One in 10 men is likely to develop prostate cancer, the most frequently diagnosed cancer in men. The disease disproportionally affects African-Americans. What’s more, the disease often goes unnoticed in its most curable stage.
In recognition of Prostate Cancer Awareness Month, Dr. Michael Koch, urologist at the IU Health Simon Cancer Center and chair of the Department of Urology at the IU School of Medicine, discusses the basics of prostate cancer diagnosis and treatment.
Who is at risk for prostate cancer?
All men are at risk. African-Americans tend to be diagnosed with more aggressive prostate cancers and are more likely to die from it. Men with a family history of the disease are also at increased risk, particularly if a relative had prostate cancer at an early age or died from the disease.
How is prostate cancer detected?
There are no early symptoms for prostate cancer. If men wait until they have trouble urinating or feel pain, it’s usually too late to cure them. The challenge with prostate cancer is that in order to detect it while it is curable, you have to screen men. Most men that have urinary symptoms do not have prostate cancer; they have benign prostate enlargement.
How do you screen for prostate cancer?
Men at high risk for prostate cancer should have regular checkups with their doctors. In addition to a prostate exam, the most common screening for prostate cancer over the past 20 years is a blood test called prostate-specific antigen, or PSA. This test detects markers of a prostate protein within the blood. A higher PSA level typically means a higher probability of prostate cancer and would be followed up by a biopsy of the prostate to determine if cancer is present. A biopsy can tell you whether cancer is present, how large it is and whether or not it will grow quickly or spread. Elevated PSA tests can also be due to a benign, enlarged prostate – something all men experience at some point in their lives.
What is the controversy surrounding PSA tests?
The problem with the PSA test is that it is not really a cancer test. It’s just a marker of problems with the prostate. So anything wrong with the prostate – including cancer – raises your PSA level. Having an enlarged prostate, a prostate infection and even intercourse raises the PSA level. Most men that have a moderately elevated PSA level do not have cancer, so the only way you can tell if it’s a cancerous cause is to do a biopsy. Some say PSA tests invite unneeded treatments and stress due to false positives. My personal belief is that PSA tests have significantly decreased the death rate from prostate cancer and I can’t tell you how many men’s lives have been saved because their cancers were picked up from a PSA test.
At what age should I consider screenings?
You should decide for yourself if you want to be screened for prostate cancer after discussing this with your doctor. High risk populations such as African-American men and those with a family history should talk to their doctors about screenings in their 40s. If you’re not in a high-risk population, discuss screenings in your 50s.
What are the treatment options for prostate cancer?
The most common forms of treatment are radiation therapy and surgery (prostatectomy) to remove the prostate. In many men with small, slow-growing prostate cancers, we’ll put the patient on active surveillance to delay treatment or even avoid it all together to minimize side effects such as impotence and incontinence. Most of what I do is robotic prostatectomies, which are minimally invasive and have excellent outcomes in about 80 to 90 percent of patients, depending on how advanced their cancer is.
