By Dr. Vivek Sinha
Prostate cancer is the most commonly diagnosed cancer for men in the United States. It’s anticipated that 165,000 men will be diagnosed with it this year alone.
Who is at higher risk of being diagnosed with prostate cancer? Who should be checked for it? How do medical professionals screen for it? These are important questions that primary care physicians should address with all of their adult male patients. Luckily, there is a lot we know about prostate cancer. Like everything else in medicine, we must start at the beginning.
All men have a prostate. The prostate gland is a small structure that is a part of the male reproductive system. It is found directly below the bladder, in front of the rectum. The location of the prostate is integral in understanding the symptoms of prostate problems.
As men approach 50, many will experience prostate enlargement. This is a condition called Benign Prostatic Enlargement and is a separate condition from prostate cancer. It’s theorized that BPH is not a direct risk factor for prostate cancer; however, tests and research are still being done.
The central part of the prostate enlarges as a result of BPH, while the outer portion of the gland enlarges in the case of prostate cancer. When the central part of the prostate enlarges, it often compresses the tube, or uretha, carrying urine out of the bladder. This is why men with BPH will often experience symptoms related
to problems with urination, including increased frequency of urination, urgency in urination, intermittent urinary stream, hesitancy in initiating a urine stream, increased nighttime urination and urinary incontinence.
While BPH is not a life-threatening condition, it can affect the quality of life drastically. The initial work up involves looking for other causes of the above symptoms, and it also involves checking for prostate cancer. There are medications and procedures that can help relieve the pressure on the urinary tube and thereby relieve the urinary symptoms.
The enlargement caused by prostate cancer is different than BPH, as are its consequences. If left unchecked, aggressive forms
of prostate cancer can spread to various parts of the body, such as the bones or the lungs. Once prostate cancer has spread, the five-year survival rate is significantly decreased compared
to the same period of time if it has not spread. So, early detection and determination of the type of prostate cancer – and whether it’s aggressive or non-aggressive – is critical information physicians must determine whenever the diagnosis is made.
Who should be checked for prostate cancer? We know that there are certain risk factors that, when present, put men at a higher risk of developing prostate cancer.
Prostate cancer, of all human cancers, has one of the most direct relationships with age. Certain studies have indicated that men between 51 to 60 years of age can have a 5 to 46 percent chance of having cancer, with percentages rising up to 31 to 83 percent for men between the ages of 71 to 80. Unfortunately, the wide ranges of the percentages show just how difficult it can be to accurately diagnose aggressive prostate cancer.
It is believed that African American men and
Hispanic men have a higher incidence of prostate cancer.
Genetic factors also play a major role in developing prostate cancer. A male with the presence of certain cancer genes or who has a family history of prostate cancer may often be at higher risk.
How do we check for prostate cancer? There is much debate in the medical field about who and when we should be screening for prostate cancer. The biggest reason as to why there is controversy in screening is because, while current tests are fairly good at detecting the presence of prostate cancer, they are not as accurate at determining if the particular cancer that is diagnosed is aggressive or not. Proponents argue that this often leads to over-treatment of non-aggressive types of prostate
As a primary care physician, I feel the best approach is to start with a conversation with your doctor. In fact, in June, the United States Preventative Services Task Force updated their prostate cancer screening guidelines to specifically advise men between 55 and 69 to have a targeted discussion with their physician about the risks vs. the benefits of screening and to come up with an individualized screening plan, based on their individual risk factors.
There are various methods that are used for screening for prostate cancer. A digital rectal exam and a blood test called the Prostate Specific Antigen are common initial forms of screening, though there are various studies that show different success rates of the rectal exam. The PSA can also be elevated in non-cancerous conditions (such as infection of the prostate and BPH) therefore careful interpretation — and possible repeat testing — are important in making an accurate diagnosis. Once the initial testing returns abnormal, tests should be interpreted in the context of the specific patient and then a plan of action should be formed. This plan may include further testing, like a prostate biopsy, or it may include watchful waiting and re-checking blood work at specific intervals.
With all the variations in prostate cancer screening and diagnosis, there are a few things that are absolutely certain: prostate cancer is extremely common and, if it’s left unchecked, certain types will be fatal. The best course of action any man can take is to have a trusted health care provider who can guide him through his own personal risk factors and come up with an individualized plan to be screened for prostate cancer.
If you are a male above the age of 40, talk to your doctor. While they may not test you immediately, it’s an important discussion to have each year and it may even save your life.
Dr. Vivek Sinha is the chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.