Prostate cancer forms in tissues of the prostate, a gland in the male reproductive system found below the bladder and in front of the rectum.
Prostate cancer is the most common cancer in men in the United States, regardless of race or ethnicity. Though it is incredibly common, little is known about the cause, and there are few definitive answers about the best course of treatment. However, prostate cancer can be effectively treated when detected early.
The only known indicator of prostate cancer is family history. Men with a family history are two to three times more likely to experience prostate cancer. Age may also be a factor as prostate cancer usually occurs in older men. Aside from family history and age, medical research has yet to determine the causes and contributing factors of prostate cancer, or whether there are measures to prevent it.
Prostate cancer is often incredibly slow growing — taking years to develop to a small lump the size of a pea. But in some cases it can grow much more quickly and can spread to other areas. Researchers have very little understanding of how or why prostate cancers behave the way they do. Because of the cancer's typically slow growth rate, double blind studies that are often used to better understand cancers are difficult to conduct.
The American Urology Association (AUA) recently released new guidelines for prostate cancer screening, recommending that physicians screen patients age 55-69, but only at the patient's request and as a shared decision based on health, values and principles. The AUA does not recommend screening for men under 40 and only before age 55 if the patient is at higher risk because of family history. The new, looser guidelines may have some wondering how to determine whether they are at risk and need a screening.
Different people have different symptoms for prostate cancer. Some men have no symptoms at all. Symptoms of prostate cancer may include difficulty urinating, weak or interrupted flow of urine, frequent urination (especially at night), difficulty emptying the bladder completely, pain or burning during urination or blood in the urine. Pain in the back, hips or pelvis area that doesn't ease could also indicate the presence of prostate cancer.
There are two ways that a doctor can screen for prostate cancer. The most common screening method is a prostate specific antigen (PSA) test, which evaluates the level of PSA in the bloodstream. A higher PSA level may be found in men who have prostate cancer; however, the number can be affected by other factors. After a PSA test, physicians can best determine the diagnosis and course of treatment. Finally, a digital rectal exam, the second screening tool, may be performed by your doctor to detect prostate nodules, lumps, or other abnormalities.
If you think you may be at risk for prostate cancer — based on a family history, or symptoms you've experienced — a visit to your primary care physician is the first course of action. Your doctor can help you decide if screening is right for you and refer you to a urologist who will be able to diagnose and treat any cancer that may be present.
Dr. John Tuttle is a board certified urologist with Saint Joseph Urology Associates, part of KentuckyOne Health.