Screen for Prostate Cancer

By Joel Slaton, M.D.

With the exception of skin cancer, prostate cancer is the most commonly diagnosed malignancy in American men. The American Cancer Society predicts that there will be about 189,000 new cases of prostate cancer in the United States this year. 

The prostate is a walnut-shaped gland involved in producing semen. It is located just below the bladder and in front of the rectum. Early prostate cancer is localized, or confined, to the prostate gland. Compared to other cancers, prostate cancer usually grows slowly. Many, if not most men will live with it until they die from an unrelated cause.

While all men are at risk for prostate cancer, the factors listed below can increase the chances of having the disease. 

• Age:the chance of getting prostate cancer increases as men age.
• Race:for unknown reasons, prostate cancer is more common among African-American men than among white men. 
• Diet: a high-fat diet may play a part in causing prostate cancer. 
• Family history: men with close family members who have had prostate cancer are more likely to get prostate cancer themselves. 

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include frequent urination, especially at night; inability to urinate; trouble starting or holding back urination; a weak or interrupted urine flow; frequent pain or stiffness in the lower back, hips or upper thighs. However, other diseases of the prostate, some of them benign, might also produce the same symptoms, so be sure to see your physician if you experience any of these symptoms.  

Prostate cancer can be detected by using a screening method such as serum testing for the prostate-specific antigen (PSA), digital rectal exam (DRE), or, in some cases, diagnostic imaging techniques. The American Cancer Society recommends a PSA and DRE yearly for men age 50 years and older. African-American men should begin testing at age forty since the risk of developing prostate cancer is almost twice as high in this group as it is in others. Men with a family history of two or more immediate family members who have had prostate cancer should also begin at a younger age. A diagnosis of prostate cancer can be confirmed only by a microscopic examination to identify cancerous prostate tissue. This is done by a biopsy performed in the doctor's office. 

Treatment depends on the stage of the cancer when it is found and on the patient's age and health status. Standard treatment options for cancer that is confined to the prostate include surgically removing the entire prostate gland or radiation therapy aimed at the pelvic area. Some patients, especially elderly men or men with unrelated severe medical problems, may choose to have no immediate treatment. However, if the cancer has spread outside of the prostate gland, hormone therapy is most commonly used and may include surgically removing the testicles or giving drugs that reduce the effects of male hormones.