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Prostate Cancer

Prostate cancer is the second leading cause of cancer-related deaths in American men, with about 1 in 9 developing the disease in their lifetimes.

Prostate cancer is the second leading cause of cancer-related deaths in American men, with about 1 in 9 developing the disease in their lifetimes.

Overview

Prostate cancer is most common in older men and African American men; the disease’s average age of diagnosis is 661http://gco.iarc.fr/today/fact-sheets-cancers. However, the overall likelihood of someone developing prostate cancer depends on a number of risk factors, including age, race/ethnicity, family history, geography, genetic changes, and lifestyle patterns2http://gco.iarc.fr/today/fact-sheets-cancers.

Generally, prostate cancer is initially screened for by looking at your prostate-specific antigen (PSA) levels via a blood test, which is often followed by an invasive biopsy. These biopsies involve a doctor using a removing samples of prostate tissue with a needle through either the rectal wall or the perineum. As it turns out, PSA blood tests are not highly accurate3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392481/. In other words, PSA tests can lead to men undergoing invasive biopsies when they don’t have to. On the other hand, MRIs have a negative predictive value (NPV) of about 92% – indicating high accuracy in determining when there is no cancer present and therefore can help men avoid secondary procedures involving needles 4https://www.europeanurology.com/article/S0302-2838(15)01214-2/fulltext.

Learn more about Ezra's prostate cancer MRI

Symptoms

Prostate cancer is typically asymptomatic, but early warning signs may present as lower urinary tract symptoms because of how close the prostate is to the bladder and urethra. 

A prostate tumor could compress the urethra, thereby constraining the flow of urine. Related symptoms may include:

  • Blood in the semen on urine
  • Loss of bladder control
  • Painful ejaculation or urination
  • Difficulty urinating
  • Difficulty starting or stopping while urinating
  • Decreased urine flow
  • Increased urges to urinate at night time

However, prostate cancer can metastasize, or spread to tissues and bones in the surrounding area. In this event, symptoms may include:

  • Pain or numbness in the legs, feet, or hips
  • Swelling in the pelvic area or legs
  • Bone pain that doesn’t let up, or even results in fractures

(Source)

If you are having any of the above symptoms you need to talk to a doctor about the appropriate diagnostic work up. The Ezra scan is a screening test for asymptomatic individuals and it is not designed to diagnose existing or suspected cancers.

Causes

It is difficult for researchers to pinpoint precisely what causes prostate cancer, though they do know that prostate cancer originates in genetic changes, or mutations, found in the DNA of normal prostate cells. Sometimes, these mutations can occur in oncogenes or tumor suppressor genes, which are the genes in charge of when cells grow, divide into daughter cells, or die. Such mutations can be at least in part responsible for cancer and can be inherited from one’s parents or picked up randomly during one’s life5https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/what-causes.html.

Inherited gene mutations are associated with between 5-10 percent of prostate cancers. Some genes known to result in an increased risk of prostate cancer when mutated include:

BRCA1 and BRCA2: When functioning normally, these tumor suppressor genes help fix mistakes in a cell’s DNA, or cause it to die if the mistake is irreparable. Inherited mutations in these genes–especially BRCA2–often lead to ovarian and breast cancer in women, and account for a small number of prostate cancer cases in men.

RNASEL: When this tumor suppressor gene is functioning properly, it helps cells die when something goes awry within them. Inherited mutations in RNASEL could result in abnormal cells living longer than is healthy, which may lead to a higher risk of prostate cancer.

DNA mismatch repair genes (such as MLH1 and MSH2): These genes are supposed to help fix mismatches in DNA when a cell is getting ready to divide into 2 daughter cells; men with inherited mutations in these genes have Lynch syndrome, which puts them at a higher risk of prostate and other cancers.

(Source)

Dectection

The American Cancer Society recommends that most men should begin getting regularly screened for prostate cancer beginning at 50, but those who are at a higher risk should consider doing so earlier6https://www.cancer.org/latest-news/4-cancer-screening-tests-for-men.html. Popular prostate cancer screening tests include: the digital rectal exam, PSA blood test, prostate biopsy, transrectal ultrasound, and various imaging tests, such as MRIs7https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html.

Digital rectal exams (DREs) are procedures in which a physician will insert a lubricated, gloved finger into a patient’s rectum and feels the prostate for any bumps or other abnormalities. If the doctor finds any cause for concern, they will order another type of exam, such as a PSA blood test or prostate biopsy8https://prostate.net/articles/what-happens-during-a-prostate-exam/.

As mentioned before, PSA blood tests look for a prostate-specific antigen found in the blood; it’s most often used to screen asymptomatic men, or those who are exhibiting very early signs of the disease. In general, men with prostate cancer will have PSA levels of at least 4 ng/mL, though a PSA level lower than that doesn’t guarantee an absence of the disease. If one’s doctor is worried about a PSA test’s results, they will often recommend moving forward with a prostate biopsy.

Men with a PSA between 4 and 10 have approximately a 25% chance of having prostate cancer, and those with a PSA level above 10 has an over 50% chance of having the disease. PSA tests are also frequently used to monitor an existing prostate cancer or treatment regimen9https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. As previously mentioned, PSA blood tests were found to be only about 21% accurate in a 2012 study10https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392481/

A prostate biopsy is the next step if a doctor finds cause for concern on another test, such as a DRE or PSA test. In this exam, a specialist will insert a small needle into the patient’s rectum and take small samples of the prostate to be examined under the microscope. Biopsies, however, can sometimes miss a cancer, resulting in a false-negative result11https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Additionally, biopsies are risky, and can result in bleeding, discomfort, and infection12https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690315/.  

Another method of detecting prostate cancer involves using MRIs to scan and analyze the pelvic region for prostate cancer. With the help of MRI, a 2017 study showed that 30% of patients were able to avoid unnecessary prostate biopsies. And, as stated before, they’re approximately 92% accurate in detecting cancer13https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32401-1/fulltext.

Diagnosis

Upon diagnosis, prostate cancer is graded on a Gleason Score, which is used to evaluate the likely aggressiveness of a given case. They range from 2-10, grade how quickly the cancer will probably grow, and indicate the likelihood of metastasis. Specialists calculate a Gleason Score by examining and numerically grading cell patterns in prostate tissue under a microscope, then adding the grades of the two most commonly-observed cell patterns together14https://prostatecancerfree.org/prostate-cancer-gleason-score/?gclid=EAIaIQobChMItK3dnZPV4QIVCp6fCh0DZQekEAAYAyAAEgKs1PD_BwE. Gleason Scores for prostate cancer usually fall in the 6-10 range. The higher the score, the more likely it is to quickly grow and spread15https://www.prostateconditions.org/about-prostate-conditions/prostate-cancer/newly-diagnosed/gleason-score.

Physicians also commonly describe prostate cancer using the TNM staging system. They employ results obtained from scans and other diagnostic tests to answer the following questions:

  • T is for tumor: How large is the primary tumor, and where is it?
  • N is for node: Has the tumor spread to the lymph nodes? If it has, to which nodes and how many?
  • M is for metastasis:: Has the cancer metastasized anywhere else in the body? If it has, to where and how much?

(Source)

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Treatment

The best treatment for prostate cancer depends on the nature of the disease and how far it has spread. Treatment options include: active surveillance, combined individualized treatment, hormone therapy, brachytherapy, radiation, focal therapy, prostatectomy, chemotherapy, and bone-targeted therapy16https://www.mskcc.org/cancer-care/types/prostate?gclid=EAIaIQobChMIrYG-25D24QIVgoxRCh0KFQy7EAAYAiAAEgLvo_D_BwE.

Please consult with a physician on treatment options as necessary.

Notes from Ezra:
If you have prostate cancer, your chance of surviving at least five years increases by about 70% if you catch it early17https://www.cancer.net/cancer-types/prostate-cancer/statistics This makes early detection your best bet for fighting the disease.

A plan for everyone.

We offer multiple pricing plans to ensure everyone can benefit from the Ezra cancer screening solutions.

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