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Top Five Questions for Prostate Cancer

Men's Health

Prostate cancer is the second-leading cause of cancer death in American men (behind lung cancer), accounting for about 30,000 deaths in 2012. Despite the numbers, prostate cancer, if discovered early, is highly treatable. About 1 in 6 men may be diagnosed with prostate cancer in their lifetime, but only 1 in 35 will die from it. The problem with catching it early is that prostate cancer starts without symptoms.

Srinath Sundararaman, MD, Medical Director of Radiation Oncology at Memorial Cancer Institute, sees dozens of prostate cancer patients each month. Dr. Sundararaman answered frequently asked questions about the disease.

1. At what age should a man begin to have prostate checkups?
There is no consensus on the age to begin screening prostate-specific antigen (PSA) levels revealed in blood tests and the only true marker for cancer. The controversy spans from over-diagnosing and over-treating men with prostate cancer to missing diagnoses at an early stage. It is important to start speaking to your primary care provider about prostate screening between age 40 to 50.

Because many guidelines cite age 50, Medicare doesn't cover a screening test for men younger than 50. This is unfortunate, as some men with higher risk, including African-Americans or men with multiple family members diagnosed with prostate cancer, should definitely be considered for screening at 40 or 45 and every year after. The standard recommendation is that men beginning between the ages of 40 and 50, be screened and absolutely should discuss the potential of prostate cancer with their primary care provider.

2. What are major risk factors for prostate cancer?
Prostate cancer seems to run in families. If two male family members have been diagnosed with prostate cancers, you are definitely at higher risk. Two out of three prostate cancers affect men older than age 65. African-American men are more than twice as likely to die of prostate cancer than white men. Asian and Latino men seem to have an even lower incidence of cancer and death rate. Diet, obesity and exercise may also play small factors in risk.

Of course, men are less likely to get check-ups, especially when conditions like erectile dysfunction or incontinence are ultimately involved. This is why loved ones and family should encourage the men in their life to get screened regularly.

3. How can I tell the symptoms of prostate cancer from an ordinary urinary tract infection?
In 90 percent of cases of men newly diagnosed with prostate cancer, there are no symptoms. The lack of symptoms describes the paradox of prostate cancer diagnosis. Men without any discernible symptoms should not hesitate to be screened.

4. Does an enlarged prostate (Benign prostatic hyperplasia or BPH) or prostatitis lead to prostate cancer?
These conditions are uniquely distinct, and do not raise cancer risk, but both can make it more difficult to diagnose prostate cancer. BPH and prostatitis gradually increase PSA levels, which raise the red flag for cancer. As men age, the prostate naturally grows larger, with about half of men between ages 50-60 experiencing BPH. An enlarged gland may physically obscure small cancers, and imaging is less than perfect.

5. How is prostate cancer treated?
In treating prostate cancer, staging is much less important than with other cancers. Instead the severity of the cancer is categorized or stratified into risk levels, determined by a Gleason Score, which grades prostate cancer cells by how they look compared to normal cells under a microscope. Patients with low-risk, localized, nonaggressive tumors may require little treatment more than regular monitoring, screening and biopsies. The most aggressive cancers may be treated with radiation, chemotherapy, surgery and any means necessary.

The important thing is that men empower themselves with regular check ups and speak openly with their physician about the prostate. It is also very valuable and important to involve men's significant others in decision-making considering the psychological and sexuality implications of treatment options. Memorial Cancer Institute offers screenings and advanced care for prostate cancer at every level.