What is Prostate Cancer?
Prostate Cancer is the most common cancer in men and accounts for the 2nd most common cause of cancer related deaths. In the year 2013, prostate cancer accounted for over 230,000 deaths in the United States. Clearly this is a significant problem and one that your urologist will pay close attention to.
Can You Prevent Prostate Cancer?
Chances of curing prostate cancer are best if the disease is detected at an early stage. This is the primary reason why annual rectal examinations by your doctor and appropriate use of PSA blood testing are encouraged. The treatment focus for curing prostate cancer should be in men who are expected to have at least 10-15 years of good quality health and life ahead of them. Based on very large international prostate cancer studies the age groups we are most focused on are men between 55-70 years of age.
As prostate cancer is usually slow growing, if it is detected in men after the age of 75 years of age, most urologists would be relatively conservative in their treatment. In this age group, the treatment for prostate cancer may actually cause more problems than the disease itself. Most likely no treatment would be offered other than close observation. Chances are that other medical problems such as heart disease, stroke or other medical problems will cause death in this more senior age group.
What Causes Prostate Cancer?
Risk factors include:
- Family History: If your father, brother, or other 1st male relative has had prostate cancer, your risk increases.
- Race: African-Americans have a greater risk; Asians lower risk
- Diet: Our American diet, which is high in fats, is associated with an increased risk for prostate cancer.
How is Prostate Cancer Diagnosed?
It is recommended that males after the age of 40 years should undergo a digital rectal examination as part of their annual physical examination by their primary care physician or urologist so as to evaluate the prostate gland. This is especially true in the presence of some of the risk factors listed above.
Associated with the digital rectal examination, your doctor may also recommend obtaining a blood test which further evaluates the prostate gland. This blood test is called PSA (prostatic specific antigen) and may also assist in detecting the presence of prostate cancer. Unless there is an abnormal rectal examination or other risk factors as listed above, it is recommended that PSA blood test be obtained starting after the age of 50 years.
If there is a concern, based on rectal examination and/or PSA blood test, your urologist will recommend a prostate biopsy which is normally performed in the office. If prostate cancer is detected on your biopsy, your urologist will have an extensive discussion with you about the best treatment options.
Further X-ray testing may be recommended to rule out spread of cancer to other parts of the body. This further testing is based on how aggressive the prostate cancer appears on the prostate biopsies as well as the PSA blood test.
How is it Treated?
Each case is different and there are a number of advantages and disadvantages of each treatment approach. The treatment options would include:
- Removing the prostate gland – Radical prostatectomy
- Radiation to the prostate gland – External beam or Radioactive Seeds
- Watchful Waiting or Active Surveillance – Careful monitoring and follow-up
- Hormonal therapy – Medical or surgical castration
- Others – Cryoablation/ High Intensity Focused Ultrasound, etc.