by Dr. C.H. Weaver M.D. Medically reviewed 8/2020
If you are like most American women, chances are you serve as the key decision-maker when it comes to the health of your family— whether it’s selecting a physician, deciding on treatment options, or taking steps to prevent the onset of illness. It’s a role that carries with it the awesome responsibility for making effective, informed decisions that give your loved ones the best chance of a good outcome and enduring health. This is particularly true when confronting the issue of cancer. And the cancer that is most likely to strike the men in your family, as they age, is prostate cancer.
What Exactly Is the Prostate?
The prostate is a walnut-size gland located between the bladder and the penis. It surrounds the urethra, the tube that carries urine from the bladder to the penis. When it becomes enlarged, a common condition with age, the urethra is squeezed and urinary problems can result. The prostate plays an important role in reproduction, being responsible for much of the seminal fluid produced by a man.
What Is Prostate Cancer?
When cellular growth goes awry in any organ, cancer is often the result. When this happens in the prostate, it is referred to as prostate cancer. Doctors refer to the most common type of prostate cancer as adenocarcinoma of the prostate, based on the particular type of cancer cells that have developed.
How Common Is Prostate Cancer?
With the exception of skin cancer, prostate is the most common cancer occurring in men. According to the National Cancer Institute (NCI), there are close to 3 million men living with prostate cancer in the United States. An additional 180,000 new cases of prostate cancer will be identified in 2016, and approximately 26,000 deaths will be associated with the disease.(1)The good news is that most forms of prostate cancer are relatively indolent, or slow growing. As a result, the five-year survival rate following a diagnosis of prostate cancer is 98.9 percent. The NCI further states that while “an estimated 16 percent of men will be diagnosed with prostate cancer in their lifetime…only 3 percent will die of it.”(1)
What are the risk factors?
Although scientists are uncertain about the exact cause of prostate cancer, some of the following risk factors have been linked to the disease:
- Age. Chances of having prostate cancer increase significantly after age 50.
- Family history. Men whose fathers, brothers, uncles, or grandfathers have had prostate cancer are at double the risk.
- Race. The highest incidence of prostate cancer occurs in African-American men, and they are more than twice as likely to die from the disease.
Are There Clear Symptoms Associated with Prostate Cancer?
Prostate problems are relatively common in men over the age of 55, and these issues may be mistaken for cancer in some cases. An enlarged prostate, known as benign prostate hyperplasia (BPH), can be particularly troublesome, causing problems with urination, sexual function, and other symptoms. And while problematic, BPH is far more of a nuisance than a serious threat to a man’s health.Though prostate cancer can mimic the symptoms of BPH, it can also be present without the appearance of symptoms, particularly in its early stages. When prostate cancer becomes advanced, other symptoms may be present, including bone pain (frequently occurring in the lower back) and unexplained weight loss.
Often prostate cancer has no symptoms; however, some men experience:
- Urination problems
- Blood in urine or semen
- Difficulty with erections
- Painful ejaculations
- Back or hip pain
Note: Benign prostatic hyperplasia, commonly known as an enlarged prostate, can also cause these symptoms, so speak with a doctor to be diagnosed and treated if necessary.
How Is Prostate Cancer Diagnosed?
Preliminary diagnosis generally relies on screening, which consists of a blood test, known as a PSA (prostate specific antigen), accompanied by a digital rectal exam. Because the prostate is located directly in front of the rectum, a physician is able to palpate the gland with his or her finger to see if there are any obvious abnormalities. Neither test is definitive, which means that suspected cases of cancer must be biopsied. (2)
When performing a biopsy, a surgeon—most frequently a urologist—relies on ultrasound-guided imaging to insert needles into various sites on the prostate. The hollow needles extract tissue cores that can then be examined to determine the extent of the disease. Twelve samples are most commonly collected. The cores are then examined by a pathologist, who rates them based on what is known as the Gleason score, which ranges from 2 to 10; higher numbers signify a more serious expression of the disease. If more-advanced disease is suspected, additional imaging studies may be performed to determine if the cancer has metastasized, or spread to bones or other organs. Based on the sum of the evidence collected through these various tests, patients are assigned a stage that indicates the extent of the disease. The earliest-stage cancers are described at Stage I; cancer that has spread to other portions of the body are Stage IV. (1-3)
How can prostate cancer be detected early?
Communication with a physician along with prostate cancer education is crucial to a man’s prostate health. The best early-detection tools currently available are a PSA blood test and a DRE*.* The American Urological Association recommends a baseline PSA and DRE at age 40. Patients and physicians should discuss risk factors and future annual screenings. The patient and his spouse or partner must be proactive about knowing his PSA numbers. PSA numbers should be tracked over time, as significant increases could indicate the need for further testing.
If the PSA or DRE is abnormal, the patient needs to be informed of the risks and the benefits of invasive prostate cancer screening (needle biopsy). Every case is unique, so getting a second opinion, ideally at a cancer center, can be an important next step. It is every patient’s right to speak up and receive the best healthcare possible, and wives and partners can be invaluable teammates in achieving this goal.
What Types of Treatment Are Recommended?
The stage of the tumor, the presence of cancer driving mutations detected by NGS and one’s age at diagnosis may significantly guide treatment options. Because many forms of prostate cancer are slow growing, very early-stage tumors may warrant careful observation, known as active surveillance, rather than aggressive treatment.
When treatment is required, the urologist may recommend either radiation therapy or the surgical removal of the prostate, known as a radical prostatectomy. Radiation therapy can take several forms, with the most common being an external beam of radiation to target the prostate and kill cancer cells. Brachytherapy involves a single, surgical insertion of radioactive seeds into the cancerous portions of the prostate. Before deciding on a treatment option, it is vitally important that you and your loved one understand the nature of each, as well as its potential short- and long-term side effects. It is advisable to get more than one opinion. Consider scheduling a consultation with both a urologist and a radiation oncologist. You may also find it helpful to do some research into the disease and your treatment options.
Are There Significant Side Effects of Treatment?
Prostate cancer treatment, whether involving surgery or radiation, can cause a host of short- and long-term side effects. Transient side effects are generally tolerated well. Long-term problems with incontinence and or erectile dysfunction, however, can have a major impact on a man’s quality of life. Though estimates vary widely, it is reasonable to assume that such long-term or permanent side effects may occur in significant percentage5 of all patients.When surgery is performed, a nerve associated with sexual function can be severed. A skilled surgeon may be able to spare the nerve, but there are no assurances. Radiation often damages the nerve, though the onset of symptoms may be delayed by as much as one to two years. You should actively question your physicians about their outcomes—specifically the frequency with which their patients experience long-term problems with incontinence and/or impotency.
What can women do to encourage men’s prostate health?
Women can ensure that the men in their families get their annual physicals and, if necessary, make the appointment for him. Early detection is the key to a good quality of life. If your partner is diagnosed with prostate cancer, attend his medical appointments with him and stay as well informed as possible. Support groups such as those offered by Us TOO and Women Against Prostate Cancer are invaluable resources for support and information.
- SEER Cancer Statistics Fact Sheets: Prostate Cancer. National Cancer Institute website. Available at: seer.cancer.gov/statfacts/html/ prost.html. Accessed July 25, 2016.
- PSA Velocity Does Not Improve Prostate Cancer Detection. National Cancer Institute website. Available at: http://www.cancer.gov/types/prostate/research/psa-velocity-detection. Accessed July 25, 2016.
- Understanding Your Pathology Report: Prostate Cancer. American Cancer Society website. Available at: cancer.org/treatment/ understandingyourdiagnosis/understandingyourpathologyreport/prostatepathology/prostate-cancer-pathology. Accessed July 25, 2016.
- Wisenbaugh ES, Andrews PE, Ferrigni RG et al. Proton beam therapy for localized prostate cancer 101: Basics, controversies, and facts. Reviews in Urology. 2014;16(2):67-75. doi: PMC4080851.
- Pardo Y, Guedea F, Aguiló F et al. Quality-of-life impact of primary treatments for localized prostate cancer in patients without hormonal treatment. Journal of Clinical Oncology. 2010;28(31):4687-96. doi: 10.1200/ JCO.2009.25.3245.