For The Gents: What You Need to Know About Prostate Cancer
During September, the cancer community highlights two gender-specific cancers – prostate and ovarian. We’ll focus on prostate cancer in this month’s article and will highlight ovarian cancer in a future post.
Although a large number of men are diagnosed with prostate cancer each year, the survival rate is relatively high. The American Cancer Society estimates that there will be approximately 174,650 new cases of prostate cancer in 2019, with about 31,620 deaths.1 As with any type of cancer, early detection and treatment are crucial to recovery.
Over the years, guidelines for prostate cancer screening have evolved based on numerous factors. Because each man’s health is unique, it’s important to discuss screening with your physician and come to a decision you both feel is right for your individual needs.
For men age 55 and under, screening is not generally recommended unless you fall into a higher-risk category. This includes those African American men or those with a family history of prostate cancer (especially if it’s your brother or father).
If you’re age 55-69, you and your doctor may decide that screening is right for you. Since the average age of being diagnosed is 66, this age group is a good time to be proactive about your prostate health.
This discussion should include your risk factors, the pros and cons of testing versus the potential for overtreatment, and the side effects of testing or treatment. There are several different types of screening for prostate cancer – and clinical research is already looking at additional testing options.
- The DRE (digital rectal exam) is conducted by a doctor or nurse, who inserts a lubricated, gloved finger in your rectum to check the prostate for any lumps or other unusual findings.
- The PSA blood test is common, but it’s not without controversy. Some doctors are divided on what level of prostate-specific antigen (PSA) warrants taking the next steps (biopsy, MRI or ultrasound) versus a watch and wait approach.
Once a man turns 70, he may not require additional screenings (unless he’s high risk or his healthcare provider feels it’s important). Reasons behind this recommendation include potential risks of treatment and the fact that prostate cancer is typically slow growing.2
Another area that holds promise for reducing prostate cancer deaths is genetics to predict those men who may be at increased risk for prostate cancer. Researchers are looking at gene mutations that are inherited from both parents, as well as those that come from just the patient’s mother.
About That PSA
Since the PSA blood test is an quick, easy and inexpensive way to measure prostate-specific antigen, you may be wondering why there aren’t automatic screening guidelines for certain ages (like a colonoscopy for both sexes or a woman’s mammogram).
One issue is the fact that the blood test can give false positives or false negatives, leading to unnecessary biopsies or overlooked cancer. These inaccurate levels can result from a variety of factors that affect the production (or reduction) of PSA in the bloodstream.3
There are several things that could potentially reduce your PSA levels, even if you actually have prostate cancer.
- Obesity: Men who are obese tend to have lower PSA levels.
- Medications, Herbs and Supplements: Certain drugs and dietary supplements can produce a deceivingly-low PSA level. It’s important for your medical team to know all of the substances you take, even ones that aren’t necessarily meant for prostate health.
- Statins: Some studies have linked the long-term use of cholesterol-lowering drugs (statins) with lower PSA levels. Commonly-prescribed statins include atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor).
- Certain Diuretics: Thiazide diuretics, such as hydrochlorothiazide, are a type of water pill used to treat high blood pressure and other conditions. Taking a thiazide diuretic for an extended period of time is linked to lower PSA levels.
Conversely, a number of factors other than prostate cancer can also raise PSA levels and provide a false positive for cancer:
- Certain Medications: Taking male hormones or other medicines that raise testosterone levels can potentially cause a higher PSA number.
- An Enlarged Prostate: Conditions such as benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that commonly affects men as they age, can raise PSA levels. An enlarged prostate gland can cause uncomfortable urinary symptoms, including bladder, urinary tract or kidney problems.
- Advanced Age: PSA levels normally go up slowly as you get older, even if you don’t have a prostate condition or cancer.
- Prostatitis: This infection or inflammation of the prostate gland can increase PSA levels.
- Ejaculation: This can make the PSA go up for a short time and then drop back down. Some doctors suggest that men abstain from ejaculation for one or two days leading up to the blood test.
- Some Urologic Procedures: Certain procedures done in a doctor’s office that affect the prostate (such as a prostate biopsy or cystoscopy) can result in a short-term increase in PSA levels. Although some studies have suggested that a digital rectal exam (DRE) might raise PSA levels slightly, this hasn’t been verified. However, because of this, if both a PSA test and a DRE are being done during the same doctor visit, some providers recommend having the blood drawn for the PSA before the DRE.
- Riding a Bicycle: Interestingly enough, some studies suggest that cycling may raise PSA levels (possibly because the seat puts pressure on the prostate).
If your PSA or DRE screening suggests a possible abnormality, your physician may recommend an ultrasound, MRI or biopsy. If those indicate the presence of cancer, he or she will explain the various treatment options.
In an upcoming article, we’ll review the traditional treatment approaches and introduce you to newer options that show promise for addressing prostate cancer. In the meantime, if you’re over age 55, please ask your primary care provider if prostate screening is right for you or visit our website.