Your Prostate Gland, Your Responsibility: Understanding the Risks, Diagnosis, and Treatment Options for Prostate Cancer

Prostate cancer occurs when healthy cells in the prostate start to differentiate from normal cells, growing uncontrollably and resulting in a tumor. The prostate is a walnut-sized gland in men, located just below the bladder and in front of the rectum, and is involved in the creation of semen.

Tumors on the prostate may be on one side of the gland or on both sides. Without treatment, the tumor can continue to grow and may spread (or metastasize) to other parts of the body.

Prostate cancer often grows slowly, and symptoms may only appear after many years, which explains why many men are unaware of the tumor until it is relatively advanced.

The good news is that the prognosis for prostate cancer is good, among the best of all cancers, so even with advanced-stage diagnosis, most patients can continue to have a high quality of life for many years.

As men get older, the prostate can enlarge and result in symptoms such as obstruction of the urethra, which is caused by benign prostatic hypertrophy (BPH), a benign enlargement of the prostate gland. Although BPH can create discomfort and difficulty in passing urine, it is not associated with prostate cancer.

Prevention and Risk Factors

Because prostate cancer often progresses slowly, the need for early screening is inconclusive. The American Cancer Society and other medical organizations offer specific recommendations and guidance, explaining the potential benefits and drawbacks of prostate cancer screening.

Possible risk factors for prostate cancer include older age (usually after age 65), race, and ethnicity. African men, or men of African ancestry, are at increased risk of prostate cancer; this cancer is less common in Asian and Hispanic men.

Family history may be a risk factor, but the majority of patients with prostate cancer have no family or genetic history of prostate cancer. Although having a first-­degree relative with prostate cancer, especially if it was at a younger age, can put you at increased risk.

Some gene mutations have been shown to run in families with known genetic diseases, such as Lynch syndrome, as well as those who have relatives with cancer associated with BRCA1 or BRCA2 gene mutations.

Other less relevant possible factors include diet (such as increased dairy products or increased calcium intake), chemical exposures, recurrent inflammation of the prostate, smoking, and a sedentary lifestyle.

Prostate Cancer Diagnosis

The initial diagnosis of prostate cancer involves preliminary tests by a primary care physician or a urologist, including a physical examination of the prostate via the rectum. If a tumor is suspected, the doctor will order a prostate-specific antigen (PSA) blood test, a biopsy, or both.

The PSA test is used mainly to screen for prostate cancer in men who don’t have symptoms, and is also used in those already diagnosed with prostate cancer to monitor for possible cancer recurrence (coming back). If the PSA number goes up, the chance of being diagnosed with prostate cancer increases, but there is no specific cutoff number that can determine if a man does have prostate cancer.

Most men without prostate cancer have PSA levels under 4 ng/mL. Still, a PSA level below 4 is not a guarantee that a man doesn’t have cancer. PSA levels between 4 and 10 are considered borderline, and when the values are higher than 10, the chances of having prostate cancer increase significantly.

If prostate cancer is confirmed, multiple imaging tests will be done to determine if the tumor is localized (early stage) or has spread to other areas, such as the lymph nodes or bones. The tests include a transrectal ultrasound, an MRI of the pelvis, and a radionuclide bone scan. A PET/CT scan, including the newer technique of the PSMA PET scan, may also be done.

Treatment Options

Once the recommended tests are completed, you will need a treatment plan that should be prepared by a team of doctors, likely including a urologist, medical and radiation oncologist, radiologist, and a pathologist. Your team must take into account your particular prostate cancer and your complete medical history and overall situation. This will help to build a personalized treatment plan for your specific needs.

Today, early prostate cancer can often be managed by monitoring only, without cancer therapies. The decision to start treatment should be made with your doctors. The factors you may want to consider are your age, medical history, and family history, which can help to establish your risks from the treatment.

The side effects of prostate cancer treatment may include urinary incontinence or erectile dysfunction, so some patients prefer to delay treatment as long as possible. Other men are more concerned about the cancer than the treatment side effects and prefer to treat it immediately.

Choosing the Right Treatment for You

Choosing a treatment option can be complex, with multiple options and often no best-recommended solution.

For advanced prostate cancer, or for men who require early treatment, the treatment options include surgery, chemotherapy, immunotherapy, radiation therapy, hormone therapy, targeted therapy, and if the cancer has spread to the bones, supportive treatments. Surgery, external radiation, and brachytherapy have similar success rates for early-­stage prostate cancer.

Recently, newer treatment options have become available to patients with prostate cancer, including robotic surgical equipment. Many promising newer treatments are only available through clinical trials, but some of these still don’t have enough long-term data to establish their effectiveness and potential side effects. In addition, many newer treatments are only available in specialized clinics and are not accessible to many patients.

Questions to Consider

Men with prostate cancer often find it stressful to choose a treatment option. Discussing the following questions with your doctor may help make your decision easier:

1. Is it important for you to treat your cancer immediately, regardless of possible difficult side effects?
2. Would you be able to stick with a monitoring approach, which may require frequent tests and clinic visits, and possibly increase your anxiety?
3. Are you interested in learning about the newest treatment options, or are you satisfied with the current standard of care?
4. Are you concerned about receiving treatments and enduring long-term side effects?

When making your decision, you may consider getting a few expert opinions, perhaps from different types of specialists. Consulting with different physicians can give you a better understanding of your situation.

You may also consider speaking to other patients—this can be beneficial, but remember that everyone’s experience is unique, and just because someone had a good or a bad experience with a specific treatment doesn’t mean your experience will be the same.

If you are diagnosed with prostate cancer, it is crucial that you have access to reliable medical professionals and to evidence-based information for your specific situation, to understand all your treatment options.