Prostate cancer is second only to skin cancer as the most common cancer in men living in the United States. Each year more than 200,000 men are diagnosed with prostate cancer and over 30,000 will die from the disease. Men aged 50 and older, African American men and men with a family history of prostate cancer are at higher risk. Fortunately, most prostate cancers are slow-growing and can be detected at an early stage when treatment is most effective.

Risk Factors

Factors that may increase your risk of prostate cancer include:

  • Family history — having a brother, father, grandfather, son or cousin with prostate cancer
  • Age — 90% of prostate cancers are diagnosed in men 50 and older
  • Race — African Americans are at greater risk
  • Diet and lifestyle — obesity and/or a diet high in saturated fats has been associated with more aggressive prostate cancer. Eating fruits and vegetables high in antioxidants such as broccoli and cauliflower may decrease risk.

Please note that an enlarged prostate (benign prostatic hyperplasia{?} or BPH) does not increase your risk of prostate cancer.

Symptoms and Screening

Early-stage prostate cancer often has no warning signs and can only be found through routine testing such as a rectal exam (DRE) and PSA, (prostate-specific antigen) a protein that may be elevated in men with prostate cancer. During the DRE, your physician will insert a gloved finger into your rectum to feel the size, shape, and texture of your prostate. The PSA test determines the level of a protein, PSA, in a blood sample; high levels could indicate prostate cancer and may require further testing. Other benign conditions such as an enlarged prostate or prostate infection may also elevate this test. Despite this lack of specificity, PSA remains a useful test to help detect prostate cancer before it spreads outside the gland.

Because many men with prostate cancer are diagnosed at early stages and the fact that prostate cancer often grows slowly, recent publications have highlighted the risks of over-diagnosis and over-treatment, which may cause more harm than good. However, prostate cancer is still a lethal disease for over 30,000 men each year in the United States. A more measured approach to early detection has been published by the American Urological Association (AUA) and is outlined below.

  • Screening for prostate cancer before age 40 is not recommended (men with a strong family history or symptoms could be an exception)
  • Men age 40 to 54 with high risk (family history, African American men) may benefit from early detection.
  • Men age 55 to 69 will have the greatest benefit from early detection. KCUC recommends annual PSA and DRE for men with average risk and every 6 months for men with high risk.
  • Men over the age of 70 will have the least amount of benefit from early detection with PSA. Exceptions are men at high risk and those in exceptionally good health. KCUC recommends having a discussion with your doctor (shared decision making) to see if PSA testing is appropriate for you.

Diagnosis and Staging

If further evaluation is needed after the screening tests, a prostate biopsy or prostate MRI (Magnetic Resonance Imaging, similar to CT scanning but without radiation) may be recommended. If the MRI reveals a lesion with a high risk of cancer, then a fusion biopsy may be recommended. During fusion biopsy, the MRI images are overlapped (fused) with real-time ultrasound images and the lesions seen on MRI can be targeted with a great deal of accuracy. Samples of the prostate obtained in this manner are mapped out and sent to pathology for diagnosis. If prostate cancer is found during the biopsy, additional testing such as a bone scan or a CT scan may be recommended.

The biopsy report will determine the cancer grade. This is the “Gleason Score” that estimates the aggressiveness of the cancer based on microscopic features.  This grade will also determine the type of prostate cancer treatment recommendations.

Based on the DRE, PSA, grade, and imaging results, a cancer grouping is determined, and the stage of cancer can be predicted.

In its early stages (T1 and T2), prostate cancer is usually confined to the prostate itself. As the cancer advances, it may move outside the prostate to surrounding tissues, lymph nodes, bones, or other parts of the body (Stage T3 or T4). Prostate cancer treatment success reduces as the cancer stage increases.