Approximately 1 in 8 men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society, which projects 248,530 new prostate cancer cases and 34,130 prostate cancer deaths for 2021. The risk is 75% higher for Black men, according to the Prostate Cancer Foundation.
Prostate cancer is one of the most heritable cancers, explained Brian Helfand, M.D., Division Chief of Urology, Northshore University Health System. Therefore, genetics largely determines one’s risk of developing malignant prostate tumors.
Check family history
“With some rare exceptions, there are few environmental factors that contribute to increased prostate cancer susceptibility,” Helfand said. “Recognized risk factors for prostate cancer are increased age, Black race and family history of prostate cancer.”
Dr. Helfand recommends asking family members about their history of prostate cancer, as well as any history of breast, ovarian, pancreatic, or colorectal cancers.
Regular screenings enable asymptomatic men to be diagnosed after an elevated PSA value or abnormal prostate exam.
“Prostate cancer screening should include a blood test for PSA (prostate specific antigen) as well as a digital rectal exam,” said Helfand. While screening guidelines vary, he recommends annual screenings starting at age 40 for men with risk factors (family history, race, etc.) and at 50 for males with average risk.
“Men with advanced prostate cancer who have not been screened can present with difficulty urinating (e.g. weak urinary stream, increased urinary frequency, etc), weight loss, or bone pain,” Helfand explained. However, “most men who present with urinary symptoms do NOT have prostate cancer. These men are most likely to have benign enlargement of their prostate (known as benign prostatic hyperplasia). This benign condition can usually be treated by medications or elective surgery.”
Lifestyle and diet
“There is limited data regarding specific foods or behaviors that reproducibly [impact] a man’s risk of prostate cancer. However, evidence derived from men with advanced prostate cancer suggest that men at a more ideal body weight and who exercise more frequently generally have better cancer outcomes,” Helfand said, including:
- Regular exercise: 30 minutes, three times weekly
- Heart-healthy diet: fewer simple sugars and more fruits, vegetables and proteins
- Limit barbequed/smoked meats which may contain toxins that promote prostate cancer
“The most important [aspect of managing] prostate cancer is deciding who needs to be treated and who can be safely followed by active surveillance. In order to determine this, we need to appropriately screen healthy men for prostate cancer. Therefore, it remains important to get screened and appropriately evaluated,” Helfand explained.
Prostate cancer is diagnosed via prostate biopsy. “About half of newly diagnosed prostate cancers are considered low risk,” i.e. the risk of the tumor spreading outside of the prostate is low. “Most of these tumors are actively followed by repeat biopsies and blood tests,” Helfand said.
Prostate cancer treatments depend upon the patient’s prognosis and cancer stage. Helfand summarized options for patients requiring treatment:
- Surgery – for more aggressive forms of prostate cancer, a combination of minimally invasive robotic surgery and radiation is a common treatment
- Radiation – includes a variety of methods such as implanted seed radiation (brachytherapy), external beam, and proton therapy
- Medication – a newer but promising prescription eliminates testosterone (androgen deprivation therapies)
- Ultrasound & cryoablation – High-intensity focal ultrasound and cryoablation are a few newer, more experimental approaches
“There has been much confusion regarding prostate cancer screening,” Helfand has observed. “When men stop screening for prostate cancer, I’ve witnessed many more men present with advanced/aggressive tumors,” especially during the COVID era when many men have avoided going to doctors. Therefore, Dr. Helfand strongly recommends men continue to get screened for prostate cancer during the pandemic.
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