Noyes News and Events

September 22, 2017

Prostate Cancer Awareness

Approximately 161,000 men will be diagnosed with prostate cancer this year and almost 27,000 will die.  After skin cancer, prostate cancer is the most common cancer for men.  Prostate cancers, however, usually grow slowly and most men with prostate cancer are older than 65 years and do not die from the disease.  Because of its slow growth, lower mortality rate, and serious treatment side effects, screening for prostate cancer is controversial.

The prostate is a part of the male reproductive system, which includes the penis, prostate, and testicles. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder). It produces fluid that makes up a part of semen. As a man ages, the prostate tends to increase in size. This can cause the urethra to narrow and decrease urine flow. This is called benign prostatic hyperplasia, and it is not the same as prostate cancer.

According to the CDC, the following are risk factors for prostate cancer:

  • Age: The older a man is, the greater his risk for getting prostate cancer.

  • Family history: Certain genes (passed from parent to child) that you inherited from your parents may affect your prostate cancer risk. Currently, no single gene is sure to raise or lower your risk of getting prostate cancer. However, a man with a father, brother, or son who has had prostate cancer is two to three times more likely to develop the disease himself.

  • Race: Prostate cancer is more common in African-American men. It tends to start at younger ages and grow faster than in other racial or ethnic groups, but medical experts do not know why.

Like so many cancers, symptoms vary from person to person.  Some men experience no symptoms.  In general, however, a man may experience one or more of the following symptoms if he has prostate cancer:

  • Difficulty starting urination

  • Weak or interrupted flow of urine

  • Frequent urination, especially at night

  • Difficulty emptying the bladder completely

  • Pain or burning during urination

  • Blood in the urine or semen

  • Pain in the back, hips, or pelvis that doesn’t go away

  • Painful ejaculation

Two common screening tests for prostate cancer are:

  • Digital rectal exam (DRE): A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.

  • Prostate specific antigen (PSA) test: Measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. However, many factors, such as age, race, medical procedures, medications, an enlarged prostate, or infection can affect PSA levels. Some prostate glands make more PSA than others. Because so many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results. Only a biopsy can diagnose prostate cancer for sure and even then, your doctor may not recommend treatment. If the cancer is small and low risk, you and your doctor may decide on active surveillance, which means closely monitoring with PSA tests and biopsies over time to see if there are any changes.  

As mentioned, most prostate cancers found by screening are small and slow growing and may not be fatal.  In addition, the side effects from radiation and/or surgery may include impotence, loss of bladder control, and problems with the bowels.  Due to these serious side effects and the fact that most prostate cancers are not fatal, medical groups do not agree on screening recommendations. Many believe screening is not necessary for most men.  Others believe a baseline PSA level should be measured and looked at over time.

The CDC indicates that the decision to be screened is a personal one.  Men should work with their doctors to understand the benefits and harms of screening. Keep in mind that if a man chooses not to be screened, he can always change his mind in the future.  In addition, if a man is screened and cancer is found, it does not necessarily mean immediate treatment.  It is important to have these discussions with your doctor so he or she can discuss your risk factors and determine if screening is right for you.  

Lorraine Wichtowski is a community health educator at UR Medicine Noyes Health in Dansville, NY.  For article suggestions or questions, contact Lorraine at lwichtowski@noyeshealth.org or 585-335-4327.