In the United States, prostate cancer is the second most common cancer, behind non-melanoma skin cancer. It is also the second leading cause of cancer-related death in American men. Each year, nearly 250,000 men in the United States are diagnosed with the disease; another 30,000 die from it.
 
For many men, the disease progresses so slowly it doesn’t cause problems—but for others, prostate cancer can be a very aggressive, deadly disease. Here, who is at risk and why early detection is key to increasing survival rates.
 
What Is Prostate Cancer?
Prostate cancer is cancer that occurs in the prostate—a walnut-sized gland that sits just below the bladder.
 
What Are the Symptoms of Prostate Cancer?
Prostate cancer may cause no symptoms or signs when it is in its earliest stages. Many men can be diagnosed with the disease without having ever experienced a symptom. As the cancer grows and becomes more advanced, it can begin pushing on the urethra, the tube that carries urine from the bladder to the penis. When that occurs, men may begin experiencing symptoms such as trouble urinating, decreased force when urinating, blood in the urine or semen, low back pain, and pain with ejaculation.
 
Who Is at Risk?
Factors that increase a man’s risk of prostate cancer include:

  • Age. Prostate cancer is most common in men over 65—men under the age of 40 rarely develop the disease.
  • Race. African American men have a greater risk of developing prostate cancer than men of other races. Prostate cancer is also likely to be more aggressive in African American men, though the reasons aren’t well understood.
  • Family history. Men with a family history of prostate cancer are at an increased risk of developing the cancer, too. The closer the connection to you, the greater your risk—if your father or brother was diagnosed with prostate cancer, your risk is much greater.
  • Obesity. Obese men have a higher risk of developing prostate cancer than men of healthier weights. Also, prostate cancer in obese men is typically more advanced and more difficult to treat.

Early Detection is Key!
According to the National Cancer Institute, more than 90 percent of all prostate cancers are diagnosed at an early stage. That’s good news, because prostate cancer that is detected early is easier to treat, and treatment is usually more effective when the cancer remains contained to the prostate. The earlier it’s caught, the more successful the treatment will be.
 
How does screening help?
Screening for prostate cancer typically consists of two tests: a digital rectal exam and a prostate-specific antigen test. If the results of either of these tests are suspicious, your doctor may require additional tests.

  • Digital rectal exam (DRE). Your doctor will perform a close examination of the prostate. This allows him to examine your prostate more easily. If your doctor feels any abnormalities or changes since your last DRE, he may check your levels of prostate-specific antigen.
  • Prostate-specific antigen (PSA) test. This test analyzes your blood for the PSA protein that is naturally produced by the prostate gland. It’s common to have a low level of PSA circulating in your bloodstream throughout your life, but if a higher level is found, it may indicate you have a problem with your prostate. It may not be cancer, however—a high PSA could also indicate you have an infection, inflammation, or enlargement of the prostate.

 The results of a PSA test and a DRE are reported as a Gleason score. This number tells how advanced the cancer is and how far it might have spread. The higher the Gleason score, the more likely it is that the prostate cancer has spread past the prostate into nearby tissue, organs, or bones. On the low end, a score of 2 to 5 would indicate early stage prostate cancer that has likely not progressed past the prostate. A score of 8 to 10 would suggest advanced stage prostate cancer.
 
If both a DRE and PSA test return normal results, you can rest assured you likely do not have prostate cancer. However, a questionable DRE or a higher-than-normal PSA test can send off alarm bells—and sometimes for no reason. As mentioned, PSA levels can be elevated for several reasons, not just in the presence of cancer. Your doctor may prescribe antibiotics as a first line of treatment. If your PSA level returns to normal, you likely do not have prostate cancer. However, your doctor may wish to check you again in a few months.
 
To screen or not to screen?
Researchers point out that the negative effects of worry and anxiety related to the “false-positive” results of a PSA test might be too stressful for many men. Some men will choose to undergo treatment for prostate cancer despite the fact that the cancer might never have caused symptoms or threatened their lives.
 
This conundrum puzzles many health-care professionals. Is it better to screen all men and find many false positives? Or should we allow men to wait until more advanced prostate cancer begins causing symptoms? Health-care professionals and researchers wrestle with these questions. Many of the most notable and respected medical organizations in the country have differing opinions on the topic. Ultimately, the decision is up to you. Talk with your doctor about your risks for prostate cancer. Together, you can decide what is most appropriate for you.