September is prostate cancer awareness month. My dad was diagnosed with prostate cancer back when I was in undergrad. It was scary to hear him tell me that. I wish I knew then what I know now. Over the past several years, I have helped manage hundreds of guys diagnosed with prostate cancer, working alongside physicians/researchers who are wholeheartedly invested in improving its outcomes.
What are the stats? One in nine men will be diagnosed with prostate cancer during his lifetime. All men are at risk for developing prostate cancer, but in the United States, men of African descent are more likely to develop prostate cancer than any other race or ethnicity, and are 2.4 times more likely to die from the disease. African-Americans present with higher grade disease, are younger, have higher PSA levels, and have greater incidence of metastatic disease across all age groups compared with Caucasian men. Part of this is likely due to access to care and the disparities in care that these men face.
So although I could never be given the diagnosis, I have my dad, my husband, my brother, and my son…which is why this post is still personal.
Here is a little information:
What is the prostate?
Just for kicks (and in case you didn’t know) let’s have a little anatomy lesson.
The prostate is a small gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum. It is important for reproduction because it supplies the seminal fluid, which mixes with sperm from the testes. Seminal fluid helps the sperm to travel and survive.
The seminal vesicles are rabbit-eared structures that sit on top of the prostate and store and secrete a large portion of the ejaculate. The neurovascular bundle is a collection of nerves and vessels that run along each side of the prostate, and helps to control erectile function.
The bladder sits on top of the prostate and the urethra, a narrow tube that connects to the bladder, runs through the middle of the prostate and along the length of the penis. The rectum sits right behind the prostate.
How does prostate cancer grow?
The prostate uses male hormones called androgens, such as testosterone and dihydrotestosterone (DHT), to trigger and maintain male sex characteristics and reproduction. Normally, the process of producing male hormones and using them to guide and maintain male gender characteristics and sexual function happens smoothly. However sometimes something goes wrong within the prostate cells and cancer develops. In general, cancer is a condition in which a normal cell becomes abnormal and starts to grow and/or reproduce uncontrollably without having the signals or “brakes” that stop typical cell growth. Once prostate cancer forms, it feeds on androgens and uses them as fuel for growth.
This is why one of the backbones of treatment for men, especially with advanced prostate cancer, is to lower a man’s androgen levels with drugs called hormone therapy.
What causes prostate cancer?
The short answer is doctors and researchers really don’t know. However, there are a number of risk factors, such as one’s family history, and age.
What are the warning signs of prostate cancer?
Unfortunately, there usually aren’t any early warning signs for prostate cancer. The growing tumor does not push against anything to cause pain, so for many years the disease may be silent.
Should I be screened?
There is a lot of debate about whether ordering the PSA test for routine annual prostate cancer screening is a good idea. One side of the debate is that many prostate cancer cases are slow growing. The other side is of course early detection, which offers a better chance to cure the disease if the cancer warrants treatment. It also may inform you that you don’t need your prostate cancer treated at all.
When to start screening is generally based on individual risk. The following takes into account US Preventative Services Task Force (USPSTF) recommendations issued in 2017.
If you have a family history, begin screening at age 40.
If you are African American, begin screening at age 45
If you have no family history and are not African American, begin screening at age 50.
If you are age 55-69, discuss screening with your doctor.
Screening is generally not recommended over age 70.
It should be noted that these recommendations apply to screening only, which means testing of healthy men without symptoms. If you have symptoms (frequency or urgency of urination, waking up multiple times at night to use the bathroom, and hesitancy) you and your doctor should determine what the next steps should be. PSA screening may reveal results that prompt a doctor to recommend a biopsy.
What is the PSA test?
There are two primary means of screening for prostate cancer. The digital rectal exam (DRE), which is a physician inserting a gloved finger into the rectum to examine the prostate for irregularities (I know, fun times right), and the PSA test, which is the leading method.
PSA, or prostate specific antigen, is a protein produced by the prostate and found mostly in semen, with very small amounts released into the bloodstream. When there’s a problem with the prostate, such as development and growth of prostate cancer, more PSA is released. Sometimes though, a man’s prostate releases slightly high PSA for other reasons.
Doctors look at the overall PSA numbers, as well as the rate at which it rises over time and repeated tests (velocity).
Sometimes cancers can be present even when PSA levels are lower.
In general, older men’s normal PSA levels run a little higher than those of younger men. Normal levels tend to vary a little between different ethnic groups but in general:
Asian AmericansCaucasians
| Age Range (Years) | ||
| 40 to 49 | 0 to 2.0 ng/mL | 0 to 2.5 ng/mL |
| 50 to 59 | 0 to 3.0 ng/mL | 0 to 3.5 ng/mL |
| 60 to 69 | 0 to 4.0 ng/mL | 0 to 4.5 ng/mL |
| 70 to 79 | 0 to 5.0 ng/mL | 0 to 6.5 ng/mL |
How is prostate cancer treated?
Treatment options include surgery, radiation therapy, hormone therapy, and chemotherapy, any or all of which might be used at different times depending on the stage of disease and the need for treatment. A consultation with all three types of prostate cancer specialist, a urologist, a radiation oncologist, and a medical oncologist will offer the most comprehensive assessment of the available treatment and expected outcomes.
What are the survival rates?
A great majority of prostate cancers are detected when the cancer is confined to the prostate, and treatment success rates are pretty high compared with most other types of cancer. The 5-year survival rate (probability of surviving prostate cancer for 5 years following treatment) in the United States for many men diagnosed with prostate cancer is 99%.
However, prostate cancer comes in many forms and some men can have aggressive prostate cancer even when it appears to be confined to the prostate. About 1 man in 41 will die of prostate cancer.
So guys when you see your doctor for a checkup, have a conversation about prostate health and prostate cancer screening.
Check out the Prostate Cancer Foundation at pcf.org for more information!
Happy awareness month!
P.S. My dad who will be 79 years old next month is still cleaning his own gutters! He never ceases to amaze us!
photo credit: Timothy Blanks
