Your Questions About Prostate Cancer, Answered

On average, one in nine men will develop prostate cancer in their lifetime. The good news is that when caught early, prostate cancer is highly treatable.

As part of the partnership between South Shore Health and WCVB-TV called One Healthy Boston, I recently answered some questions about prostate health from Facebook users. Here are some highlights from our conversation.

(If you missed it, you can watch the full conversation here.)

What exactly is a prostate?

The prostate is a sexual organ in men that secretes fluid that nourishes and protects sperm. The prostate is located just below the bladder, and the urethra, the tube that transmits urine from the bladder to the exterior of the body during urination, runs directly through the prostate. As men age, a number of prostate conditions can develop including prostatitis (inflammation of the prostate, sometimes caused by infection, which is typically treated with antibiotics), an enlarged prostate (called benign prostatic hypertrophy or BPH) and prostate cancer (surgery, radiation and hormone therapy can be used to treat prostate cancer).

What are the symptoms of prostate cancer that men should be aware of?

Some common signs of prostate cancer that should not be ignored include frequent urination, weak or interrupted urine flow or the need to strain to empty the bladder, painful or burning urination, difficulty in having an erection, and/or pressure or pain in the rectum. Any of these symptoms can also be caused by benign conditions, but all these symptoms should be brought to the attention of your healthcare provider so that they can be addressed. There is no point in suffering in silence, because a lot of these issues are correctable.

What types of screening and tests do you do for prostate cancer?

The same way you bring your car to the shop, you should bring yourself in for prostate cancer screenings. You need a check-up every so often too.

A digital rectal examination is the most common first step in prostate cancer screening. It’s a fancy way of saying your doctor feels the prostate by inserting a gloved, lubricated finger into the rectum. We feel for any lumps, bumps, abnormalities, or pain when we are pushing on the prostate. It seems invasive, but it really isn’t. The 30 seconds of discomfort or embarrassment that accompany a digital rectal examination could save your life.

There is also a blood test called Prostate Specific Antigen (PSA), which is a simple blood test. Low levels of PSA are produced by the prostate when functioning normally. However, there are times when the PSA begins to elevate abnormally, which could be a sign of prostate cancer that we should investigate further.

Is there an age group with a higher risk for prostate cancer?

The number one risk factor for prostate cancer is age. The older a man gets, the longer he has been exposed to testosterone. The longer a man has been exposed to testosterone, the higher the probability that cancer will develop.

In men younger than 40, prostate cancer is very uncommon. Between 40, 50 and 60, the likelihood increases, and the median age of diagnosis is actually 65 years of age.

When should you start screening for prostate cancer?

We start screening men with average risk at age 50. If there is a family history of prostate cancer, you should be getting screened in your 40s. Genetically, if you are a first degree relative of someone who’s had prostate cancer, you have twice the risk of developing it yourself. By being screened early, you would be well informed, and if anything changes be able to take preventative measures.

Is prostate cancer a form of cancer that is highly curable if caught early?

Yes! Prostate cancers detected early have a very high chance of survival. You are more likely to die with prostate cancer than of it.

If you can catch prostate cancer early, there are a multitude of treatment options which can cure you, sometimes with minimal side effects, and you can go back to enjoying a normal life thereafter.

If you ignore your signs and symptoms or delay screening, you may unknowingly be allowing the disease to become more advanced, and your treatment options become much more limited. Prevention is key.

Why do men have a difficult time talking about prostate cancer?

In order to complete a digital rectal exam, your doctor must feel the prostate through the rectum, which is uncomfortable and feels invasive to some men. The stigma is cultural, but that needs to change.

Men regard themselves as tough but are still afraid to get these preventative screenings. Why die when prostate cancer can oftentimes easily be treated?

We still lose 32,000 men to prostate cancer each year. A large reason for this number is either lack of access to care, not having a primary care physician, or just not wanting to see a doctor because they think it might be invasive and embarrassing.

Knowledge is power. It is our responsibility as physicians to provide you the knowledge, and as men it is your responsibility to take that knowledge and make informed, empowered decisions. It is important to have a conversation with your primary care physician about the risks and benefits of prostate cancer screening.
 

Dr. Peter Orio is a radiation oncologist at the Dana-Farber/Brigham & Women’s Cancer Center in Clinical Affiliation with South Shore Hospital. Visit his provider profile to learn more.