Prostate enlargement, how it affects men as they age, and its prostate cancer link
The prostate is a small organ that sits under the bladder in men, and provides a nourishing fluid that helps transport sperm. It often enlarges as men age, most commonly as benign tissue growth — called benign prostatic hyperplasia, or BPH. In fact, about half of men have BPH by age 60, and over three-quarters after 70. And for some of these men, the enlarging prostate tissue becomes cancerous.
Prostate cancer is common, with almost 300,000 new diagnoses in the U.S. each year; one in every eight men is diagnosed with it in their lifetime. Prostate cancer is the second leading cause of cancer death in American men (behind lung cancer), killing almost 30,000 annually.
Although this sounds grim, the natural course of most prostate cancer cases is indolent. It grows very slowly and doesn't cause problems for many years, if ever. Therefore, the overwhelming majority of men with prostate cancer do not die from it, but rather "with it” — meaning they have it but die of some other cause. In fact, the five-year survival rate after a prostate cancer diagnosis is 97%.
Does prostate cancer run in families?
Risk factors for prostate cancer include certain ethnicities, age and, in some cases, inherited genetic factors. So a family history may increase risk, but because this is such a common condition it's generally just a happenstance.
Are there symptoms of having prostate cancer?
Most prostate cancer patients have no symptoms. When symptoms do occur, they are generally indistinguishable from symptoms of BPH, and may include:
Compromise of passing urine (due to the physical size of the enlarged prostate gland pushing on the urethra), including difficulty initiating a urine stream, a weaker urine stream and even an inability to pass urine.
Changes in urination, possibly including blood in the urine and/or pain while passing urine.
Changes in sexual function, including blood in the sperm or erectile dysfunction.
Patients with prostate cancer that has metastasized to other locations in the body may have bone pain, swollen glands, fatigue, swelling in the legs or other symptoms that do not occur from BPH.
How is prostate cancer diagnosed?
Screening for prostate cancer may include a digital rectal exam, where the clinician assesses for an enlarged prostate, and/or a blood test to measure a prostate-specific antigen (PSA) level. PSA is made by cells of the prostate gland, so a baseline level in the blood is normal. If there is increased production, the blood level may be higher, and this is how PSA is used to screen for cancer. However, many things can increase PSA production. Essentially all types of prostate cancer do this, as well as inflammation of the prostate (for example, from a bacterial infection), BPH and trauma (from a prostate biopsy, a DRE, and even from certain exercises such as vigorous bicycle riding). Certain medications may also affect PSA levels.
So an elevated PSA does not mean the patient has prostate cancer. In fact, only about 25% of patients with elevated PSAs are found to have prostate cancer on biopsy when 4 mg/dl is used as the cut-off for normal. In addition, some men with prostate cancer have non-elevated levels of PSA. If a patient has had multiple PSA measurements, a rapid rise in their level over time may indicate an increased risk of cancer.
How often should men be screened for prostate cancer
Because of difficulty interpreting PSA results, the United States Preventive Services Task Force recommends that the decision to have a PSA level measured should be made by the patient after an informed discussion with their health care provider. If prostate cancer is suspected, the initial imaging test is typically an MRI, and then if indicated a prostate biopsy may be done to differentiate cancer from benign conditions (including BPH) and to assess the characteristics if there is cancer.
As with so many other cancers, prostate cancer is staged based on characterization of the cancer (specific cell type, other characteristics) and extent of the disease. Specific treatment recommendations, as well as the overall prognosis, depend on the staging of the cancer. For example, five-year survival for localized prostate cancer is over 99% (so calling this "cancer" may create more anxiety than is merited), while only about a third of patients with cancer metastasized to distant locations survive five years.
What's the treatment for prostate cancer?
Treatment for prostate cancer depends on its aggressiveness, stage, patient preferences and other factors (for example, other health issues or life expectancy). Treatment options range from regular periodic clinical evaluations, radiation therapy, surgery, minimally invasive treatments for select patients and medication, to some combination of these.
About one in 200 men undergoing radical prostatectomy and radiation treatment die from complications of their treatments; this number doubles to one in 100 for men over age 75. In addition to this significant mortality, there is significant morbidity from many prostate cancer treatments; radical prostatectomy causes sexual dysfunction and/or urine problems in 25% to 50% or more of treated men. Thus, treatment decisions must be made with these possible complications in mind.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: Dr. Hersh: Prostate cancer is common, and usually won't cause problems
