Prostate cancer is the most common cancer among men and the second most common after lung cancer. The American Cancer Society estimates that nearly 250,000 men in the United States will be diagnosed with prostate cancer in 2021.
While prostate cancer rates increased sharply in the late 1980s and early 1990s due to increased screening with the prostate-specific antigen (PSA) blood test, incidence rates stayed steady from 2013 to 2017.
The average age of diagnosis is 66, and it rarely occurs in those younger than 40. And the number of new cases diagnosed in African American men is nearly 80% higher than the number of new cases diagnosed in Caucasians.
According to Yousef Al-Shraideh, MD, a urologic oncologist with OSF HealthCare, early detection is the key to good outcomes.
Most prostate cancers are found at the local or regional stage when the disease is confined to the prostate or locally advanced, which involves nearby organs, mainly the seminal vesicles.
The good news
The five-year survival rate for most people with local or regional prostate cancer is nearly 100%, and the 10-year survival rate is 98%. According to the ACS, there are more than 3.1 million prostate cancer survivors in the United States today.
How is prostate cancer diagnosed, graded and watched?
“Diagnosis of prostate cancer is done mainly with local anesthesia by transrectal, ultrasound-guided prostate biopsy. Usually, patients tolerate it very well,” Dr. Al-Shraideh said. “It’s also performed through FUSION (Uronav) biopsy, which is more or less the same technique. The technology is different where ultrasound image is fused with the MRI image to precisely target the suspicious lesions detected by MRI.”
Prostate cancer is classified depending on the risk, which is usually the product of the PSA value, clinical exam/MRI, and the Gleason score (grading system of the tumor cells under the microscope that ranges from 6-10).
It’s low risk when the cancer is still confined to the prostate and has a PSA of less than 10 ng/ml or a Gleason score (a grading system for tumors that ranges from 6 to 10) of 6.
“In this case, the cancer can be watched by a protocol called active surveillance, which entails checking PSA every six months, having a digital rectal exam every year and a repeat MRI or prostate biopsy 12-18 months after diagnosis,” Dr. Al-Shraideh said.
You’re at an intermediate risk when cancer is still confined to the prostate and you either have a PSA of 10-20 ng/ml or a Gleason score of 7.
“In this scenario, the preferred option is to get the cancer treated to cure the disease, especially for men with life expectancy more than 10-15 years,” Dr. Al-Shraideh said.
Surgery and radiation are the two main ways to treat intermediate prostate cancer.
“We do the robotic surgical removal of the prostate at OSF with excellent results of tumor cure, early urinary control for full urinary continence and erectile functionality,” Dr. Al-Shraideh said. “The other modality of cure is through radiation.”
When cancer goes through the prostate capsule (locally advanced), spreads out (metastasizing to bone or solid organs) or has a PSA of more than 20 ng/ml or a Gleason score between 8-10, it is considered high-risk.
According to Dr. Al-Shraideh, the treatment of cancer at this stage depends on many factors, including tumor stage and grade, life expectancy and functional status of the patient.
“Locally advanced cancers could still benefit from attempts to cure by either surgery or radiation,” Dr. Al-Shraideh said. “However, cancer that has spread is treatable but difficult to cure, and it usually requires androgen hormonal therapy and additional second-line treatment of chemotherapy, hormonal therapy or immunotherapy.”
“It is recommended that men 40-54 years old get screened if they are at a high risk of prostate cancer. I do not recommend screenings for men under 40,” Dr. Al-Shraideh said. “High risk includes African American men and those with strong family history for lethal cancer, such as prostate, breast, ovarian or pancreatic cancer, especially if the affected persons were immediate relatives or had cancer at a younger age.”
For men ages 55-69 years, you should talk to your primary care provider to weigh the benefits of reducing prostate cancer metastatic disease and death. However, this age group would get the greatest benefit from screening.
PSA screening is not recommended for men over 70 unless they have excellent health and life expectancy of more than 10-15 years.
How to get proper screening
Proper screening consists of two tests: the digital rectal exam and the PSA blood test.
“Most people are aware of the rectal exam because many men find it uncomfortable and embarrassing, and it makes for an easy premise in a comedy movie or television show,” Dr. Al-Shraideh said. “But it only takes 10 seconds with mild discomfort.
“Basically, early detection with men at risk prevents major damage.”
The PSA blood test checks for the presence of prostate-specific antigen. Typically, PSA is only found in the blood if something is wrong with the structure of the prostate, allowing the antigen to leak into the bloodstream.
“If you have an elevated or rising amount of PSA in your blood, it’s a sign something might be wrong in the prostate, and cancer could be one of those things,” Dr. Al-Shraideh said.
Both exams are necessary because one can reveal an issue that the other might miss, Dr. Al-Shraideh said. During a rectal exam, your doctor could find a suspicious nodule while the blood test appears normal. Likewise, the blood test could reveal the presence of PSA in your blood while the rectal exam fails to reveal anything.
So, talk to your doctor about regular prostate exams. It just might save your life!