PROSTATE CANCER SCREENING

By Penda Health,

What is prostate cancer?

Prostate cancer happens when normal cells in the prostate gland change into abnormal cells and grow out of control. The prostate gland makes fluid that is part of semen. This gland sits below the bladder and in front of the rectum, and forms a ring around the urethra, the tube that carries urine out of the body. Prostate cancer occurs most often in men older than 50. Although prostate cancer is very common, most men do not die from it. This is because prostate cancer usually grows very slowly.

What are the symptoms of prostate cancer?

Prostate cancer often causes no symptoms at first. But if symptoms do occur, they can include:

• Dull pain in the lower pelvic area

• Frequent urinating

• Trouble urinating, pain, burning, or weak urine flow

• Blood in the urine (Hematuria)

• Painful ejaculation

• Pain in the lower back, hips, or upper thighs

• Loss of appetite

• Loss of weight

• Bone pain

These symptoms can also be caused by conditions that are not prostate cancer. But if you have these symptoms, you should let your doctor or nurse know.

What are the causes of prostate cancer? 

No one knows why or how prostate cancer starts. Autopsy studies show 1 in 3 men over the age of 50 have some cancer cells in the prostate. Eight out of ten “autopsy cancers” found are small, with tumors that are not harmful. Even though there is no known reason for prostate cancer, there are many risks associated with the disease.

What are the risk factors for prostate cancer?

•Age

As men age, their risk of getting prostate cancer goes up. It is rarely found in men younger than age 40. Damage to the genetic material (DNA) of prostate cells is more likely for men over the age of 55. Damaged or abnormal prostate cells can begin to grow out of control and form tumors. Age is a well-known risk factor for prostate cancer. But, smoking and being overweight are more closely linked with dying from prostate cancer.

•Family History

Men with a family history of prostate cancer also face a higher risk of also developing the disease. A man is 2 to 3 times more likely to get prostate cancer if his father, brother or son had it. This risk increases with the number of relatives diagnosed with prostate cancer. The age when a close relative was diagnosed is also an important factor.

•World Area

Prostate cancer numbers and deaths vary around the world but are higher in North America and Northern Europe. Higher rates may be due to better or more screening procedures, heredity, poor diets, lack of exercise habits, and environmental exposures.

•Diet

Diet and lifestyle may affect the risk of prostate cancer. It isn’t clear exactly how. Your risk may be higher if you eat more calories, animal fats, and refined sugar, and not enough fruits and vegetables. A lack of exercise is also linked to poor outcomes. Obesity (or being very overweight) is known to increase a man’s risk of dying from prostate cancer. One way to decrease your risk is to lose weight and keep it off.

•Smoking

Studies show prostate cancer risk may double for heavy smokers. Smoking is also linked to a higher risk of dying from prostate cancer. However, within 10 years of quitting, your risk for prostate cancer goes down to that of a non-smoker the same age.

Can Prostate Cancer Be Prevented?

Doing things that are “heart healthy”, will also keep your prostate healthy. Eating right, exercising, watching your weight and not smoking can be good for your health and help you avoid prostate cancer.

Is there a test for prostate cancer?

Yes. Doctors use a blood test called a PSA test and an exam called a rectal exam to check for prostate cancer. In a rectal exam, your doctor or nurse puts a finger in your anus and up into your rectum. They press on the rectum wall to feel for abnormal areas on the prostate.

If your doctor or nurse suspects you have prostate cancer, they will follow up with one or more tests. These can include:

•Biopsy – A doctor will take a small sample of tissue from the prostate. Then another doctor will look at the sample under a microscope to see if it has cancer.

•Ultrasound, MRI scan, or other imaging tests – These tests create images of the inside of the body and can show abnormal growths.

What is a PSA test?

PSA stands for “prostate-specific antigen.” PSA is a protein made by the prostate. Levels of this protein usually go up when a person has prostate cancer. The protein also goes up for reasons that do not involve cancer. For example, PSA levels rise when a man:

•Has a condition called benign prostatic hyperplasia (BPH), sometimes called an enlarged prostate

•Has a prostate infection, also called prostatitis

•Hurts his prostate, for example, while riding a bike

•Ejaculates (has an orgasm)

What if my PSA level is too high?

If your PSA level is high, try not to panic. It’s possible your PSA is high for reasons unrelated to cancer. If your PSA level is only somewhat high, often the next step is to have the PSA test again. For 2 days before the second test, avoid ejaculating and bike-riding. If your doctor thinks you have a prostate infection, you might also need to take antibiotics for a while before you repeat the test.

If your PSA is still high on the second test, or if it was very high the first time, you will probably need more testing. This might include a biopsy or other

test. If it turns out you do have cancer, remember that prostate cancer is not usually deadly. It usually grows slowly, so you probably have time to decide what to do. There are treatments that can sometimes cure prostate cancer. You might also choose to hold off on treatment and wait to see if your cancer shows signs of progressing.

Who should be screened for prostate cancer?

Prostate cancer screening is done in people who have no symptoms of the disease. It is not clear whether getting screened for prostate cancer can extend life or prevent symptoms or problems. For this reason, doctors do not know who – if anyone – should be screened for prostate cancer.

Most experts recommend working with your doctor to decide whether screening is right for you. In most cases, this discussion should start around the age of 50. If you have any risk factors for prostate cancer, you might want to begin screening at age 40 to 45. Your risk is higher if you are black, have a father or brother with prostate cancer. Most doctors recommend against screening if you are age 70 or older, or have serious health problems.

Why do doctors offer screening?

Doctors offer screening in the hopes of catching prostate cancer early – before it has a chance to grow, spread, or cause symptoms. With many

cancers, catching the disease early is an important part of effective treatment. But prostate cancer is not like many other cancers. It usually grows slowly and does not usually lead to death. The problem is that a small number of prostate cancers are serious and can lead to death. Doctors do not have an ideal way to tell which prostate cancers are deadly and which ones would never cause any problems.

Certain tests can suggest which prostate cancers might be more likely to cause problems. But the tests are far from perfect. Also, different studies have come to different conclusions about the benefits of screening and whether or not it lowers the risk of dying from prostate cancer.

What are the drawbacks to getting screened?

PSA tests have 2 main drawbacks:

•PSA tests sometimes give “false positives.” This means they suggest cancer when there is actually no cancer. This can lead to unneeded worry and to further tests. One of these tests, a biopsy, can be briefly painful.

•When PSA tests lead to the discovery of cancer, there is very often no way to tell whether the cancer is one that could do harm. That means you could get treated for cancer that would never have done you any harm. That’s a problem because treatment for prostate cancer has risks and often causes problems of its own. For instance, prostate cancer treatment can cause you to leak urine and to have problems with sex.

How often should I be screened for prostate cancer?

If you do decide to be screened, experts recommend repeating screening every 2 to 4 years. Doctors recommend stopping screening when you turn 70 or if you develop serious health problems. In these cases, the benefits of screening are not worth the possible harms.