About one man in seven will be diagnosed with prostate cancer, the American Cancer Society says—a statistic that means the odds are good you or someone you know will have or has had prostate cancer.
“The older you get, the higher your risk gets,” says Alfred Di Stefano M.D., oncologist and physician on the medical staffs at Texas Health Arlington Memorial and Arlington Cancer Center, a Texas Health Physicians Group practice. “It’s been said that if you did autopsies on 100-year-old men, you’d find prostate cancer in all of them—but we don’t do that.”
The ACS says that there will be about 161,360 new cases of prostate cancer this year, and 26,730 deaths. About six cases in 10 are found in men 65 and older, and the average age of diagnosis is about 66. It’s rare to find it in men younger than age 40.
“Really, all men over 50 are at risk,” Di Stefano says. “You can see it younger than 50 but it’s unusual.”
Prostate cancer screenings begin with a digital rectal exam. “You screen with a digital rectal exam,” Di Stefano explains. “The location of the prostate is between the bladder and the rectum.”
A PSA blood test is also done, and the combination of the two can pick up most prostate cancers.
PSA—or prostate specific antigen—is a protein produced by prostate cells. Prostate cancer cells make larger amounts of this protein than normal.
While a PSA test may be part of your annual exam, the Prostate Awareness Foundation says men should be on the lookout for specific symptoms that may lead them to seek out their doctor earlier than that. The symptoms include:
- A change in urinary patterns lasting two weeks
- Persistent back, hip, pelvis or thigh pain
- A burning sensation during urination
- The inability to produce urine or difficulty starting urination
- Weak or interrupted urine flow
- Painful urination
If the digital rectal exam and/or PSA turns up anything questionable, Di Stefano says a biopsy would be the next step. If cancer is present, then treatment options can be discussed.
“The doctor will decide how advanced it is, and whether it’s spread anywhere else,” Di Stefano says, adding that CAT scans can help a doctor determine if the cancer has spread to lymph nodes or bones.
“It almost always spreads to bone when it’s going to spread outside the prostate,” he explains.
A doctor will use a Gleason Score to determine the best course of action.
“The Gleason Score is the determination of how malignant it will behave or is behaving,” Di Stefano explains. “Eight is intermediary, high is nine or 10. A low score has many more options for treatment than a high score.”
An oncologist will likely also take into account other factors in determining what treatment is best.
“We take into account age, the general health of the patient, and how advanced it is,” Di Stefano says.
Treatments can include radiation, chemotherapy, radiation seeding, removing the prostate surgically, and hormone therapy.
“If you pick up (prostate cancer) early, it’s highly curable,” Di Stefano says. “Even if it’s advanced, frequently you’ll live a long time. I have patients who have been alive with it for 20, 25 years on hormone therapy, or intermittent hormone therapy.”
Some prostate cancers can even wait for treatment, depending on a variety of factors—including age.
“If it’s contained to the prostate, you can follow and watch it without treatment,” Di Stefano says. “In some cases, especially if the patient is very old, you’ll survive about as long with treatment as you would with watch and wait.
“Generally, if you’re younger, you tend to go towards surgery and more aggressive treatment,” he adds. “If you are diagnosed with prostate cancer when you’re 80, odds are you’re going to die of something else. The more aggressive treatment is for when they’re 55 and otherwise healthy.”
The ACS agrees. While prostate cancer is the third-leading cause of cancer death in American men, the group says most men diagnosed with prostate cancer don’t die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today, the ACS says.
While much research still needs to be done on what can prevent someone from getting prostate cancer, Di Stefano says a healthy lifestyle can’t hurt.
“Research isn’t 100 percent clear that it can be prevented,” he says. “Data does indicate that if you control your weight, are physically active, eat at least two and a half cups of fruits and vegetables daily, and include fish with omega-3 fats in your diet, you can help. There’s also some data that aspirin can help prevent it, and there are medicines that are currently used to treat benign enlargement of the prostate that some research says may be helpful in preventing prostate cancer, too.”
Use our “Find a Physician” tool to find a doctor who can help you manage your prostate health.
Interested in learning more about men’s health risks? Read “Top 10 Health Risks for Men.”