By Wally Curran, MD, FACR, FASCO, Chief Medical Officer, GenesisCare
If there’s any message that should be delivered to men about prostate cancer risks, screenings, and treatments, it’s a simple, three-word piece of advice: talk about it.
Men should be encouraged to talk about prostate cancer with their family physicians and oncologists. Additionally, men should be provided facts that debunk common myths about prostate cancer and its treatment. Talking with their fathers, brothers, sons, uncles, and friends —especially those diagnosed with, treated for, and survivors of prostate cancer- offers immense support. Helping men navigate their family health history, which can be an indicator of their health needs now and in the future, often starts with leaning into their family’s health background.
Why are these conversations so meaningful?
In the U.S., men are more likely to die from prostate cancer than any other cancer. Yet caught early, prostate cancer is highly treatable.
Comments from online support groups for men with prostate cancer hint at the questions, concerns, and fears they face as they make decisions about a cancer diagnosis. One example from ProstateCancer.net2 forums:
“Been preparing myself for major surgery; however, after consultation with an oncologist today, I learned radiation is a viable treatment option. I am a bit overwhelmed by the choice of treatments and would appreciate advice and wisdom from other community members.”
Doctor-patient and peer conversations can help men understand lifestyle factors associated with prostate health and cancer, including preventive and lifestyle measures, dietary changes that can reduce cancer risks, and integrative therapies that can support them through recovery and a healthier post-treatment life.
Talk about facts and risk factors.
The prostate gland, about the size of a walnut, produces the fluid that nourishes and transports sperm. It is located behind the rectum bladder and below the bladder, surrounding the top part of the tube that drains urine from the bladder. Early symptoms, usually involving problems with urination, are signs that the prostate should be examined for signs of cancer.
According to the American Cancer Society’s (ACS) 2022 Facts & Figures3, prostate cancer is:
- The leading cause of cancer in men, with an estimated 268,490 new U.S. cases in 2022
- The second-leading cause of cancer death in men, with an estimated 34,500 U.S deaths in 2022
- Far more common in Black men, with a 73% higher incidence rate compared to non-Hispanic White men
- Associated with key risk factors: Black men and Caribbean men of African ancestry, a family history of the disease (especially a brother or father), and certain genetic conditions (e.g., Lynch syndrome, and BRCA1 and BRCA2 genetic mutations)
- More common in men who smoke or who are overweight. Modifiable risk factors are linked to more aggressive/fatal cancers.
An online cancer survivor offers this insight: “No matter how you look at a prostate cancer diagnosis, know things will be different going forward. The key I found was to roll with the punches, adapt to the changes, and maintain a positive outlook.”
Talk about symptoms and causes.
Researchers still do not know the exact causes of prostate cancer, but they know that certain factors affect the genes that control cell growth within the prostate gland. Common symptoms include:
- weak or interrupted urine flow
- difficulty starting or stopping urination
- frequent urination, especially at night
- blood in the urine, or pain or burning with urination
- pain in the hips, spine, ribs, or other areas if late-stage cancer spreads to the bones
Talk about tests and treatments.
According to ACS, medical specialists recommend “informed decision-making” about prostate cancer screenings. Schedule and initiate doctor-patient conversations:
- At age 50, men are at average risk of prostate cancer and have a life expectancy of at least ten years.
- At age 45 for Black men and other men who have a family history (close relative) of prostate cancer before age 65.
- At age 40 for men whose family history includes several close relatives who were diagnosed with prostate cancer at an early age and who exhibit BRCA1 and BRCA2 genetic markers (two of 10 known genetic markers)
Two tests are vital in diagnosing prostate cancer:
- A blood test measures prostate-specific antigen (PSA), a protein created in the prostate gland. Normal PSA levels are under 4 nanograms/milliliter (ng/mL). Men with a PSA level between 4-10 are considered “borderline”; a level of ten or higher can indicate a 50% chance of cancer. Note: not all men with high PSA levels have prostate cancer.
- A digital rectal exam to determine if the prostate is enlarged or has bumps/hard areas that might indicate cancer
Treatments vary depending on the type of cancer. Treatments include surgery (traditional, laser, cryosurgery, and robotic), radiation, radioactive seed implants (brachytherapy), lithotripsy, medications, and targeted therapies that treat only a part of the prostate.
For advanced cancers, men might be prescribed hormones after surgery or radiation. Late-stage cancers might require hormone therapy, chemotherapy, and/or radiation. Common side effects include pain, urinary incontinence, erectile dysfunction, and lower quality of life.
On the ProstateCancer.net forum, men ask and share tips for post-treatment recovery and quality of life.
“In a month, I’ve got a …. robotic prostatectomy with lymph node dissection coming up. I’m just trying to get the most realistic expectation on what the recovery is going to be like as far as being able to get some work done and walk around the house and upstairs? Am I going to want to pretty much sleep most of the day for a week? Will I not be able to walk a mile for at least three weeks?”
“Start walking asap, even with the annoying but temporary catheter. Try to make sense of how to do (muscle exercises known as) Kegels (still a challenge for me). Listen to your body but move as frequently as you can.”
Men encouraged to talk about prostate health and prostate cancer actively are more likely to pay attention to symptoms that have plagued them for weeks, months, or years.
They also can benefit from open lines of communication with healthcare professionals who can provide sound medical advice about risk factors, regular screenings, testing and treatment options, and post-treatment care and follow-up.
When considering treatment options for prostate cancer, it’s imperative to speak with your physician and oncologist to ensure the best in coordinated care based on your diagnosis, state and treatment options. Right now, PSMA PET is one of the most effective and precise treatments for localizing metastatic prostate cancer. Targeted imaging allows oncologists to detect areas of suspected metastasis for initial therapy and suspected recurrence based on an elevated serum prostate-specific antigen (PSA) levels. Again, it’s always best to consult with your physician on the best method of care for each situation because everyone is unique. Lastly, make screening a part of your yearly routine. Early detection provides patients with the best possible routes to treatment, care and hopefully recovery.
About the Author
Dr. Wally Curran, MD, FASC, FASCO, is the Group Chief Medical Officer for GenesisCare, one of the world’s largest cancer treatment providers. He is a professor emeritus and former chair of the Emory University Department of Radiation Oncology.