Five Questions on Prostate Cancer Prevention, Answered

In an effort to increase awareness about the importance of cancer screening and prevention, this series asks experts in five cancer specialties – breast, colorectal, gynecologic, lung, and prostate – five questions focused on wellness, prevention, and the crucial screenings that help save lives.

November is Men's Health Awareness Month. Sometimes referred to as "Movember" or "No Shave November,” the month is supposed to shine a light on health issues affecting men, including prostate cancer.

According to the American Cancer Society, about one in seven men will be diagnosed with prostate cancer during his lifetime, and one in 41 will die of the disease. Because there are often no symptoms associated with early-stage prostate cancer, screening is crucial for early detection, better treatment options and more favorable outcomes for men.

Here are five common prostate cancer questions radiation oncologist Peter F Orio,III, DO and urologist Sergio D Fefer, MD discuss with their patients.

When it comes to prostate cancer prevention, how important are routine or annual screenings?

Orio: Many men with early-stage prostate cancer never experience symptoms and without screening, would never know they have the disease. Because of this screening protocols are critically important to early detection as they allow men to be diagnosed with prostate cancer many years before it becomes problematic. This is especially true in the era of PSA screening.

Fefer: Prostate cancer is a very prevalent disease that is not preventable and due to its paucity of symptoms has been usually diagnosed at an advanced stage. Since the introduction of PSA testing as part of the routine physical exam there has been a shift to diagnose prostate cancer at an earlier stage which translates into a better outcome through earlier interventions.

What kind of screening is available for prostate cancer and at what age should people start being screened?

Orio: Periodic prostate-specific antigen (PSA)-based screening and physical exam are the two most common prostate cancer screenings available for men today. The U.S. Preventive Services Task Force suggests that for men aged 55 to 69 years, the decision to undergo PSA-based screening for prostate cancer should be an individual one.

Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. In determining whether screening is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs.

“In health care, knowledge is power and a patient should always be provided both the power and knowledge to make informed decisions in the treatments they elect and receive.”

What are some of the risk factors for prostate cancer and are there lifestyle or diet changes that can lower someone’s risk?

Orio: Approximately one in seven men will be diagnosed with prostate cancer during his lifetime, and it accounts for nearly 10% of all newly diagnosed malignancies among men. Prostate cancer is rare in men younger than 40, and the chance of having prostate cancer rises drastically after age 50.

African American men and men with a family history of prostate cancer have an increased risk compared with other men. Having a father or brother with prostate cancer nearly doubles a man’s risk of developing this disease. 

Fefer: Age, African American race, and first degree relative with prostate cancer are known risk factors for prostate cancer. There is ongoing research about the influence of diet on the risk of getting prostate cancer but there are no conclusive results that can be applied at the present time.

What are some of the symptoms of prostate cancer that someone should be concerned about and discuss with their primary care provider or specialist?

Orio: In the early stages of prostate cancer most men do not have any symptoms associated with their malignancy, which is what makes screening protocols critical. However, in more advanced stages of prostate cancer men can experience difficulties urinating due to the prostate cancer obstructing the urethra, which is the tube that empties the bladder and goes directly through the prostate.

Although obstructive urinary symptoms can be the result of a benign enlargement of the prostate, symptoms such as a weak urinary stream, straining with urination and the need to urinate frequently and urgently should be discussed with a physician to make sure they are not associated with prostate cancer.

In the very late stages of untreated prostate cancer men can present with bone pain associated with the cancer traveling from the prostate and metastasizing to the bone.

Fefer: Prostate cancer tends to be a silent disease with barely any symptoms but as the disease progresses some manifestations include worsening urinary symptoms, blood in the urine, and pelvic or bony pain.

What kind of treatment options are available for someone diagnosed with prostate cancer?

Orio: Several treatment options exist for prostate cancer, including surgery, external beam radiation therapy, brachytherapy and hormonal therapy. Choosing the right treatment option is highly individualized and can be confusing for men and physicians alike.

In choosing the treatment option that is right for them, men should seek medical advice from their urologist, as well as a radiation oncologist and medical oncologist to hear all of their options. In health care, knowledge is power and a patient should always be provided both the power and knowledge to make informed decisions in the treatments they elect and receive.

Fefer: Prostate cancer is not a single disease but a spectrum that ranges from an indolent tumor with excellent prognosis that requires no other treatment than periodic surveillance, to an aggressive cancer that requires aggressive treatment either with surgery or with radiation.

In some cases, treatment includes both surgery and radiation and many times hormonal treatment, androgen deprivation, is added to enhance the response to the treatment. Due to the complexity of the disease and the different treatment modalities, men newly diagnosed with prostate cancer should be evaluated by a multidisciplinary approach including a urologist, medical oncologist, radiation oncologist, and geneticist.

Prostate cancer infographic

 

Peter F. Orio, III, DO, MS is the Medical Director of Radiation Oncology at the Dana-Farber Brigham Cancer Center in clinical affiliation with South Shore Hospital and Associate Professor of Radiation Oncology at Harvard Medical School.  Learn more about prostate cancer care and radiation oncology  at the Cancer Center.

Sergio D. Fefer, MD is a urologist at South Shore Urology in Weymouth. Learn more about genito-urinary care at South Shore Health.