Prostate Cancer

As men age, one concern they frequently have is whether they’ll be diagnosed with prostate cancer and, if so, what they can do about it. It’s a legitimate concern: One in seven men in America will be diagnosed with prostate cancer, the most common cancer in the United States outside of skin cancer. 

Roughly three million American men currently have prostate cancer, which almost always occurs during midlife or beyond. In fact, according to the Prostate Cancer Foundation (PCF), 97 percent of all cases occur after the age of 50, with 60 percent of cases occurring after the age of 65.

Are You At Risk?
As with many types of cancer, the causes of prostate cancer are unclear. However, there are risk factors that make it more likely for some men to develop this disease than others. Men who have a father or brother who has been diagnosed with prostate cancer are twice as likely to develop it, and those with two or more close relatives who have been diagnosed are nearly four times as likely to have it. Men whose family members were diagnosed before the age of 65 are at highest risk, according to the PCF. 

African-American men are also at much higher risk. They are 56-percent more likely to develop the disease and 2.5 times as likely to die from it than Caucasian men, according to the National Cancer Institute.

There are often no symptoms during the early stages of prostate cancer. When they do occur, symptoms include difficulty urinating but a frequent need to do so, a burning feeling during urination, difficulty getting an erection or pain during ejaculation and pain or stiffness in the lower back, hips or upper thighs. 

Memorial Sloan Kettering Cancer Center cautions that many of these symptoms can also be caused by an enlarged prostate gland — a benign condition.

Screening and Diagnosis
The only way to know for sure if you have prostate cancer is to get screened. There are two initial screening tests, both of which can be performed in your healthcare provider’s office: the PSA, which is a blood test, and the DRE (digital rectal exam). However, neither test alone is sufficient to diagnose prostate cancer and must be part of a more comprehensive exam. 

“A PSA test can’t be classified as normal or abnormal in simple terms,” says Behfar Ehdaie, MD, MPH, who is a prostate surgeon. “It should be used as one of multiple clinical factors suggesting a patient may be harboring cancer.”

A patient’s age, the size of the prostate, whether there are any urinary symptoms, whether there’s a history of prior biopsies and other factors much also be considered, says Dr. Ehdaie. Your provider will look at the totality of those factors when determining whether further tests, including a biopsy, are needed.

The American Cancer Society recommends that men discuss screening with their healthcare providers to determine the most appropriate age for testing based upon their personal risk factors.

General guidelines suggest screening men at age 50 who are at average risk and expected to live at least another ten years; at age 45 for men at high risk, including African Americans and men with a family history of prostate cancer; and at age 40, men at the highest risk (those with two or more first-degree family members who have been diagnosed with prostate cancer).

Treatment Options
There are numerous treatments to choose among if you are diagnosed with prostate cancer, depending upon the stage the disease is in. Surgery, radiation therapy, hormone therapy and chemotherapy may be considered. The PCF notes that no “one size fits all” and outlines information about these and other options on its website: