Weighing Your Options For Treatment
If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.
Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, associate professor of urology at Keck School of Medicine of USC and director of urologic oncology at the USC Institute of Urology at Keck Medicine of USC. So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine whats the best course of treatment for them.
There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.
If you are in the Los Angeles area, schedule an appointment with one of our urologists by calling or by visiting Urology.KeckMedicine.org/request-an-appointment.
When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
What Do You Say To Patients Diagnosed With Prostate Cancer
Something I say to my patients a lot is that, in treating prostate cancer, we end up trying to extend your quantity of life at the cost of your quality of life. And so, at some point, if the quantity is extended a lot, and we can minimize the effect on quality, that makes sense, but the equation is different for every man. How much decrease in quality of life are you willing to accept if were going to extend your life?
Realistically, a lot of guys who are 70 dont have any sexual function anyway, so thats not a huge loss for them. As men get older theres definitely an increased chance of having erectile dysfunction the guys who have sexual function over 70 are very keen on preserving it. Even for the guys who dont have good sexual function, who are on Viagra, for them its often even more important to preserve what sexual function they have.
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Who Should Get A Prostate Exam
Men should understand the importance of a prostate exam. This will help men determine when it is essential for them to get a digital rectal exam .
Age is one of the most important risk factors associated with prostate problems. The risk tends to increase once a man reaches the age of 40. Thus, men over 40 should ensure they get regular health screening. The man should also provide a prostate exam as part of the health screening.
This becomes especially important once the man reaches the age of 60. The majority of prostate problems occur in men of this age and older. Thus, at the age of 60, a man should never delay a prostate exam.
There are other reasons for men to get a prostate exam, apart from age.
Men who experience certain symptoms should ensure they get a prostate exam. A man should educate himself on common symptoms associated with prostate problems.
The sooner the prostate exam is done once the symptoms appear, the earlier a diagnosis can be made.
Most prostate conditions will cause an enlargement of the gland. Sometimes inflammation may affect the gland instead. The prostate gland is situated directly beneath the bladder. It also surrounds the urethra. This is why men will usually experience lower urinary symptoms when they have a prostate problem.
Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
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There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
What Happens After The Exam
When abnormalities are found with the rectal exam, the doctor will order a PSA test. After the results for PSA testing are returned, the doctor will analyze the measurements of prostate-specific antigen in the patients blood.
The findings of the PSA test determine what the doctor will do next.
If the doctor suspects prostate cancer, other tests may be requested. A transrectal ultrasound is often requested. This gives the doctor a visual view of the patients prostate gland.
Cancerous growths can be observed through this type of ultrasound test. The test is also relatively quick to perform. Men may experience discomfort when an ultrasound is performed. The discomfort should not last long, however.
A prostate biopsy is sometimes done. This helps to provide a more accurate test for cancer. A colonoscopy is sometimes needed too. This is especially the case when prostatic carcinoma is suspected.
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Whats The Recommended Age For Your First Prostate Exam
Starting at age 50, all men should discuss getting a prostate exam with their doctor.
The reason for this is prostate cancer. In the UK, about one in eight men will be diagnosed with this in their lifetime. It mainly affects men aged 50 plus, but your risk increases as you get older, and the most common age to be diagnosed is between 65 and 69 years. Most men with early prostate cancer dont have any noticeable signs or symptoms.
The exception to this rule is if you are experiencing symptoms, or if your genetics predispose you as higher risk. Doctors are increasingly finding the tendency towards some prostate cancers can be inherited from your fathers family. Additionally, black men are at a higher risk, with one in four getting prostate cancer in their lifetime.
If youre experiencing no symptoms, heres the recommended age for prostate exam:
- If you have a family history, first prostate exam at age 40
- If you are black, first prostate exam at age 45
- If you have no family history and youre not black, first prostate exam at age 50
Prostate Cancer And African Ancestry
Interviews with a Patient and an Expert
As fast as my PSA was rising, if another 12 months had gone by, who knows?
Barney Morris was only 41 when he was diagnosed with prostate cancer during a routine annual physical in 2004. He had no symptoms just an elevated PSA test the number was 4.2. He had a biopsy cancer was found, and then he had surgery to remove his prostate.
What happened next? Well get to that in a minute. First, its very important to mention a few key points:
*At 53 now, Morris is still far younger than most men who are diagnosed with prostate cancer in fact, hes younger than many men are when they wonder if they even need to get screened for prostate cancer.
*Morris is of African descent, and African-American men are the group out of all men in the world hardest hit by prostate cancer. That puts him in a high-risk group of men who need to start screening for prostate cancer at age 40. African-American men are 1.6 times more likely to get prostate cancer, and more than twice as likely to die from it.
Now, with all this in mind, lets go back to Barney Morris. A year after his prostate was removed, his PSA came back. The number started to quadruple about every 30 days, he recalls. He underwent salvage radiation in 2006. Since then, I have been cancer-free. My PSA has remained nearly undetectable.
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What Do You Want Men To Know About Prostate Cancer
The important thing to know is that, if you live long enough, you will probably get prostate cancer. If you live into your 80s, about 80 percent of men have some sort of prostate cancer. That doesnt mean theyre going to die from prostate cancer because, as a percentage, very few men die from prostate cancer. It means its important to be aware of it and consider screening early, so if its a high-grade type, we can identify it and treat it.
What To Expect During The Digital Rectal Exam
This examination can be done while you are either standing or lying down. This may depend on the examination room and any other health conditions that you have.
If standing, you will be asked to stand facing the examination bed, with feet apart, body bent forward, and your arms or elbows on the bed. Feel free to ask your healthcare provider to give you a heads up before each part of your exam.
Your healthcare provider will coat their gloved finger in lubricant. They will insert their finger into your rectum at a downwards angle. You may feel a little pressure or slight discomfort, but it shouldn’t hurt. It is important to relax and take deep breaths and let your healthcare provider know immediately if you feel any pain.
It may take a few seconds for your external sphincter muscle to relax, and your provider may ask you to bear down as if you are having a bowel movement. They will move their finger in a circular motion in order to identify the lobes of your prostate gland.
A normal prostate is usually around 2-4 cm long and has a triangular shape, with a firm and rubbery texture.
During this exam, the healthcare provider checks for:
- Lumps on or around the prostate
- Swelling
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When Do You Need A Prostate Exam
PSA is continuously present in the bloodstream for most men, and an increase in its number may be attributed to causes other than cancer. However, men who have an increased risk of prostate cancer should undergo a regular prostate exam.
Age, family history, and race are all possible factors that can increase your risk. Likewise, your doctor may also recommend that you undergo testing if you are experiencing discomfort or pain while urinating.
Symptoms which may indicate that you have a prostate issue include the following:
- Inconsistent flow of urine
How Often Is a Prostate Exam Necessary?
Your frequency of testing may be due to several factors, including your age and present health condition:
Why Are Prostate Exams Performed
A lot of men do not realize the importance of a frequent prostate exam. When a man goes for a general check-up with his doctor, a prostate exam may be advised. This is considered part of a general health check-up.
It is generally advised that men undergo frequent health screenings once they reach the age of 40 . Research shows that this is the time when the risk of several prostate conditions increases.
For this reason, after 40, a man should ensure they obtain a prostate exam as part of their health screening.
The main reason why a doctor may advise on a prostate exam is to feel for any abnormalities with the mans prostate. This helps detect prostate disease. It is usually possible for a doctor to determine the health of the mans prostate through this examination. Further testing may be needed too.
The doctor can detect different prostate problems through a prostate exam. It is often considered the initial diagnostic option. The prostate exam itself can give a doctor an indication if there is an enlargement or swelling in the prostate gland. It also helps to determine prostate health.
In most cases, a prostate exam alone will not be the only diagnostic tool. After a digital rectal exam is done, the doctor will order additional tests if abnormalities are identified. This will help to diagnose problems like cancer and prostate enlargement.
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Two Main Screening Tests
There are two tests commonly used to screen for prostate cancer:
- The Digital Rectal Exam : A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
- The Prostate Specific Antigen Test: This exam measures the level of PSA in the blood. The levels of PSA in the blood are often higher in men who have prostate cancer. The PSA level may also be high in other conditions that affect the prostate.Usually, the higher the bloods PSA level is, the more likely it is that a prostate problem is present. But other factors, such as age and race, also can raise PSA levels. PSA levels also can be impacted by certain medical procedures, some medications, an enlarged prostate or a prostate infection.
Since your PSA level may be high for other reasons, your doctor will need to interpret the test results.
If the results of the PSA and/or DRE suggest that you might have prostate cancer, your doctor will need to do a prostate biopsy to find out. This means a sample of your prostate tissue will be removed with a needle and sent to a lab, where a specialist will determine if it contains cancer cells.
American Cancer Society Recommendations For Prostate Cancer Early Detection
The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
- Age 40 for men at even higher risk .
After this discussion, men who want to be screened should get the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the mans general health preferences and values.
If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
- Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
- Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
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What Would You Say To Men Who Dont Want To Get A Prostate Check
A rectal exam is recommended but optional. We recommend both, but if theyll just let you do a blood test, thats better than not doing anything at all.
If concern about the rectal exam is the only reason youre not getting screened, talk to your doctor about it. We can discuss the risks and benefits. None of the evaluation tests are mandatory, but the reason we do that is that it improves our ability to detect cancer. So, if thats why youre not being evaluated, we can talk and decide if we can do other tests.
What To Expect During A Prostate Exam
The prostate exam, or digital rectal exam , along with prostate-specific antigen testing, is sometimes part of the prostate cancer screening process. Recent research suggests that the DRE may be ineffective in prostate cancer screening. Current screening recommendations vary depending on age and other factors. Men aged 5569 should talk with their healthcare providers regarding their risks and benefits of prostate cancer screening. African Americans and men with a family history of prostate cancer may need early screening.
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Benefits And Risks Of Screenings
The benefit of any cancer screening test is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.
Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man’s life span.
For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found.
There are other factors to think about before having a PSA test:
- Anxiety. Elevated PSA levels does not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer.
- Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies to find out for sure. A biopsy is safe, but can cause problems such as an infection, pain, fever, or blood in the semen or urine.
- Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer.