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What You Need to Know about Prostate Cancer

With a 98.9 percent five-year survival rate, prostate cancer is one of the most curable forms of the disease, according to the National Cancer Institute.The tricky thing about it, however, is that it rarely causes any symptoms until late in the game. And even then, the main symptoms could easily indicate other conditions."The symptoms of prostate cancer are very few," explains Kim Morley, radiation oncology nurse at Providence Radiation Oncology. "Sometimes there are urinary changes, which may include frequency, difficulty, hesitancy or interruption in the urine stream and increased urination at night, but all of these symptoms can be indicators of an enlarged prostate, which does not necessarily mean it's cancer-caused. Still, changes in urination pattern should be reported to your primary-care physician."To test or not to testThe National Comprehensive Cancer Network guidelines for 2014 recommend that screening for prostate cancer start at age 45 to 50 with a single blood test for PSA (prostate-specific antigen). Often, a digital rectal exam is done annually to allow the doctor to feel the contour and approximate size of the prostate. Any suspicious asymmetry of the prostate most likely will come with a recommendation for a prostate biopsy."The American Cancer Society recommends that any man age 50 or older with a PSA of less than 2.5 nanograms per milliliter be retested every two years, and men with a PSA greater than 2.5 be retested yearly," Morley says.But prostate cancer testing is not without controversy, as there is a school of thought that believes it's not worth the risks of complications to test and treat prostate cancer under certain conditions, according to Robert Mayer, a urologist at Asante Physician Partners. This is true especially for much older patients with other health conditions, he adds."Prostate cancer is usually — but not always — relatively slow growing," Mayer says. "The life expectancy when detected early is often 15 to 20 years. If you have a patient in his 70s who has had multiple cardiac procedures, is wearing oxygen and has a life expectancy of five years, then it's not worthwhile to look for prostate cancer at that stage."In younger, otherwise healthy men, the discovery of prostate cancer doesn't always mean the need for treatment."It's like coronary artery disease. A lot of people have some degree of narrowing of heart vessels. We're not going to treat them all, but try to select those in which the benefits of treatment outweigh the risks," Mayer says. "We try to reserve testing and treatment, which can have complications, to the people who will truly benefit from it, not merely because they have it. However, determining which patients need or don't need prostate cancer treatment can be difficult and is the focus of further studies."The complications that arise from testing for prostate cancer, Mayer says, are infections that come mainly from the biopsy. Plus, there is also the considerable psychological weight of being labeled a "cancer patient.""Since a lot of men don't benefit from treatment because they are dying of something else and because of the potential complications, sometimes it's better not to look for it," he says. "However, because prostate cancer still is a frequent cause of death in men, most urologists think that looking for better ways to target the people who truly need treatment in the early stage with appropriate early detection and treatment is important."Age, genetics and general healthWhile Mayer says there isn't much that can be done by way of prostate cancer prevention, since its main risk factors are age and genetics, both he and Morley agree that healthful eating and living can help: Cut back on fatty meats, and fried or processed foods; eat more fruits, vegetables and whole grains; cut out or down on alcohol consumption; exercise daily; reduce exposure to toxins; get seven to eight hours of sleep a night; and reduce stress.Morley recommends an immediate referral to a radiation oncologist if you have a diagnosis of prostate cancer. And Mayer reminds that such a diagnosis needn't be as dire as it sounds."When most people are diagnosed with cancer, it's scary and they start writing a will and what not," he says. "But while there are some forms of prostate cancer that are very aggressive, in general, most patients won't die from it. Statistically, they are likely to pass away from something other than the cancer. It can be very serious, but it's not like pancreatic cancer, which you would very likely succumb to."

What You Need to Know about Prostate Cancer