Prostate Cancer? Here’s how to beat the odds

If you’ve got a prostate, the statistics can sound pretty scary.  It’s the second leading cause of cancer death in men, right behind lung cancer. African-American men have about a 15 percent chance of developing prostate cancer in their lifetimes, compared to about a 10 percent chance for white men, and African-American men are more likely to be diagnosed with aggressive disease.

However, there’s reason for hope, other statistics suggest. If caught early, prostate cancer has a relative survival rate of nearly 100%. (A relative survival rate compares those with and without the disease, viewed as the most accurate comparison). That’s thanks to advances in screening and treatment (and, let’s be honest, partners dragging their men to the doctor).

Often, the symptoms you think spell cancer-for-sure turn out to be benign. But a benign condition called BPH (benign prostatic hyperplasia) and prostate cancer share some common symptoms, so why guess? Or depend on those remedies sold on late-night TV to fix your issues?

Here’s what else to know about the walnut-sized gland whose main job is to secrete prostate fluid, a major component of sperm.

What Needs Checking, and When?  A test called PSA has long been available. A simple blood test, it looks for prostatic specific antigen, a protein made by both normal and cancerous cells in the prostate. High levels may indicate cancer, but may also point to benign conditions. For years, doctors have debated when this test should be started as a screening as well as when it should be repeated—and how it should be interpreted. “PSA screening is still not resolved,” says Elisabeth Heath, MD, FACP, a medical oncologist at the Barbara Ann Karmanos Cancer Institute at Wayne State University, Detroit. She is also the Patricia C. and E, Jan Harmann Endowed Chair in Prostate Cancer Research and leads a genitourinary cancer team.

Recommendations on PSA testing are made from various professional medical organizations. One respected organization, the U.S. Preventive Services Task Force (USPSTF), updated its guidelines in 2018. The task force concluded that men ages 55 to 69, without symptoms and at average risk, should talk to their doctor and make an individual decision about whether to get the PSA test.  “At 70, no more screening,” Dr. Heath says, referring to the task force guidelines for average risk men, which are echoed by other experts’ advice. If you are at higher than average risk, such as being of African-American descent, or have a family history, you may need to be more aggressive about screening, she says. And if you are 70 and very healthy, you may want to keep screening. (And recommendations vary; the American Cancer Society suggests 50 as a start screening date for men at average risk.)

Symptoms to Heed:  A weak urine stream, difficulty urinating, or feeling like you gotta go even when you just did are symptoms that should be checked out. All might be signs of simply an enlarged prostate (BPH), but they could also point to cancer, especially if weight loss is another issue.  “Guys don’t want to talk about it,” Dr. Heath finds. And they need to at this point, she says.

Among the tests your doc may order: PSA, a digital rectal exam, an MRI (imaging that uses radio waves and magnets, not X-rays), ultrasound exam and a biopsy.

If it’s Cancer:  Treatment Advances

The treatment ”arsenal” is vast, Dr. Heath says. The choices depend on the cancer stage and the man’s overall health. They range from ”active surveillance,” with the doctor monitoring the cancer to see if it grows, to surgery, radiation, freezing, hormone therapy or chemotherapy. There’s also a vaccine, sipuleucel-T (Provenge). Unlike a typical vaccine, which boosts the immune system to prevent infections, this vaccine gears up the immune system to attack prostate cancer cells. It’s custom-made for each man.

Outlook & Perspective

Most men diagnosed with prostate cancer will die with it, not from it. Right now, nearly 3 million men in the U.S. who have been diagnosed with prostate cancer are alive.

Some of them even have cancer that has spread, or metastasized, Dr. Heath says. Even in those cases, she says, there is hope with the array of treatment options. “The message is a positive one,” Dr. Heath says. It’s more positive, of course, if men check out symptoms promptly. A good clearinghouse on information can be found here. 

Getting Help, Getting Through

If you are the 1 in 9, experts also advise:

• Get a second opinion about your treatment plan.
• Get as much information as you can. Good sources: the American Cancer Society,  the American Urological Association and the U.S. Preventive Services Task Force.
• Lean on people as needed.  You may have lots of feelings to sort out; ask your oncologist or internist for a referral to a therapist or a men’s support group.

A Word from the Other Experts

If you’re one of the 1 in 9, could you spare your best bit of advice for a man who has just learned he has prostate cancer, and leave some feedback in our comments section below? If you had to be convinced to go to the doctor by your spouse or a family member, what finally convinced you?