Why should you learn about prostate cancer? After all, as a woman, you don’t have a prostate. So prostate cancer is one of the few medical diseases you can be sure you won’t get! But the men in your life—your husband, boyfriend, father, brother, son—do have prostates. And they can get prostate cancer.
Since we all know that women like you are the "gatekeepers" when it comes to the health of your family, it’s important that you understand this disease, the most common cancer diagnosed in men.
Fact 1. Prostate cancer is the most common cancer in men, representing nearly one-third of cancers diagnosed in men.
It is the second leading cause of cancer death in men behind lung cancer, although prostate cancer is much more survivable. Overall, men in the United States have about a one in six lifetime risk of being diagnosed with prostate cancer (compared with the one-in-eight lifetime risk women have of developing breast cancer).
An estimated 218,890 men were diagnosed with prostate cancer in 2007, with 27,000 deaths. About 90 percent of prostate cancers are diagnosed when the cancer is still confined to the prostate, or has only spread a little. Nearly all men whose cancers are found in these early stages are alive in five years, while 93 percent of men with any stage of prostate cancer are alive in 10 years, and 77 percent at 15 years.
Although the incidence of prostate cancer has jumped in the past 20 years thanks, primarily, to more attention to the disease and more screening, it has leveled off in recent years and plateaued in men 65 and older.
Fact 2. Age is the greatest risk factor for prostate cancer.
Prostate cancer rarely occurs in men under 40. Instead, the risk increases exponentially with every decade after 50. For instance, the incidence of new prostate cancers in men in their early 50s is about 100 in 100,000, but about 1,000 in 100,000 for men in their 70s.
Another major risk is ethnicity. African Americans are more likely to be diagnosed with prostate cancer than Caucasian or Hispanic men and more likely to be diagnosed earlier. The differences may be related to diet or genetics, but we really don’t know.
Family history also plays a role. Men whose brothers or fathers had prostate cancer have twice the risk of developing it themselves. Researchers are working to identify specific genes that may be related to the disease.
Fact 3. Good, although not perfect, screening tests exist for prostate cancer.
There are two primary screening tests for prostate cancer: A PSA test, which measures levels of prostate-specific antigen (a protein that prostate cells produce) in the blood; and a digital rectal exam, in which the doctor inserts a gloved finger into the rectum and feels the prostate, searching for any hardness or lumps.
While they can help identify a problem related to the prostate, neither can diagnose prostate cancer. For that, a biopsy is needed. Plus, unlike other cancers, we’re not sure whether diagnosing prostate cancer contributes to survival, but we do know that the treatments associated with it can have some serious side effects.
That’s why major medical organizations have not made specific recommendations as to when and how often men should be screened. Instead, they recommend only that men be offered the test. For instance, the American Cancer Society only recommends that the PSA and DRE "be offered" every year beginning at age 50 for men who expect to live at least another 10 years, and that men discuss the potential "benefits, limitations, and harms" associated with testing with their health care providers.
Bottom line? Men need to talk to their health care professionals about what’s right for them.
Fact 4. Problems urinating likely indicate enlarged prostate, but could be a sign of advanced prostate cancer.
Prostate cancer in the early stages usually causes no symptoms. Occasionally, urination problems occur as the cancer grows. Problems urinating more likely signal bacterial infections of the prostate or benign prostatic hyperplasia (BPH), in which the prostate grows larger and squeezes the urethra (the tube that transports urine from the bladder to the penis). BPH is not cancerous. Regardless, men who have one or more of the following symptoms should visit their health care professional for an evaluation of their prostate: a need to frequently urinate, especially at night; difficulty starting to urinate or holding back urine; inability to urinate, a weak or interrupted urine flow or painful or burning urination; problems obtaining an erection or painful ejaculations; blood in the urine or semen; or frequent pain or stiffness in the lower back, hips or upper thighs.
Fact 5. There is no "best" treatment for prostate cancer.
It all depends on the stage and grade of the cancer and on the man—his age, overall health and symptoms. If the cancer is found early and symptoms are mild or not bothersome, the doctor may recommend doing nothing, called "watchful waiting" or "active surveillance." This involves keeping a close eye on PSA levels to assess whether the cancer is growing. Older men, or those in poor health, may never require treatment because prostate cancer is generally slow growing. If treatment is needed, options include surgery, radiation, anti-hormonal medication and chemotherapy. These are discussed in more detail below. The American Urological Association Guidelines from 2007, based on a comprehensive, multidisciplinary review of all published literature on prostate cancer, recommend that all men with clinically localized prostate cancer, the most common form, should have the following four options explained to them: active surveillance, brachytherapy (radioactive seeds), external beam radiation and surgery. Patient preference and other medical problems, as well as urinary, bowel or sexual function, should play a significant role in decision making.
