As men age, their risk for developing prostate cancer increases. It is the second most common type of cancer for men with one in eight being diagnosed in their lifetime (one in six for Black men) and the second leading cause of cancer death in men behind lung cancer.

Having their prostate checked is an exam that most men would rather avoid. Out of sight, out of mind mentality persists until something is too uncomfortable to ignore. The good news is that found and treated early, the five-year survival rate is over 99%. Knowing your risk factors and understanding the process of detection and treatment will hopefully dispel some of the fear and anxiety about a prostate exam or prostate cancer.

The prostate is a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm and is essential for reproduction. It sits just below the bladder in front of the rectum and wraps around the urethra. It has a tendency to get larger as men age. 

Risks for developing prostate cancer include:

• Being older – it’s more common after age 50.

• Race - it is not yet understood why, but Black men are more likely to get prostate cancer and it is more likely to be aggressive.

• Family history - having a blood relative with prostate cancer or a strong family history of breast cancer.

• Obesity - being overweight carries a higher risk of developing prostate cancer and it is more likely to be the aggressive kind.

Fortunately, most prostate cancers are very slow growing and are usually confined to the prostate, though there are types that are more aggressive and spread quickly. While prostate cancer does not present as much risk as other types of cancer, it should not be taken lightly. Left untreated, it can still metastasize and spread to other organs such as your bladder or through the bloodstream or lymphatic system to your bones and other organs.

In the early stages, prostate cancer may not cause any symptoms. As it advances, you may experience symptoms such as:

• The need to urinate frequently.

• Difficulty starting or holding back urination.

• Weak, dribbling or interrupted flow of urine.

• Pain or burning with urinating.

• Blood in the urine.

• Blood in the semen.

• Bone pain.

• Pain or stiffness in the lower back, hips, pelvis or thighs.

• Pressure or pain in the rectum.

• Unexplained weight loss.

• Erectile dysfunction.

The age at which a man should be screened for prostate cancer varies, depending on several factors such as family history, age, race, etc. It is generally recommended that by age 55 you start with a PSA test, which involves a simple blood draw. PSA is a protein created by the prostate that is found in the blood. An elevated PSA level can indicate the growth of cancer cells. After an initial screening, doctors recommend a repeat PSA test every two or three years. The good news is that you may not need a digital rectal exam. 

Normal results for a PSA test vary by age. For those under 50, their PSA should be less than two; between age 50-60, under three and for a man age 60-69, under four is good. Higher PSA levels are acceptable for men over 70. Remember that a PSA test is only a screening test, not a diagnosis of cancer.

There are other reasons your PSA level can be elevated, such as a urinary tract infection. You will be referred to a urologist for further testing upon receiving an abnormal PSA. Your doctor will probably order an MRI of your prostate to check the size and shape of your prostate and to look for potentially cancerous lesions in the prostate. If suspicious lesions are found on the MRI, a urologist will perform a biopsy, using the MRI to target the location of the lesions. Using the tissue samples from the biopsy, the patient will be given a Gleason score, which is basically a rating for how likely the cancer is to grow quickly and spread to other areas.

Your treatment plan will take into consideration the Gleason score, risk category, age and general health, one’s preferences about side effects or long-term effects of treatment. Patients may be able to delay treatment and monitor their cancer by having regular blood tests, repeat biopsies or MRIs. The two most common treatments are surgery and radiation.

Surgery involves removing the prostate, seminal vesicles and possibly nearby tissue. Sometimes the lymph nodes in the pelvis that drain from the prostate are removed. The most common prostate surgery today is the robotic assisted laparoscopic radical prostatectomy in which five small incisions are made in the lower abdomen. Surgical instruments and a camera to guide the surgeon are passed through the incisions and the prostate is removed. There are other types of surgery the doctor may discuss with the patient. The risks for surgery are bleeding, infection and short-term pain. Erectile dysfunction and urinary incontinence are also possible though most men regain control of their bladder after a few months. Sometimes erections can recover, but the patient may be referred to another specialist for help.

Radiation therapy involves the use of high-powered energy to kill cancer cells. These treatments take a few minutes, five days a week for five to eight weeks. The long-term risks for radiation treatment include urinary problems, which usually resolve, rectal pain, which usually goes away, and possible erectile dysfunction.