Prostate cancer is diagnosed every single day and kills one in 41 men in this country. Compared to white men, African American men are not only twice as likely to die from the disease but more likely to be in the advanced stage of the illness by the time they are diagnosed. Black men are in a state of emergency with regards to prostate health, and education and earlier screening is what we at 50BOLD, along with the National Institutes of Health (NIH) are trying to promote.
What is the prostate?
The prostate is a walnut-shaped gland that is part of the male reproductive system. It has two or more lobes, or sections, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. It surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen.
Prostate cancer is the most common cancer in American men after skin cancer. But most men with prostate cancer don’t die from it. Many prostate cancers never even cause symptoms or become a serious threat to health. That’s because prostate cancer tends to grow more slowly than many other cancers. A prostate tumor may grow for 30 years before it gets large enough to cause symptoms. Several treatment options are available.
By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. Most of these cancers never pose a problem. They may never cause symptoms or become a serious threat to health.
- Trouble passing urine
- Frequent urge to pass urine, especially at night
- Weak or interrupted urine stream
- Pain or burning when passing urine
- Blood in the urine or semen
- Painful ejaculation
- Nagging pain in the back, hips, or pelvis
Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn’t mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Men who are 50 or older have a higher risk of prostate cancer.
- African-American men have the highest risk of prostate cancer, 1 in 4—the disease tends to start at younger ages and grows faster than in men of other races. After African-American men, the cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of it.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of it. The younger a man’s relatives are when they have the cancer, the greater his risk for developing it. The cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of the disease may be higher for men who eat high-fat diets.
Screening means testing for cancer before you have any symptoms. A screening test may help find cancer at an early stage, when it is less likely to have spread and may be easier to treat. By the time symptoms appear, the cancer may have started to spread.
The most useful screening tests are those that have been proven to lower a person’s risk of dying from cancer. Doctors do not yet know whether prostate cancer screening lowers the risk of dying from prostate cancer. Therefore, large research studies, with thousands of men, are now going on to study prostate cancer screening. The National Cancer Institute is studying the combination of PSA testing and DRE as a way to get more accurate results.
Large research studies are looking at how prostate cancer can be prevented. Studies have shown that 5-alpha reductase inhibitors finasteride and dutasteride can lower the risk of developing prostate cancer, but whether they can decrease the risk of dying of prostate cancer is still unclear.
Talk with your doctor about your risk of prostate cancer and your need for screening tests.
Digital Rectal Exam (DRE)
DRE is a standard way to check the prostate. With a gloved and lubricated finger, your doctor feels the prostate from the rectum. The test lasts only for 10-15 seconds but for many men, this life-saving exam can feel endless.
DRE checks for:
- The size, firmness, and texture of the prostate
- Any hard areas, lumps, or growth spreading beyond the prostate, and
- Any pain caused by touching or pressing the prostate
The DRE allows the doctor to feel only one side of the prostate.
PSA (Prostate-Specific Antigen) Test
The U.S. Food and Drug Administration (FDA) has approved the use of the PSA test along with a DRE to help detect prostate cancer in men age 50 and older. PSA is a protein made by prostate cells. It is normally secreted into ducts in the prostate, where it helps make semen, but sometimes it leaks into the blood. When PSA is in the blood, it can be measured with a blood test called the PSA test. In prostate cancer, more PSA gets into the blood than is normal. However, a high PSA blood level is not proof of cancer, and many other things can cause a false-positive test result. For example, blood PSA levels are often increased in men with prostatitis or BPH. Even things that disturb the prostate gland–such as riding a bicycle or motorcycle, or having a DRE, an orgasm within the past 24 hours, a prostate biopsy, or prostate surgery–may increase PSA levels.
PSA levels go up with age. African-American men tend to have higher PSA levels in general than men of other races. And some drugs, such as finasteride and dutasteride, can cause a man’s PSA level to go down. PSA tests are often used to follow men after prostate cancer treatment to check for signs of cancer recurrence. It is not yet known for certain whether PSA testing to screen for prostate cancer can reduce a man’s risk of dying from the disease.
Researchers are working to learn more about the PSA test’s ability to help doctors tell the difference between prostate cancer and its benign problems, and the best thing to do if a man has a high PSA level. For now, men and their doctors use PSA readings over time as a guide to see if more follow-up is needed.
PSA test results
PSA levels are measured in terms of the amount of PSA per volume of fluid tested. Doctors often use a value of 4 nanograms (ng) or higher per milliliter of blood as a sign that further tests, such as a prostate biopsy, are needed. Your doctor may monitor your PSA velocity, which means the rate of change in your PSA level over time. Rapid increases in PSA readings may suggest cancer. If you have a mildly elevated PSA level, you and your doctor may choose to do PSA tests on a scheduled basis and watch for any change in the PSA velocity.
Free PSA test
This test is used for men who have higher PSA levels. The standard PSA test measures total PSA, which includes both PSA that is attached, or bound, to other proteins and PSA that is free, or not bound. The free PSA test measures free PSA only. Free PSA is linked to benign prostate conditions, such as BPH, whereas bound PSA is linked to cancer. The percentage of free PSA can help tell what kind of problem you have.
- If both total PSA and free PSA are higher than normal (high percentage of free PSA), this suggests BPH rather than cancer.
- If total PSA is high but free PSA is not (low percentage of free PSA), cancer is more likely. More testing, such as a biopsy, should be done.
You and your doctor should talk about your personal risk and free PSA results. Then you can decide together whether to have follow-up biopsies and, if so, how often.
If your symptoms or test results suggest prostate cancer, your doctor will refer you to a specialist (a urologist) for a prostate biopsy. For a biopsy, small tissue samples are taken directly from the prostate. Your doctor will take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that may have cancer cells. Like other cancers, prostate cancer can be diagnosed only by looking at tissue under a microscope. Most men who have biopsies after prostate cancer screening exams do not have cancer.
A positive test result after a biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give it a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less aggressive the tumor is and the less likely it will spread. Treatment options depend on the stage (or extent) of the cancer (stages range from 1 to 4), Gleason score, PSA level, and your age and general health. This information will be available from your doctor and is listed on your pathology report.
Reaching a decision about treatment of your prostate cancer is a complex process. Many men find it helpful to talk with their doctors, family, friends, and other men who have faced similar decisions. Once your doctor determines the stage of your prostate cancer, he can start mapping out a treatment plan. A stage is based on:
- The size of your tumor
- How far it has spread
- The chances of it coming back
Matching the right treatment with your stage isn’t always cut and dry. You might benefit from a combo of a few different approaches. Together, you and your doctor will decide on the best treatment.