Other than skin cancer, prostate cancer is the most common cancer in men in the United States. Dr. Thomas Richardson, urologist with Physicians’ Clinic of Iowa Urology, and Dr. Jessica Parkhurst, radiation oncologist at St. Luke’s Nassif Radiation Center, answer frequently asked questions about prostate cancer screening and treatment.
When should a man start screening for prostate cancer?
Dr. Richardson: Men should screen for prostate cancer with a prostate specific antigen (PSA) blood test and rectal examine each year starting at age 50. If you have a very strong family history, talk to your doctor about an initial PSA test and rectal exam at age 45. This will provide a baseline and future screening recommendations, until you reach the annual screening age of 50, can be discussed.
What is Prostate Specific Antigen (PSA)?
Dr. Richardson: PSA is an enzyme produced exclusively by the prostate gland and measured by a blood test. If you have a problem with the prostate, your PSA will be elevated. However, your PSA can be elevated and there might not be a problem. That’s why a rectal exam is another important part of prostate cancer screening.
Are there symptoms that may indicate prostate cancer that men should watch for?
Dr. Richardson: This can be a challenge because many people equate the symptoms that occur as a man ages with prostate cancer, such as frequent urination, getting up more at night, urgency and weak stream. Those can exist in parallel. In other words, someone can have those symptoms and think it is indicative of prostate cancer, when the two are unrelated. Someone who has prostate cancer detected with a very high PSA may present with symptoms such as feeling poorly, weight loss and some urinary symptoms, but by and large, prostate cancer is generally asymptomatic and is found through screening.
What are the common risk factors for prostate cancer?
Dr. Richardson: Your risk increases as you age, and we most commonly see prostate cancer in older people. However, we have been seeing more prostate cancer show up in men in their 40s and 50s, which emphasizes the need for screening. Family history is the other big one. Know your family history and discuss with your provider the best screening plan for you.
Dr. Parkhurst: There are some softer risk factors as well, including dietary linkages like diets high in fat or red meat. Also, environmental exposures, such as exposure to Agent Orange, is a fairly common one in the VA population, but like Dr. Richardson said, age and family history are the big ones.
After a man has been diagnosed with prostate cancer, what are the treatment options?
Dr. Richardson: The first step is doing a biopsy. When we get the biopsy back, we use something called the Gleason Grading System. Under a microscope, we look at the cellular patter and grade it from one to five. The higher the score, the more aggressive the cancer. Prostate cancer in general is not a very aggressive cancer, but this number is important to know.
We look at the two most prominent patterns and add those numbers together to get a patients Gleason Score, which could be anywhere from 1+1=2 to 5+5=10. Most people are in the five to seven range. Gleason Scores are broken down into what we call grade groups:
- Grade group 1: Gleason score of six or less. This indicates favorable or low risk.
- Grade groups 2 and 3: Gleason score of seven (3+4 or 4+3). These grade groups indicate intermediate risk prostate cancer.
- Grade groups 4 and 5: Gleason score of 8-10. These are more aggressive forms of prostate cancer.
More common forms of non-radiation treatment include minimally invasive robotic surgical removal of the prostate and cryoablation, or freezing, of the prostate. For men who are in a very low risk grade group, active surveillance is an option for them, which means we repeat the PSA test and rectal exam intermittently. Again, prostate cancer is generally not an aggressive cancer. I have patients with grade group one prostate cancer who have been in active surveillance for nearly a decade and their PSA hasn’t changed. By doing active surveillance rather than treatment, we’ve given them several years of better quality of life and not impacted life expectancy.
Dr. Parkhurst: Prostate cancer is a diverse collection of similar diseases and treatment really depends on your specific type of prostate cancer. For radiation treatment, we can deliver the radiation from the outside into the prostate.
Additionally, patients often need short-term or long-term hormone therapy, and we sometimes treat lymph nodes. Nowadays, there is even a role for radiation at times in patients who have limited metastatic disease as well, so treatment is constantly evolving. I’d say the most important thing is to pin down the exact details of your disease with your team of physicians and get the right treatment for you.
