Prostate Cancer: Know the Facts

T.V. personality Dr. Drew Pinsky calls prostate cancer a “stealth disease” because it rarely makes its presence felt, especially in the early stages, and it can simmer for years.

Pinsky would know. He announced last week that he underwent successful prostate cancer surgery at the age of 55 after certain red flags were raised in his routine check-up, including a big jump in his Prostate Specific Antigen (PSA) — the controversial but still widely-used blood test for men over 50.

Every time a celebrity fights prostate cancer, it usually helps spread awareness to men who may be skipping out on their routine check-ups. By doing so, men increase the risk of letting the stealth threat run its course.

Despite questions about the PSA’s effectiveness, early screenings that include physical exams for prostate cancer are a must for men in their 50s, particularly if they fall into higher-risk categories, such as African-American males and those with a family history of the disease. (Pinsky revealed that his father and uncle had had prostate cancer.)

For most men at average risk, screening is started at age 50. However, doctors recommend that men at higher risk of prostate cancer start screening earlier.

“I want to state something very clearly and forcefully, if you are a male that falls into that population, such as an African-American or someone with a family history, you should get screened, and do at an early age instead of waiting,” said Fernando Bianco, M.D., a urologist affiliated with Doctors Hospital and South Miami Hospital.”These are the men who will benefit the most from early intervention.”

Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States. According to the Centers for Disease Control and Prevention, more than 200,000 men in the U.S. are diagnosed with prostate cancer annually.

More than 28,000 men die from the disease, which is the second deadliest cancer for men after lung cancer. Prostate cancer’s death rate, however, is decreasing as early detection surges.

The longer a man lives, the more likely he will have. More than half of all men by age 80, will have cancer in their prostate, but that doesn’t mean they will die from the disease.

The prostate is a gland about the size of a kiwi, located deep in the pelvis, below the bladder. It is doughnut-shaped as it surrounds the beginning of the urethra, the tube that brings urine from the bladder to the penis.The nerves that control erections surround the prostate.

Men over 50 routinely undergo a prostate examination as part of a general screening. It is advised usually because of a man’s age, or if a problem exists such as difficulty in passing urine.

During a digital-rectal examination, the doctor will move his finger in a circular motion to identify the lobes and groove of the prostate gland. The examination helps determine if the prostate is of normal size and texture. The doctor is able to feel any lumps or hard areas on the prostate.

In addition, the PSA is ordered as part of the blood work-up. And that’s the controversial aspect of prostate cancer screening.

Last year, the U.S. Preventive Services Task Force (USPSTF) recommended against screening men for prostate cancer with the (PSA) test. The recommendation — published in the Annals of Internal Medicine and on the USPSTF website — does not apply to PSA testing to monitor prostate cancer progression after diagnosis or treatment.

The problem with PSA is that it sends thousands of men a year for painful, invasive biopsies. Sometimes, high PSA readings are responsible for surgeries that can leave men impotent, incontinent or both.

“The PSA is not a very specific test. There are a lot false positives associated with an elevation in the PSA,” said Antonio Muina, M.D., an oncologist with Baptist Health South Florida. “So, if you get an elevation in the PSA, that doesn’t mean you are going to die from prostate cancer.”

Physicians still utilize the PSA as a tool in their screenings, understanding not to rely on its reading alone. Digital-rectal exams and a thorough medical history, including determining possible symptoms and family history, are all important for detecting and tracking prostate tumors in their early stages.

Most physicians view PSA levels less than 4 ng/mL as normal. Some may recommend lowering the cutoff levels that determine if a PSA value is normal or elevated, particularly in younger patients. Doctors may pay more attention to the trend in the PSA number — whether the number is going up, how quickly, and over what period of time.

“The most important thing is to get screened,” Dr. Muina said.

Prostate cancer may not cause signs or symptoms in its early stages, but when it is more advanced it may cause signs and symptoms such as: