Prostate cancer is a common concern for individuals with prostates as they age, but there has been significant controversy around the usefulness of prostate cancer screenings. Aside from skin cancer, prostate cancer is the most common cancer diagnosed in America among individuals with prostates. It’s so common in fact that the American Cancer Society estimates that one in nine individuals with a prostate will be diagnosed with the disease at some point in their lifetime. Despite how widespread it is, however, prostate cancer screening isn’t recommended for everyone. While screening may lead to the detection and treatment of prostate cancer, screening may not actually save lives from prostate cancer and has known harms. Understanding your risk level and screening options is crucial to protecting your health. From symptoms to treatment, here is everything you need to know about prostate cancer:
What is prostate cancer?
Located just below the bladder and in front of the rectum, the prostate is a walnut-sized gland in the male reproductive system that surrounds the urethra and is responsible for producing the fluid that makes up semen. Seminal fluid transports sperm during ejaculation. Prostate cancer occurs when prostate cells grow out of control, creating irregular nodules that can squeeze the urethra. These cancerous cells can then spread to other areas of the body. Oftentimes, prostate cancer is slow growing and remains confined to the prostate itself, where it can be of little harm to one’s health. Autopsy studies, for instance, found that older individuals who died of other causes often also had prostate cancer that never affected them. Other prostate cancers, however, may grow and spread quickly and require more aggressive treatment.
What are the symptoms?
In its early stages, prostate cancer may not present any symptoms. Those with more advanced prostate cancers may experience the following:
- Weak or interrupted flow of urine. Often associated with feelings of incomplete emptying.
- Frequent urination, especially at night
- Pain or burning during urination
- Blood in urine or semen
- Pain in the back, hips, or pelvis
- Painful ejaculation
It’s important to note that these symptoms may be the result of other health issues and do not necessarily mean you have cancer. If you are experiencing any of the symptoms listed above, reach out to your primary care provider. They will be able to help you rule out any other potential causes, as well as run the appropriate diagnostic tests.
Who is at risk?
Screening for prostate cancer is not for everyone, but knowing your risk level is important in determining if and when you should start screening. Unique risk factors that may increase your chances of developing prostate cancer include the following:
- Age: Risk of prostate cancer increases rapidly after the age of 50. According to the American Cancer Society, nearly 60% of all prostate cancers are diagnosed in individuals older than 65, while the average age of diagnosis is 66. Prostate cancer is rare under 40.
- Race: African-Americans are more likely to be diagnosed and twice as likely to die from prostate cancer than white people. Black individuals are also more likely to get prostate cancer at a younger age, have a more advanced stage of cancer when it is diagnosed, and have a more severe type of cancer. Meanwhile, prostate cancer is less common among Asian-American and Latino populations. More research is needed, however, to understand the underlying causes of these disparities.
- Family history: You may also be at higher risk of prostate cancer if you have an immediate relative (father or brother) who has been diagnosed with the disease. The risk also increases if you have several relatives who have been affected by prostate cancer or if they were diagnosed below the age of 55.
- Genetic factors: Several inherited gene mutations are also linked to higher risk of prostate cancer. If the BRCA1 or BRCA2 genes, which are associated with a higher risk of breast or ovarian cancer, run in your family, you may be more likely to develop prostate cancer. Your primary care provider may recommend genetic testing if there is a strong history of cancer in your family or a relative has been diagnosed with either of these genetic mutations.
Should I be screened for prostate cancer?
Routine prostate cancer screening is not recommended for all individuals as for many, the harms may outweigh the benefits. At One Medical, we believe the decision to start screening for prostate cancer should be tailored to you and your specific health needs. We encourage you to have a discussion around age 55 with your primary care provider, as we are here to help guide you in your health and find the path that makes sense for you. Those who are at higher-risk of prostate cancer should consider having these conversations earlier, around 40 or 45. Prostate cancer screening is not recommended for individuals 70 years old and older.
In the past, prostate cancer was screened by performing a digital rectal exam, but this practice is no longer recommended given the lack of evidence of its benefits. Today, prostate cancer screening involves a blood test called Prostate Specific Antigen (PSA) that detects the presence of PSA, a protein that is made in both normal and cancerous prostate cells. Higher levels of PSA in the blood may indicate the presence of cancer, but can also be due to non-cancerous causes such as prostatitis or stimulation of the prostate through anal sex.
PSA testing is not considered a reliable screener for prostate cancer as it can lead to false positives test results, which in turn can trigger unnecessary worry and invasive follow-up testing, including biopsies. To further complicate matters, screening can detect cancers and prompt radiation or surgical treatment of individuals who never would have experienced the symptoms or harms of prostate cancer in their lifetime. Diagnosis of a condition that would have never caused any harm in the first place can prompt even more anxiety and result in complications from potentially harmful treatments. Radiation and surgical treatment, for instance, can cause permanent erectile dysfunction and urinary incontinence. Additionally, early detection of prostate cancer has not been shown to significant impact morbidity due to prostate cancer. According to the United States Preventive Task Force (USPSTF), only 1 death is prevented for every 1000 people screened for prostate cancer.
The USPSTF reviewed the benefits and harms of prostate cancer screening and determined that routine screening of all individuals with a prostate would be harmful and that screening should be an individualized decision. As medicine is continually evolving and new strategies are being developed to improve the safety of prostate cancer screening, it is important to talk to your provider before deciding to get screened.
How is prostate cancer diagnosed and treated?
If your blood test detects high PSA levels, your primary care provider may refer you to a urologist for further evaluation, where additional imaging and/or a biopsy of the prostate may be performed. During a biopsy, a thin needle is inserted into the prostate to collect sample tissue. The tissue sample is then sent to a lab where it is analyzed under a microscope to determine whether the cells are cancerous. Your provider may also conduct an ultrasound or MRI to guide the biopsy. If cancer cells are detected in your biopsy, you will be assigned a Gleason score. Ranging from 2 to 10, this score indicates how aggressive the cancer is and how likely it is to spread. The lower the score is, the less likely the cancer is to spread.
If a prostate cancer diagnosis has been made, other tests will be ordered to determine if the cancer cells have spread to other parts of the body and what stage it is. Treatment will largely depend on your age, health history, and the stage of the cancer. If your cancer is slow growing and non-aggressive, your provider may recommend active surveillance, which means closely monitoring the cancer through routine PSA tests and biopsies. More aggressive cancers may require surgery, radiation, cryotherapy, hormone therapy, or chemotherapy.
While the thought of prostate cancer may be scary or overwhelming, most prostate cancers are slow-growing. In fact, more than 3.1 million people in the U.S. who have been diagnosed with prostate cancer at some point are still living today. Some individuals do not even need to have their cancer treated and would benefit in it being monitored. It’s also important to remember that you are not alone. Your primary care provider is there to guide you through your screening options, answer any questions you may have, and support you through any necessary treatment or follow-up care. At One Medical, we will work with you to develop a screening timeline and care plan based on your unique health needs and goals. Schedule a Live Well visit today if you think you are at risk for prostate cancer or have any other questions about screening.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, Portland, the San Francisco Bay Area, Seattle, and Washington, DC.
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