September is “Prostate Cancer Awareness Month.” Cancer awareness months are useful reminders that it is important to educate yourself about cancer prevention and screening. Prostate cancer is the most common cancer among men in the United States besides skin cancer and is the third-leading cause of cancer deaths in men in the U.S. and NEPA. About one in six men will be diagnosed with prostate cancer.
The prostate is a walnut sized gland located in the male reproductive system. Prostate cancer is the abnormal growth of cells (a tumor) in this gland. The tumor causes the prostate to swell and can spread to healthy tissues and other organs. As with many types of cancer, the medical community does not know what causes prostate cancer.
The title of this article illustrates how prostate cancer screening recommendations have changed over the last decade. Prior to 2012 prostate cancer screening which included a blood test (known as a PSA) and a digital rectal exam, was advised for almost all men age 50 and older. In 2012 a neutral task force in reviewing the screening gave the PSA a “D” grade essentially rejecting it completely. Recently though the same task force updated its recommendation and backed off from completely dismissing blood screening, saying it can be considered in men 55-69 years of age with informed decision making. Informed decision making means discussing both the pluses and minuses of prostate cancer screening with your health care provider and deciding what is best for you. Being informed leads to better decisions and better compliance with decisions.
Screening is looking for disease in people who have no symptoms of the disease. Many men with prostate cancer have no symptoms. If symptoms are present they can include: blood in the urine; need to urinate often; weak/interrupted urine flow; pain or burning while urinating; not able to urinate; pain in upper thighs, lower back, or hips. If you have these symptoms see your doctor as soon as possible. But, many of these symptoms are also caused by other less serious prostate issues. Older men, African-American men, and men with a family history of prostate cancer may have a higher risk for prostate cancer.
The PSA can be abnormal for a number of reasons besides cancer. So the only way to know if an abnormal PSA is caused by cancer is to do a biopsy. A biopsy is minor surgery to get a small piece of tissue to look at under a microscope. It is important to talk to your doctor about the risks and benefits associated with a biopsy.
The decision is yours to make. Some prostate cancers grow very slowly and will have no impact on your life span and quality of life. And some prostate cancers grow quickly, spread to other parts of the body and are a serious threat to your health. Right now physicians cannot always be sure what type of prostate cancer is present. Treatment for prostate cancer includes close monitoring and follow-up visits, surgery, hormone therapy, radiation and chemotherapy. Some treatments can have serious side effects such as impotence and loss of bladder and bowel control. Not all medical experts agree that screening for prostate cancer will save lives.
The Centers for Disease Control has created a list of questions to ask your doctor about prostate cancer screening. They are:
• Am I at greater risk for prostate cancer?
• At what age should I start to think about screening for prostate cancer?
• If I get my blood test, and it is not normal, what other things could I have besides prostate cancer?
• What is a biopsy, and how is it done?
• What are the side effects or risks of a biopsy?
• If my biopsy shows some cancer cells, what does that mean?
• Ask about all treatment options: watchful waiting/close monitoring and follow-up visits, radiation, or surgery to remove the prostate.
• What are the side effects or risks of each treatment?
The CDC and most organizations encourage men to talk with their doctors to learn the nature and risk of prostate cancer, understand the benefits and risks of the screening tests, and make decisions consistent with their preferences and values. The CDC states that if you decide not to get screened, you can always change your mind later. If you decide to get screened, it does not mean you have to go to the next step. You should discuss each step with your doctor. Remember talk with your health care team to decide together if prostate cancer screening is right for you.
The information contained in this article is meant to be helpful and educational but is not a substitute for medical advice. The above information is from the Centers for Disease Control and Prevention (cdc.gov). The Northeast Regional Cancer Institute can provide additional information on the above topic including the handout “Health Tips for men about prostate cancer: What you can do” that contains the above list of questions. Feel free to visit the Cancer Institute website at cancernepa.org, or contact the organization by calling (800) 424-6724.