Key takeaways:
Prostate cancer screening is an elective, preventative measure that can help the early detection of prostate cancer.
Cancer in the prostate is one of the more common cancers. In the U.S., 240,000 men are diagnosed with prostate cancer annually.
For most men, death from prostate cancer is unlikely — prostate cancer survivors commonly live for another 20 years or more.
According to the American Medical Association (JAMA) Journal, the median age of death from prostate cancer is 80 years.
Screening is key to early detection and a better prognosis, as appropriate treatment options can help extend life expectancy and preserve life quality when implemented early.
A man’s prostate is a walnut-sized gland found behind the base of the penis that surrounds the urethra. Its primary function is to make seminal fluid.
With age, a prostate enlarges, possibly leading to benign prostatic hypertrophy (BPH), which blocks the urethra. BPH may cause symptoms similar to prostate cancer but is not associated with a greater risk of developing prostate cancer.
The most common type of prostate cancer screening is a digital rectal examination (DRE).
DRE a manual rectal exam. The exam is conducted by a clinician who inserts a gloved finger into the rectum to check for hard lumps or other irregularities.
It’s a routine part of men’s annual exams.
If the doctor finds an abnormality, they may recommend a PSA blood test to measure the prostate-specific antigen.
According to the Mayo Clinic, PSA velocity is the change in PSA levels over time.
If someone is cancer-free, their PSA levels are usually under 4 ng/mL of blood. When prostate cancer is present, PSA levels often go above 4.
Fast growth in PSA could indicate cancer or an aggressive kind of cancer.
There is some controversy around using PSA to look for prostate cancer when there are no symptoms. However, the test could be useful for screening high-risk populations.
The U.S. Preventive Services Task Force recommends that men aged 55 to 69 years old decide whether to be screened for cancer prevention after talking to their physician about the potential benefits or risks of prostate cancer screening.
Likewise, the American Urological Association and the American Cancer Society recommend making an informed decision with a health care provider about PSA screening.
The National Comprehensive Cancer Network considers a patient’s age, digital rectal examination (DRE) results, and other factors in its recommendations.
Prostate cancer is rare in men ages 40 and younger. Prostate cancer affects about 60% of men over 65. Race and ethnicity also affect the risk of prostate cancer.
This type of cancer is most common in African-American men and Caribbean men of African ancestry. Asian-Americans, Hispanics, and Latinos have a lower prostate cancer risk than non-Hispanic whites.
The diagnosis of prostate cancer is more common in the United States and Canada, northwestern Europe, Australia, and the Caribbean islands.
The risk of prostate cancer becomes much bigger for biological men with a family history of prostate cancer. The incidence doubles if either their father or brother has had it.
According to the National Cancer Institute, inherited mutations of BRCA1 or BRCA2 genes can also increase prostate cancer risk.
Keep an eye out for the following symptoms, as they may indicate prostate cancer:
If well-managed, men with prostate cancer can have a long life expectancy with a good quality of life. Prostate cancer is unusual in that it tends to grow and spread relatively slowly. Often, there may be no symptoms for years, if ever. This is why it’s essential to monitor the cancer’s growth rate.
The complications of prostate cancer also extend to treatment:
Staging for prostate cancer is two-fold: clinical and pathologic. Clinical staging is done using a biopsy scored on the Gleason scale.
TNM staging, developed by the American Joint Committee on Cancer, is a globally recognized classification system, or standard of practice, which uses diagnostic tools to determine the following:
Gleason scoring makes a comparison of cancer cells to healthy tissues, which is called differentiation. The greater the cancer’s similarity to healthy tissues, the less aggressive it is. If the cells are markedly differentiated, the more aggressive the cancer is likely to be.
Pathologic staging is based on surgical findings, plus laboratory results of a biopsy. A pathologist scores the cell disparities on a scale of 3-5 from two different areas. A lower score means the cancer cells are not as highly differentiated as a higher score.
Doctors use a combination of TNM staging, PSA level, MRI scans, and Gleason Grade Group to diagnose prostate cancer:
Metastatic cancer spreads to bone structures roughly 80% of the time. If the cancer metastasizes, it’s considered advanced prostate cancer. Bone metastases will change the prognosis and treatment options.
A multidisciplinary team will work with your doctor to develop a prostate cancer treatment plan that includes managing treatment side effects and symptoms.
Active surveillance helps avoid overtreatment of prostate cancer. It is usually recommended if the tumor is small, confined to the prostate, expected to grow very slowly, or there are no symptoms.
If there are changes during active surveillance, follow-up testing may include:
Prostate surgery depends on the stage of the disease, overall health, and other factors.
A radical prostatectomy removes the seminal vesicles and possibly pelvic lymph nodes, along with the prostate.
Robotic or laparoscopic prostatectomy is less invasive than a radical prostatectomy.
Rarely used, bilateral orchiectomy involves surgery to also remove both testicles.
Conformal radiation therapy uses computers to map cancer’s location and shape, reducing radiation damage to healthy tissue and nearby organs.
Hypofractionated radiation therapy delivers a higher dose of radiation over a shorter period. The American Society of Clinical Oncology, the American Society for Radiation Oncology, and the American Urological Association recommend this therapy for early-stage prostate cancer that hasn’t metastasized in men who:
The side-effects of treatment can include:
Systemic therapy uses oral or intravenous medication to destroy cancer cells, either a stand-alone drug or several prescriptions combined, including:
The U.S. Preventive Services Task Force recommends that those with prostates, ages 55-69, make an informed decision about periodic PSA-based screening tests after a full discussion with their clinicians. The discussion should include the benefits of PSA screening as well as risks.
DRE or PSA tests and screening, together with other tools such as a prostate MRI scan or biopsy, can help provide a complete picture of the prostate gland and its health.
In fact, you can take advantage of the annual ezra full-body MRI program in order to stay ahead of the game.
When it comes to prostate or any other kind of cancer, early screening is the best medicine. Our annual scan spots cancer earlier, making it easier to cure and even possible to prevent.
At ezra, it’s easy to schedule an elective MRI scan.
