Prostate cancer is the most common non-skin cancer in America. In the United States, 1 in 8 men will be diagnosed with prostate cancer in his lifetime.
So 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. That’s why screening for prostate cancer is such an important topic for all men and their families.
In rare cases, prostate cancer can cause symptoms. Contact your doctor for an evaluation if you experience any of the following:
- A need to urinate frequently, especially at night, some- times urgently
- Difficulty starting or holding back urination
- Weak, dribbling, or interrupted flow of urine
- Painful or burning urination
- Difficulty in having an erection
- A decrease in the amount of fluid ejaculated
- Painful ejaculation
- Blood in the urine or semen
- Pressure or pain in the rectum
- Pain or stiffness in the lower back, hips, pelvis, or thighs
Screening may help detect cancer early, when the chances of treatment success are high. But there is no one-size-fits-all approach to prostate cancer screening.
First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.
In general, discussions with your doctor about screening for prostate cancer should begin in your 40s. Here are some rough guidelines:
How do I get screened?
- The “gold-standard” test for prostate cancer screening is the PSA (prostate specific antigen) test.
- The PSA test measures levels of prostate-specific antigen in the blood. PSA is a protein produced by the cells of the prostate. Because cancerous cells tend to produce more PSA, a spike in your PSA level may signify a problem, however, there are other benign conditions that may cause an uptick in PSA. Read more here about how to make sure your PSA test is as accurate as possible. If you’re having a PSA test, it can often be added on to other blood work you may be having that day, and you may not need a separate blood draw.
- Tracking your PSA over time can be valuable to distinguish a temporary increase (e.g., due to an infection) from a gradual, yet persistent rise. Even if your level is still within normal range, but is higher than it was the last time it was tested, it’s worth checking further. After a single high PSA result, often the first step is to repeat the test a couple of weeks later to confirm that it is, in fact, elevated. This should be done at the same lab as the previous test, to avoid fluctuations due to different equipment.
The DRE, or digital rectal exam, may also be used as a baseline test along with the PSA test, though is not recommended as a screening test by itself. Your doctor will insert a gloved, lubricated finger into your rectum and press toward the front of your body to feel the prostate. A prostate that’s enlarged or irregularly shaped, or bigger than it was at your previous exam, is a red flag that should be investigated.
Treatment
Doctors treating prostate cancer have a wide range of tools available. Your doctors will work with you to design a treatment plan that gives you the greatest chance of longer life, while managing side effects and preserving prostate function.
Radiation is the strategic use of ionizing radiation or photons to kill cancer cells. It works by damaging the cancer cells’ DNA (the genetic blueprint of the cancer cell).The targeted cells die without growing or replicating themselves. Radiation therapy, like surgery, is very effective at killing localized or locally advanced prostate cancer and has the same cure rate as surgery.
Just as surgical skill can play an important role in determining outcomes from prostatectomy, the technical skill of your radiation oncologist can play an important role in radiation outcomes. When choosing a radiation oncologist, look for a physicians who has broad experience with an assortment of approaches and can objectively help you decide on the best course of treatment.
Removing the entire prostate gland through surgery, known as a radical prostatectomy, is a common option for men whose cancer has not spread. For men with advanced or recurrent disease, other surgical procedures may be chosen, such as removal of lymph nodes, which are initial landing spots for the spread of prostate cancer.
Open radical prostatectomy is the classical way of surgically removing the prostate. In this procedure, the surgeon makes an incision in the lower abdomen in order to remove the prostate. The prostate may also be removed through the perineum, the area between the scrotum and the anus, although this technique is uncommon.
In the last 10 years, laparoscopic (robotically assisted) radical prostatectomy has become very popular. This method requires small incisions to be made in the abdomen. A surgical robot’s arms are then inserted into the incisions. With a robotic interface, the surgeon controls the robot’s arms, which in turn control cameras and surgical instruments. Some studies suggest a shorter recovery period with robotic compared with open prostatectomy.
The concept of Active Surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate radical treatment for prostate cancer (surgery or radiation therapy).
Active Surveillance is based on the concept that low-risk prostate cancer is unlikely to harm you or decrease your life expectancy. Over 30% of men have prostate cancers that are so slow growing and “lazy” that Active Surveillance is a better choice than immediate local treatment with surgery or radiation. Of the top 10 most common cancers, prostate cancer is the only one in which so many patients have a slow-growing tumor that does not warrant aggressive immediate treatment.
Active Surveillance is not “no treatment,” but rather a strategy to treat you only if and when your cancer warrants treatment (some think of it as deferred treatment only if you need it).
Hormone Therapy
Because testosterone serves as the main fuel for prostate cancer cell growth, it’s a common target for treatment. Hormone therapy (also called androgen deprivation therapy or ADT) is part of the standard of care for advanced and metastatic prostate cancer. ADT is designed to either stop testosterone from being produced or to directly block it from acting on prostate cancer cells. Although hormone therapy is effective at controlling prostate cancer growth, the loss of testosterone has side effects in nearly all men. These side effects range from hot flashes and loss of bone density to mood swings, weight gain, and erectile dysfunction. The timing of when to start hormone therapy once the PSA begins to rise is an individual decision and one that should be discussed with your doctor.
For a man starting hormonal therapy, doctor visits are usually timed to include the hormone therapy injections (which lower your testosterone), along with PSA and other lab checkups such as testosterone levels and liver and kidney function tests.
The majority of prostate cancer cells will die or stop growing once they are deprived of testosterone. However, in many men, some cells gain the ability to grow in the low-testosterone environment created by hormone therapy. As these hormone therapy-resistant prostate cancer cells continue to grow, hormone therapies have less and less of an effect on the growth of the tumor over time. This state is also referred to castration-resistant prostate cancer (CRPC). Despite this potential pitfall, ADT remains an important step in the process of managing advanced disease, and it will likely be a part of every man’s therapeutic regimen if he develops metastatic disease at some point during his fight against recurrent or advanced prostate cancer.
For more information visit www.pcf.org.