Prostate cancer is one of the most common types of cancer in men. Fortunately, many prostate cancers grow slowly and are confined to the prostate gland, not causing serious harm. But some types are aggressive and spread quickly.
The prostate is a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm. Prostate cancer that is detected early when still confined to the prostate gland has the best chance for treatment and recovery.
Signs and Symptoms
In many cases, prostate cancer causes no signs or symptoms in its early stages, but as it progresses it may cause signs and symptoms like:
- Blood in the urine
- Problems urinating or painful urination
- Weight loss
- Erectile dysfunction
Blood in the urine should never be ignored or overlooked, as it is often a sign of prostate cancer or other urinary tract cancers.
Risk Factors
The risk of prostate cancer increases as you age and is most common after age 50. The American Cancer Society recommends prostate cancer screening for most men beginning at age 50 to help diagnose prostate cancer in the early stages.
For reasons not yet determined, Black men have a greater risk of prostate cancer than people of other races and prostate cancer is more likely to be aggressive or advanced in Black men.
People who are obese may also have a higher risk of prostate cancer, and the cancer is more likely in obese people to be more aggressive and more likely to return after initial treatment.
Family history is also important, such as if a blood relative has been diagnosed with prostate cancer of if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a strong family history of breast cancer.
PSA Testing
Prostate Specific Antigen (PSA) is a protein produced by both cancerous and noncancerous prostate tissue, and a small amount in the bloodstream is normal. But because cancerous cells usually make more PSA than benign cells do, elevated PSA levels can be an indicator of prostate cancer.
PSA testing can be used to screen for prostate cancer, sometimes combined with a digital rectal exam to feel the prostate for abnormalities and to monitor the size of your prostate gland. There are certainly benefits of PSA testing, but there can be downsides as well.
What are the benefits of PSA testing?
- Detecting certain types of prostate cancer early can be critical in knowing if it is likely to spread to other parts of your body or is a quick-growing cancer likely to cause other problems.
- Early treatment can help catch the cancer before it is life-threatening, causes serious symptoms or needs aggressive treatment, reducing your risk of side effects like erectile dysfunction and incontinence.
What are the downsides of PSA testing?
- Elevated PSA levels can have other causes, such as benign prostate enlargement or prostate infection. “False-positives” from the test like this are common.
- Some prostate cancers may not produce much PSA and so it is possible to have a "false-negative" — a test result that incorrectly indicates you do not have prostate cancer when you actually do.
- Follow-up tests to check out the cause of an elevated PSA test can be invasive, stressful, expensive, or time-consuming.
- In many patients, slow-growing prostate cancer does not need treatment, but knowing you have cancer that is untreated can cause stress and anxiety.
Men in their 50s should discuss the pros and cons of PSA testing with their doctor and review their risk factors. Black men and those with a family history of prostate cancer should consider beginning the discussion with the doctor sooner.
Treatments for Prostate Cancer
Treatment depends on how advanced prostate cancer is when diagnosed. For some prostate tumors that are slow-growing, PSA monitoring may be recommended rather than treating it right away.
More aggressive treatment may include robotic surgery, radiation, or hormone therapy. Depending on the stage of development, your doctor may also recommend Lupron/Eligard injections to treat prostate cancer