Prostate cancer

During Men’s Health Month, let’s discuss the prostate gland to understand how to keep it healthy and help prevent prostate cancer. 

The prostate gland is only present in men and serves three important functions: 

1. Producing semen
2. Activates sperm at the time of ejaculation
3. Converts testosterone into dihydrotestosterone (DHT), which is biologically active.

A man’s health and quality of life can be negatively impacted if one or more of these is not functioning properly.  

According to the American Cancer Society, prostate cancer is the second most commonly diagnosed form of cancer in American men, following skin cancer. In 2023, there were 288,000 new cases of prostate cancer diagnosed in men and 34,700 men died from the disease. Understanding risk factors, prevention and treatment will help reduce these numbers in the future and help protect men’s health. 

Risk Factors 

While all men should talk to their doctor about prostate cancer screening, those who have additional risk factors beyond the average male should consider earlier screening. The main risk factors for prostate cancer are: 

• Age
  The overwhelming majority of cases are in men over the age of 65.
• African American ancestry
  African American men are diagnosed with prostate at higher rates than the general population.
• Family history
  Men with a first-degree relative (father, son, or brother) who has had prostate cancer are more likely to develop than men without relatives affected. 
• Family history of breast and ovarian cancer
  Inherited mutations in the BRCA1 or BRCA2 genes, which are linked to increased risk of breast, ovarian and other cancers in some families, can also increase prostate cancer risk in men. 
• Elevated prostate-specific antigen (PSA) levels 
  Elevated levels may indicate a higher risk of underlying prostate cancer. PSA levels naturally increase as men age.  

Symptoms and Signs 

In the early stages of prostate cancer, there are no symptoms, so screening and attention to risk factors are important. As prostate cancer progresses, urinary symptoms such as difficulty initiating a stream, getting up at night to use the bathroom and blood in the urine may occur.  

In advanced stages of prostate cancer, symptoms may include back pain, bone pain and weakness or numbness in the lower extremities. There may also be changes in bladder function, fatigue or unintended weight loss. 

Treatment 

Treatment options for prostate cancer include: 

• Active surveillance with routine PSA checks and subsequent biopsies for low-risk disease.
• Localized external beam radiotherapy for intermediate or high-risk disease.
• Brachytherapy with radioactive seed implantation for intermediate or high-risk cases.
• Surgical removal performed laparoscopically using the Da Vinci robot for intermediate or high-risk disease.
• Systemic therapies such as androgen deprivation therapy, chemotherapy, and targeted therapies for advanced or metastatic disease. 

Prevention Strategies 

Extensive trials and studies have been conducted on prostate cancer prevention strategies, but no conclusive prevention method has been identified. The best recommendations include maintaining a healthy weight, being physically active and following a healthy eating pattern that includes whole grains, fruits and vegetables, while limiting processed or highly sweetened foods. 

Screening 

Men should take a shared decision-making approach with their doctor to determine when PSA prostate screening should be done. We recommend that all men between the ages of 40 and 75 should talk with their doctor about cancer screening. Typically, men should start this screening between the ages of 45 and 50, but those men with higher risk factors should talk with their doctor and may start screening at 40. In general, a screening consists of a PSA blood test combined with a digital rectal exam performed by the patient’s doctor. 

Genetic Testing 

Two types of genetic tests are available for prostate cancer: 

• Germline testing - this looks for inherited changes in cancer-related genes and is offered to men with familial risk factors such as a close relative who had breast or ovarian cancer before the age of 50, several family members with prostate cancer or someone who has metastatic prostate cancer.
• Genetic biomarker testing - this testing uses tissue from a biopsy or a prostatectomy specimen to identify the presence of gene mutations acquired during tumor development. It may help direct care for the patient and make screening recommendations for family members. 

Research Advancements 

Research is leading the way for treatment options and decision making: 

Dealing with advanced prostate cancer – a highly active area of research is studying adjuvant therapies in men with metastatic cancer as well as the use of genomic classifiers for decision making. 

• Next generation imaging - the PSMA (prostate-specific membrane antigen) PET (positron emission tomography) scan is considered the most sensitive and specific radioactive tracer for prostate cancer. It can help doctors locate cancer and pinpoint tumors for treatment.
• High-Intensity Focal Ultrasound (HIFU) – this treatment uses high-frequency sound waves to destroy prostate cancer cells, and is one part of a growing area of research on focal therapy for prostate cancer.
• Support Strategies
• If you or someone in your family is dealing with prostate cancer, here are some resources:
• Nurse Navigator Program: This program provides one-on-one personal guidance for the patient.
• Support groups: The American Cancer Society offers online support groups and access to local support resources.
• Friends and family: One of the strongest support systems for many patients is their circle of friends and family, especially those who have gone through cancer treatment. 

At Endeavor Health, we want men to be informed about prostate cancer prevention, care and treatment. We are excited about the latest prostate cancer research and genetic testing advancements and encourage men to talk with their doctors for personalized care. To get screened or schedule your next appointment, contact our network of healthcare providers and convenient lab locations. Visit us online or call 847-618-4968. 

Visit us online or call 847-618-4968.