recommend one of the following courses of action:
- Getting another type of test to get a better idea of if you might have cancer.
- Getting a prostate biopsy to find out if you have cancer.
At this point, you may be referred to a urologist. A urologist is a doctor that specializes in care of the urinary tract and reproductive organs, including the prostate. Urologists can perform specialized testing procedures, such as the prostate tissue biopsy. They may also investigate the type of cancer present and help guide the best course of treatment for it. If surgery is recommended, urologists can operate on the prostate to remove tumors.
What May Increase My Risk for Prostate Cancer?
A discussion about risk factors will help both you and your doctor determine your risk for developing prostate cancer. There are two types of risk factors: modifiable risk factors and non-modifiable risk factors. Non-modifiable risk factors for prostate cancer are things you cannot change, such as age. Modifiable risk factors are things you can change, such as diet. Knowing your risk factors can allow you to make choices that may reduce your risk or initiate screening earlier if risk cannot be reduced. Here are some examples of each.
Examples of non-modifiable risk factors:
- Age. The risk of prostate cancer rises after age fifty. About 60% of prostate cancer cases occur in men who are older than 65.
- Race. Prostate cancer tends to occur more often in African American men and Caribbean men of African descent. It also tends to occur at a younger age in these groups.
- Family history. Prostate cancer may run in families, so having a father or brother with prostate cancer doubles your risk of developing prostate cancer. If you have multiple relatives with prostate cancer, your risk may be even higher.
- Genetic traits. BRCA1 or BRCA2 genes, commonly associated with breast cancer, also raise the risk of prostate cancer in men. If anyone in your family has been told they have BRCA1 or BRCA2 genes, or if there is a strong history of breast cancer in your family, you may be at increased risk of prostate cancer. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, is another genetic mutation that can raise the risk of prostate cancer.
Examples of modifiable risk factors:
- Diet. Individuals who eat a heart-healthy diet that consists of mostly vegetables, fruits, lean proteins, and whole grains, legumes and healthy fats such as olive oil may have a reduction in prostate cancer risk. Eating a diet heavy in processed foods with saturated fats such as fast food may be at increased risk.
- Obesity. Obesity is not necessarily linked with prostate cancer risk, but it is associated with developing a faster-growing, more aggressive type of prostate cancer.
- Smoking. While the link between smoking and lung cancer is common knowledge, smoking can also increase the risk of prostate cancer.
- Chemical exposures. Long-term or heavy exposure to certain chemicals can increase the risk of prostate cancer. These chemicals include firefighting agents, pesticides, Agent Orange, and chemicals used for industrial purposes including benzene, toluene, xylene and styrene.
- Chronic inflammation of the prostate. Some studies suggest that prostatitis (inflammation of the prostate gland) may increase the risk of prostate cancer. Chronic prostatitis can be caused by recurrent bacterial infections or untreated STDs.
Evaluation of risk factors will help guide prostate cancer screening, which is the most effective way to prevent prostate cancer from becoming serious. Screening means doing tests to find cancer before there are symptoms. Screening can help doctors find cancer early, when treatment is more likely to be successful. Being honest about your risk factors with your doctor is important, as it will help determine when to start screening and how often it should be done so you get the most benefit.
Conclusion
Men benefit from understanding their risk of prostate cancer and having informed discussions with their healthcare professionals about risk and screening. Letting your doctor know how you feel about prostate cancer treatment is also important, as it will guide screening intensity and factor in your wishes regarding diagnosis and treatment. Ultimately no patient is alike, and you and your doctor should come up with a prostate screening plan that is individualized for your specific needs. It all starts with a conversation.
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice, please speak with your healthcare provider.
References
American Cancer Society. Prostate Cancer Early Detection, Diagnosis, and Staging. https://www.cancer.org/cancer/types/prostate-cancer/causes-risks-prevention/risk-factors.html. Accessed July 12, 2023.
American Cancer Society. Prostate Cancer Risk Factors. https://www.cancer.org/cancer/types/prostate-cancer/causes-risks-prevention/risk-factors.html. Accessed July 12, 2023.
Center for Disease Control and Prevention. Prostate Cancer. https://www.cdc.gov/cancer/prostate/index.htm. Accessed July 12, 2023.
Jain MA, Leslie SW, Sapra A. Prostate Cancer Screening. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556081/
Merriel SWD, Funston G, Hamilton W. Prostate Cancer in Primary Care. Adv Ther. 2018;35(9):1285-1294. doi:10.1007/s12325-018-0766-1
