Prostate cancer: Early screening is key to detection and treatment

Prostate cancer is the second-leading cause of cancer death among American men, behind only lung cancer. Fortunately, when detected early it can often be successfully monitored and treated. 

Early prostate cancer screening helps detect cancer before symptoms appear, when treatment is most effective. Screening typically begins with a conversation with your healthcare provider about your age and risk factors, followed by a blood test that measures a protein produced by the prostate gland.

What is the prostate?

The prostate gland is a small, walnut-shaped structure in the male reproductive system. It is located between the bladder and the penis and surrounds part of the urethra. Its main functions are to produce seminal fluid to nourish sperm and to help control urine flow.

What is prostate cancer?

Prostate cancer is a disease in which cells in the prostate grow uncontrollably. It is rare in men under 40 and most often affects men over 60. About 6 in 10 prostate cancers are diagnosed in men age 65 or older.

Almost all prostate cancers are adenocarcinomas. These cancers arise from the gland cells in the prostate that produce the fluid added to semen. Other types of prostate cancer are rare.

What are the stages of prostate cancer?

Staging helps doctors choose the best treatment and predict outcomes. Prostate cancer has four stages, ranging from the least to the most advanced:

• Stage 1: Early cancer that is confined to the prostate and mainly involves one-half or a portion of the gland.
• Stage 2: Cancer that is confined to the prostate and involves most of it.
• Stage 3: Cancer that is growing outside the prostate.
• Stage 4: Advanced cancer that has spread to other areas of the body, including bones and other organs.

What is prostate cancer screening?

Most prostate cancers grow slowly or not at all. The goal of prostate cancer screening is to detect cancers that are likely to spread if untreated.

The most common screening method is the prostate-specific antigen (PSA) test, which measures PSA levels in your blood.

PSA is a substance produced by the prostate. Elevated levels can indicate a prostate problem, but they do not always mean cancer is present.

If your PSA level is high, your doctor may first recommend an MRI of the prostate to evaluate if abnormal areas can be seen and targeted with a biopsy. During a biopsy, a small needle is used to remove multiple tiny tissue samples from your prostate for examination under a microscope.

If cancer is detected, a pathologist will grade the tumor, and doctors may use MRI or PET scans to determine whether the cancer has spread. Treatment may range from active surveillance to surgery or radiation, depending on the results.

What is a digital rectal exam for prostate cancer?

In a digital rectal exam, a healthcare provider inserts a gloved, lubricated finger into the rectum to feel the prostate for abnormalities. Although it was historically a standard test, many doctors now choose the PSA blood test as the primary and more accurate screening method.

Are there possible harms from a prostate exam?

It is important to talk with your doctor about the potential benefits and risks of screening — and understand the possibility of a false-positive result. This occurs when the results suggest cancer when it is not present.

This can cause anxiety and lead to discussion of additional medical procedures, such as a biopsy. A PSA test may also detect slow-growing cancers that would never cause symptoms, potentially leading to unnecessary treatment and side effects.

Who should consider prostate cancer screening?

About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, but each person’s risk can vary. You’re more likely to get prostate cancer if:

• You are 65 or older.
• Prostate, breast or ovarian cancer runs in your family.
• You are Black or African American.

Screening is a personal decision based on values and preferences. Generally, men at average risk should start screening at age 50 and continue through age 69. You should consider screening as early as 40 if you’re in a higher-risk category. Routine screening is generally not recommended for men older than 75.

What are the symptoms of prostate cancer?

Many men with prostate cancer have no symptoms. However, common symptoms include:

• Frequent urination, especially at night
• Trouble emptying the bladder
• Painful or burning urination
• Blood in the urine or semen
• Frequent pain or stiffness in the lower back, hips or pelvis

It is important to note that these symptoms may be caused by conditions other than prostate cancer. That’s why it’s important to talk with your doctor about anything you’re experiencing.

What treatments are available for prostate cancer?

Treatment for prostate cancer depends on your age and overall health, the stage and grade of the cancer, and whether it has spread.

It’s important to discuss all your treatment options with your doctor to help you make the decision that best fits your needs. Important considerations include:

• The stage and severity of the cancer.
• Your age and life expectancy.
• Any other serious health conditions.
• The likelihood that treatment will cure your cancer or help in some other way.
• Your feelings about possible side effects.

How can you prevent prostate cancer?

There are no medicines or supplements approved by the U.S. Food and Drug Administration to prevent prostate cancer. Screening is the best way to detect prostate cancer early or identify increased risk. Men at average risk should consider screening at age 50. Consider screening earlier if you’re at higher risk.  

Additionally, ask your primary care provider about ways to lower your risk of prostate cancer. They may recommend lifestyle changes such as maintaining a healthy weight, exercising regularly and eating a diet that’s low in animal fats and high in fruits and vegetables.