JOHNSTOWN, Pa. – Prostate cancer is the second-leading cause of cancer deaths and the second-most-common cancer in men.
The American Cancer Society estimates the disease will strike more than 190,000 men this year and cause more than 33,000 deaths.
But doctors say many lives can be saved with annual screenings.
Sound familiar? There is similar information shared every October for breast cancer awareness.
“It's the men’s equivalent of breast cancer in women – the caveat being: It’s not as lethal as breast cancer,” said Dr. Gideon Lorber, a UPMC urologist who sees patients at UPMC Somerset.
“It is definitely something that we would like to screen for,” he said.
The prostate is walnut-sized a gland that produces some of the fluid that carries sperm. Located below a man’s bladder, it surrounds the urethra, the tube through which urine passes out of the body.
Screening for prostate cancer begins with a simple blood test to check levels of prostate-specific antigen. Results are reported in nanograms per milliliter.
Normal PSA results range from 0 to 4 ng/ml, with some variables. Higher PSA levels indicate the possibility of cancer.
In addition to an annual PSA test, it is recommended men get an annual digital rectal exam from their doctors, said Dr. Juddson Chason, a urologist at Conemaugh Memorial Medical Center in Johnstown.
“They go together,” Chason said. “The PSA finds things you can’t feel on a digital rectal exam and the rectal exam finds cancers that don’t produce a lot of PSA.”
Like many cancers, the prognosis improves with early detection. The American Urology Association guidelines say screening has the greatest benefit in men ages 55 to 69. Men 70 and over who are in good health may continue the screenings, and those with elevated risk factors may begin screenings as early as age 40.
“If you catch it early, it’s curable with either surgery or radiation,” Chason said, adding that even many whose cancer is not eliminated can be successfully treated to survive with a good quality of life.
Diagnosis takes several steps, beginning with the PSA, rectal exam and a medical history review, Lorber said.
Combining those three, doctors may order a biopsy to take some tiny samples from the prostate. The minimally invasive procedure is done with a needle-like tube the doctor directs using ultrasound imaging.
“The biopsy is an office-based procedure with local anesthesia,” he said.
Samples from the biopsy are sent to pathology to determine not only if it is cancer, but the type of cancer.
“If it comes back positive, we would have a discussion of the next step based on the type of prostate cancer,” Lorber said, explaining the discussion would weigh the patient’s age, general health, other medical conditions and personal wishes.
“We factor all those come up with a plan of what is the best treatment for the patient,” Lorber said.
'Surgery or radiation'
The American Cancer Society says almost all prostate cancers are adenocarcinomas, which develop from the prostate gland’s cells producing the semen fluid.
Other types include small cell carcinoma, neuroendocrine tumors, transitional cell carcinomas and sarcomas.
“For prostate cancer, we categorize it into risk stratification: Very-low, low, intermediate and high-risk,” Chason said. “By far, the vast majority are either low-risk or intermediate-risk, which are treated with surgery or radiation.”
For very low-risk cancer, active surveillance is often the initial plan. It includes a stepped-up screening schedule and sometimes a magnetic resonance imaging scan of the prostate, Lorber said.
The primary surgical option is removal of the prostate, called radical prostatectomy.
With radiation therapy, a radioactive beam is pinpointed on the cancer.
“Radiation therapy is usually given in conjunction with hormonal therapy,” Lorber said. “We would give an injection that would block the effect of testosterone on the prostate cancer. (The injection) has been proven to improve the efficacy of the radiation treatment.”
Urinary incontinence and erectile dysfunction are the most significant side effects with either surgery or radiation, Chason said. Both conditions often improve as muscles regain tone, but there are treatment options if they persist.
Hereditary risk factor
Like breast cancer, prostate cancer screenings were disrupted following a controversial recommendation by the U.S. Preventive Task Force.
In 2009, the task force pushed its recommendation for screening mammograms from beginning at age 40 to age 50 and from annually to bi-annually. Most doctors’ groups rejected the change and continued to recommend the screenings for those age 40 and older with average risk factors.
In 2012, the task force recommended against PSA-based screening for prostate cancer. Subsequent studies showed cancer rates went up following the change. The task force changed its recommendations again in 2018 to include annual PSA screenings, but Lorber said many primary care physicians are not routinely suggesting the tests.
Prostate cancer also shares a hereditary risk factor with breast cancer, Chason said.
“It can definitely run in families,” Chason said. “The BRCA genes, just like breast cancer, have been shown to increase the risk of prostate cancer. And not just prostate cancer, but a higher-grade, higher-risk prostate cancer.”
Although even talking about prostate disease is uncomfortable for some men, both urologists say that preventing and surviving prostate cancer starts with communication.
Men should be discussing their risk factors and benefits of screening with their primary care doctors and not waiting until symptoms develop, the doctors say.