- In many cases, a prostate cancer tumor can’t be felt during the prostate cancer screening method of digital rectal exams, and the patient may never exhibit symptoms.
- Most prostate cancers grow slowly and remain localized, requiring little, if any, treatment throughout a man’s life.
- Early detection of prostate cancer through screening can help ensure enhanced quality of life and a longer life expectancy.
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.
What is the prostate?
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.
What is prostate cancer screening?
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.
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.
Who should have prostate cancer screening?
The U.S. Preventive Services Task Force recommends 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 risk factors.
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.
Warning signs of prostate cancer.
Keep an eye out for the following symptoms, as they may indicate prostate cancer:
- Frequent urination may indicate a need to visit your urologist.
- Weak or interrupted urine flow suggests that routine screening is in order.
- Blood in the urine or seminal fluid could indicate trauma, infection, inflammation, stones, or cancer. Make an appointment to see your doctor immediately if you find blood in your urine.
- Prostate cancer can also lead to erectile dysfunction.
- Pain or burning during urination could indicate an infection or something more serious such as prostate cancer. If these symptoms appear, make an appointment with your primary care doctor or a urologist.
- Discomfort or pain when sitting may indicate an enlarged prostate gland. A diagnostic MRI could help rule out more serious conditions such as prostate cancer.
What if I am diagnosed with 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:
- Cancer metastasizes, appearing in other organs or bone structures
- Urinary incontinence
- Erectile dysfunction
Stages of prostate cancer.
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:
- How big is the primary tumor, and where is it?
- Are the lymph nodes involved? How many and where?
- Has the cancer metastasized? If so, where and by how much?
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.
Understanding cancer staging.
Doctors use a combination of TNM staging, PSA level, MRI scans, and Gleason Grade Group to diagnose prostate cancer:
- Stage I: This is early-stage, slow-growing cancer.
- Stages II, IIA, IIB, IIC: The tumor is only in the prostate, and in Stages IIB and IIC, involves one-half or less of the prostate. PSA levels are low to medium.
- Stage III IIIA, IIIB, IIIC: In all stages: PSA levels are high and the tumor is growing, or it’s a locally advanced cancer that is likely to grow and spread.
- Stage IV, IVA, IVB: The cancer has spread beyond the prostate.
- Recurrent: The cancer has returned after treatment.
What if prostate cancer metastasizes?
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.
Treatments of prostate cancer.
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:
- 3 to 6-month PSA test
- Annual DRE
- Follow-up biopsy in 6-12 months, repeated every 2-5 years
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:
- Need or prefer treatment over active surveillance
- Are at intermediate or high-risk and receiving radiation that doesn’t include pelvic lymph nodes
The side-effects of treatment can include:
- Increased urinary urge or frequency
- Sexual function issues
- Bowel function problems, including diarrhea, rectal discomfort or bleeding, and fatigue
Systemic treatments for prostate cancer.
Systemic therapy uses oral or intravenous medication to destroy cancer cells, either a stand-alone drug or several prescriptions combined, including:
- Testosterone suppression therapy
- Androgen axis inhibitors
- Targeted therapy
Early detection is the best medicine for prostate cancer.
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.
At Ezra, it’s easy to schedule an elective MRI scan.
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 detection is the best medicine. Our annual scan spots cancer earlier, making it easier to cure and even possible to prevent.
Unfortunately in our current health system, most of the time men have to first get a prostate biopsy before their health insurance will cover a Prostate MRI with IV contrast. This is backwards because a prostate biopsy has notable risks (infection, bleeding and sometimes, erectile dysfunction). Conversely, a prostate MRI is non-invasive and therefore, less risky. That’s why Ezra physicians at our New York locations now offer a prostate MRI with IV contrast to men with elevated PSA levels or urinary symptoms. With our prostate MRI, you can get a head start on prostate cancer — sign up for a consultation today.