Prostate cancer is a leading cancer among men. It affects about one in seven men nationwide, with more than 180,000 new cases diagnosed each year in the United States. Prostate cancer affects aging males, typically in their early 60s. Men who are 50 to 70 years of age and in good health should consider annual prostate cancer screening.
The prostate is a gland that makes up part of the male reproductive system. As men age, the prostate might grow, change and develop problems. Prostate cancer occurs when the prostate gland grows irregularly and develops cancer cells. It progresses slowly and might show no symptoms for many years. In most cases, prostate cancer is not immediately life-threatening.
Prostate cancer can either be incidental (shows no symptoms) or clinical (shows symptoms). Symptoms are usually similar to benign prostate problems. Initial symptoms include frequent urination, weakness of urine stream and difficulty emptying the bladder.
As the cancer progresses, symptoms include frequent urinary tract infections and blood in the urine. Late-stage prostate cancer can metastasize to the bones, such as the spine, hips and ribs, causing bone pain. It can also cause kidney or renal failure. Once prostate cancer reaches its final stages, life expectancy is about two years.
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It is important to get screened for prostate cancer before symptoms appear, to catch the disease in its early stages. There are multiple tests conducted during the screening process. A prostate-specific antigen blood test screens for high levels of PSA in the blood, which could be a sign of prostate cancer. Another test is the digital rectal exam, during which a physician will feel inside the anus for lumps in the prostate. If these tests show signs of prostate cancer, a urologist will conduct a prostate ultrasound and/or needle biopsy to determine if cancer is present.
Because prostate cancer progresses slowly, treatment initially might be less aggressive than with other cancers. After diagnosis, a urologist might recommend “active surveillance” rather than definitive treatment. This means that physicians will monitor the cancer for progression over time, and they will only proceed with treatment if the cancer becomes a threat.
Men with clinical prostate cancer, with a life expectancy of 10 years or more, might need treatment. Treatments include surgery to remove the prostate or radiation to kill cancer cells. However, both have dangerous risks, such as sexual impotency and urinary incontinence, so treatment might be avoided if appropriate. Physicians will work with patients to decide if treatment is necessary.
In general, men should be screened by age 50, although this varies depending on age, ethnicity, family history and other factors. Blacks and those with a family history of prostate cancer should be screened sooner, by age 40 or 45. Primary-care physicians should recommend prostate cancer screening during routine checkups, and will refer patients to a urologist for testing. Men 50 and older should ask their doctor about prostate cancer screening.
Dr. John Tuttle is a urologist with KentuckyOne Health Urology Associates.