In the current era of screening awareness, most men diagnosed with prostate cancer experience no symptoms at all. However, when caught early, prostate cancer that has not spread is very treatable and boasts a 99% survival rate.
Because early detection is so important, regular prostate-specific antigen (PSA) blood tests remain a vital screening tool. Yet, as medical understanding evolves — recognizing that many prostate tumors grow very slowly — the guidelines and dialogue around screening and treatment are shifting.
Endeavor Health urologic oncology specialist Brian Helfand, MD, breaks down what you need to know about screening, who’s at risk, and advanced treatment options for prostate cancer.
When should you start prostate cancer screening?
First and foremost, men who are at average risk for developing cancer, with no family history of the disease, are recommended to begin screening with a PSA blood test at age 50, said Dr. Helfand.
For men who have risk factors such as a family history of prostate cancer or other related cancers including breast, ovarian, pancreatic cancers, certain heritable genetic mutations (e.g., BRCA2 mutation), baseline screening is recommended at age 40.
Who is most at risk for prostate cancer?
“It’s important for men to talk with their physicians about screening and their own risk profile,” urged Dr. Helfand.
Black men are at higher risk both for developing prostate cancer and for developing more aggressive cancers. In addition, certain heritable gene mutations and variations also increase prostate cancer susceptibility. Few environmental exposures contribute to increased risk of prostate cancer, however, exposure to Agent Orange is a known risk factor.
Are urinary changes always a sign of prostate cancer?
Urinary symptoms from an enlarged prostate are quite common as men age, and most of the time they are not caused by cancer, added Dr. Helfand, addressing questions about early signs.
“Benign enlargement of the prostate is the most common reason men suffer from a range of urinary symptoms,” he added. The treatment of this bothersome condition is very different than for prostate cancer.
Unfortunately, late-stage cancer that has spread includes more obvious and destructive symptoms, including bone pain and weight loss. “We want to prevent those advanced cancers, so we don’t see patients suffering those consequences,” said Dr. Helfand.
What is active surveillance?
One of the biggest changes in treatment paradigms in the last decade and longer is the advent of active surveillance, and Endeavor Health was one of the first systems in the country to adopt the advanced practice, said Dr. Helfand.
“We used to actively treat everyone diagnosed with prostate cancer with either surgery or radiation, but we now know that about 40% of those tumors may never need treatment,” he explained. DNA germline testing and genomic-based tumor testing have led to more personalized and effective treatment strategies.
“We are able to better identify which men actually need early treatment based on their specific cancer and which men are appropriate candidates for active surveillance and watchful waiting,” said Dr. Helfand.
What advanced treatments are available?
Advances in treatment continue to improve care options and outcomes. More focused radiation and significant advances in surgical techniques provide more effective treatment while mitigating some side effects. An array of new therapeutic agents and novel treatments combined with cutting-edge imaging and diagnostics are continuing to provide hope for men with more aggressive cancers.
“Novel treatments and sophisticated diagnostics are continuing to provide more hope and brighter futures for men facing prostate cancer,” said Dr. Helfand.
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