The American Cancer Society estimates that approximately 241,740 new cases of prostate cancer will be diagnosed in the United States this year. Prostate cancer is the most frequently diagnosed cancer in men, aside from skin cancer. For reasons that remain unclear, incidence rates are significantly higher in African-Americans than in whites, with 241 versus 149 (per 100,000 men), respectively, in 2008. Incidence rates for prostate cancer changed substantially between the mid-1980s and mid-1990s and have since fluctuated widely from year-to-year, in large part reflecting changes in prostate cancer screening with the prostate-specific antigen (PSA) blood test.
Am I at risk?
The only well-established risk factors for prostate cancer are increasing age, African ancestry, and a family history of the disease. About 60 percent of all prostate cancer cases are diagnosed in men 65 years of age and older, and 97 percent occur in men 50 and older. African-American men and Jamaican men of African descent have the highest documented prostate cancer incidence rates in the world. Genetic studies suggest that strong familial predisposition may be responsible for 5-10 percent of prostate cancers. Recent studies suggest that a diet high in processed meat or dairy foods may be a risk factor, and obesity appears to increase the risk of aggressive prostate cancer.
What are the symptoms of prostate cancer?
Early prostate cancer usually has no symptoms. With more advanced disease, men may experience weak or interrupted urine flow, inability to urinate or difficulty starting or stopping the urine flow, the need to urinate frequently, especially at night; blood in the urine, or pain or burning with urination. When experiencing such symptoms, a physician should be consulted to determine their actual cause.
What are the American Cancer Society recommendations for screening?
The American Cancer Society recommends that, beginning at age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years receive information about the potential benefits and known limitations associated with testing for early prostate cancer detection and have an opportunity to make an informed decision about testing. Men at high risk of developing prostate cancer (African-Americans or men with a close relative diagnosed with prostate cancer before age 65) should have this discussion with their health care provider beginning at age 45. Men at even higher risk (because they have several close relatives diagnosed with prostate cancer at an early age) should have this discussion with their provider at age 40. All men should be given sufficient information about the benefits and limitations of testing and early detection to allow them to make a decision based on their personal values and preferences.
Results from clinical trials designed to determine the efficacy of PSA testing for reducing prostate cancer deaths have been mixed. Two European studies found a lower risk of death from prostate cancer among men receiving PSA screening, while a study in the United States found no reduction. Current research is exploring new biologic markers for prostate cancer as well as alternative ages of screening initiation and timing of testing–the goal being to identify and treat men at highest risk for aggressive disease while minimizing unnecessary testing and over-treatment of men at low risk for prostate cancer death.
Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
• Men who have a PSL level of 2.5 ng/mL may only need to be retested every two years.
• Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
Because prostate cancer often grows slowly, men without symptoms who do not have a 10-year life expectancy should not be offered testing, since they are unlikely to benefit. Overall health status, not merely the patient’s age, is important when making decisions about screening.
How is prostate cancer diagnosed?
As part of the initial screening, your physician may order a PSA blood test and conduct a digital rectal examination (DRE). Your physician will also take into account your general health, personal values, and preferences.
Based on the initial findings, your physician may require that a prostate biopsy (the primary method used to diagnose prostate cancer) be performed. In obtaining a biopsy, your physician performs a surgical procedure using a very thin needle to remove a small piece of abnormally appearing tissue from your prostate gland. The tissue sample is then sent to a diagnostic laboratory for microscopic examination by a pathologist, a physician trained in the diagnosis of disease through the examination of tissue and cells. If the existence of cancer is confirmed, the pathologist will assist your physician in determining the stage and extent of disease.
What treatment options are available for prostate cancer?
Treatment options vary depending on the patient’s age and the stage and grade of the cancer, as well as other medical conditions. The grade assigned to the tumor, typically called the Gleason score, indicates the likely aggressiveness of the cancer and ranges from 2 (nonaggressive) to 10 (very aggressive).
Options for treating early-stage prostate cancer include surgery (open, laparoscopic, or robotic-assisted), external beam radiation, or radioactive seed implants (brachytherapy). Data show similar survival rates for patients with early-stage disease treated with any of these methods, and there is no current evidence supporting a “best” treatment for prostate cancer. Adjuvant hormonal therapy may be indicated in some cases. All of these treatments may impact a man’s quality of life through side effects or complications, including urinary and erectile difficulties. Accumulating evidence suggests that careful observation (active surveillance), rather than immediate treatment, can be an appropriate option for men with less aggressive tumors and for older men.
Hormonal therapy, chemotherapy, radiation, or a combination of the foregoing are used to treat more advanced disease. Hormonal therapy may control advanced prostate cancer for long periods by shrinking the size or limiting the growth of the cancer, thus helping to relieve pain and other symptoms.
More than 90 percent of all prostate cancers are discovered in the local or regional stages for which the 5-year relative survival rate approaches 100 percent. Over the past 25 years, the 5-year relative survival rate for all stages, combined, has increased from 68 percent to almost 100 percent. According to the most recent data, 10- and 15-year relative survival rates are 98 percent and 91 percent, respectively. Obesity and smoking are associated with an increased risk of dying from prostate cancer.
This information is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon your medical history and current condition. Only your physician and you can determine your best treatment option.
For more information:
American Cancer Society
250 Williams Street NW
Atlanta, Georgia, 30303
American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090