What is the prostate?
The prostate is a walnut sized gland that sits between the bladder and the penis. The urethra runs through the prostate from the bladder to the penis. It is responsible for secreting fluids that support sperm.
Is prostate cancer common?
Prostate cancer is the number one cancer among men in the USA with about 165 000 new diagnoses per year. Around 30 000 men will die of this per year there. Men with a primary relative (father, brother or son) with a history of prostate cancer are two to three times more likely to also develop prostate cancer.
How is prostate cancer diagnosed?
Despite the high incidence of this type of cancer, screening for it is not universally recommended. This is because screening with PSA (prostate specific antigen- a protein produced by both cancerous and noncancerous prostate tissue) does not give a definite diagnosis. False positive and negative results are possible so determining what a high PSA is due to can be complicated.
Factors which influence the how PSA level should be interpreted include your age, the size of the prostate (often checked during a clinical examination with a palpation of the gland via an internal rectal examination), how fast the PSA levels rise and whether you are taking medications that affect PSA levels like Finasteride (Propecia/ Proscar), Dutasteride and herbal preparations like saw palmetto.
Conditions that can cause an elevated PSA level in the absence of a cancer include: benign prostate enlargement (benign prostatic hyperplasia), a prostate infection (prostatitis) and other less common conditions. Only a quarter of patients with an abnormal PSA test actually have prostate cancer.
The known risk factors for prostate cancer are:
- Age- The risk increases with age and there is a significant increase after age 50. The majority are discovered after age 65. Testing of the PSA levels can start at age 40 and continues till your life expectancy is 10 years or less as prostate cancer progression is likely to be slow enough then that it is unlikely to cause problems during the remainder of your lifetime.
- Race- Black men have a 1.5 times higher risk of developing prostate cancer.
- Family history- Prostate cancer in a close relative is associated with a 2-3 times increase in risk.
- Diet- A high fat diet and obesity has been associated with prostate cancer.
What are the symptoms of prostate cancer?
Symptoms of prostate cancer can be absent in the early stages. Later on, symptoms may include passing urine frequently, passing urine frequently at night, a weak urinary stream, blood in the semen, new onset erectile dysfunction (rare), pain when passing urine and pain or discomfort when sitting due to an enlarged prostate.
Some of the main arguments against screening for prostate cancer are the anxiety from false positive results, invasive and expensive follow up tests (that can cause issues with incontinence and erectile dysfunction) and even anxiety from knowing you have a slow growing prostate cancer that does not need treatment.
The American Cancer Society (ACS) recommends that men consult with their doctors to make an informed choice about PSA testing. The ACS says men should consider starting PSA screening at age 50. Those with a high risk profile should start at 45 and at 40 if they are at very high risk (those with multiple first degree relatives who had prostate cancer at an early age). Testing is done annually.
As you now see, prostate cancer screening is a complicated issue. We therefore recommend discussing screening with your doctor before as interpretation of the results can be difficult.