November has been designated as Prostate Cancer Awareness month. The prostate is a gland unique to men that is located at the base of the bladder. It naturally enlarges with age and can cause benign urinary symptoms but also can develop cancer. The goal of this article is to help raise awareness and provide some information on prostate cancer and screening.
Except for skin cancer, it is predicted that in 2014 prostate cancer will be diagnosed more than any other type of cancer in men. It is estimated that one out of seven men will be diagnosed in their lifetime. It is predicted that it will be the fourth leading cause of cancer death, below lung cancer and colon cancer, and slightly less than breast cancer. Also, it is predicted there will be about 30,000 deaths due to prostate cancer but there are 2.5 million men alive with prostate cancer. The high number of survivors is felt to be due to better treatment options and at least partly due to early detection.
Prostate cancer screening is more controversial than screening for colon, breast, or cervical cancers. There are techniques for early detection but studies question whether mass screenings actually prevent deaths. This has led organizations, like the American Cancer Society, to advise men to discuss the benefits and risks of screening with their provider to decide if it is right for them.
For years prostate cancer screening was done by a rectal exam. The exam was not very effective at detecting cancer in the early stages. In the 1990s a blood test was developed. This test is known as the PSA or prostate specific antigen. The widespread use of this test was associated with a spike in the diagnoses of prostate cancer. However, the prostate cancer deaths did not dramatically decrease. The PSA does not differentiate between the cancers that are aggressive and those that may grow very slowly. So the controversy revolves around whether the risk and expense of early diagnosis and treatment justifies the potential benefits.
So, the American Cancer Society has advised that whether to screen or not to screen should be a decision made between the patient and provider. If a decision is made to screen, it is advised to do a PSA blood test with or without a digital exam starting at age 50. High risk individuals may start at age 45. If the PSA level is less than 2.5, it can be repeated every other year. If greater than 2.5 it is suggested to be done every year. Generally a PSA greater than 4 is considered abnormal. A high PSA may prompt an ultrasound and biopsy. One drawback to the PSA is that it can be elevated without cancer being present leading to unnecessary testing. If an individual has medical problems that would indicate his life expectancy is less than 10 years, or if he is over 75 years old, the PSA is generally not indicated as a screening test.
Those who would benefit most from screening would be men who are relatively healthy, between the age of 50 and 75, who are willing to accept the risk of a biopsy and then treatment if a cancer was found.
There are no lifestyle factors known to be associated with prostate cancer. The major risk factors are aging, having a first degree relative diagnosed at age less than 65, and being African American.
In summary, prostate cancer is common, it can be screened for, but the screening is controversial. Men are encouraged to discuss screening with their provider and make a joint decision about whether to do it. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician