Charlotte, NC
Lumanti Manandhar, BPH
Gauri Adhikari, MD
Prostate cancer develops in the prostate, an important part of the male reproductive system. The prostate gland lies below the bladder, surrounds the urethra, and is in front of the rectum. The prostate gland secretes fluid that mixes with semen during ejaculation.
Prostate cancer, besides skin cancer, is the most common cancer in American men. According to the American Cancer Society, about one man in eight has been estimated to be diagnosed with prostate during his lifetime, and it is more common in older men and non-Hispanic Black men.
The benign and cancerous growth of the prostate are two distinct conditions with varying implications for health. Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland commonly occurring in older men and is non-cancerous. It is primarily due to hormonal changes and typically results in urinary symptoms such as increased frequency and urgency. BPH, while it can be uncomfortable, is not life-threatening.
In contrast, prostate cancer is the uncontrolled growth of malignant cells within the prostate gland. Unlike BPH, it can be life-threatening, especially if it spreads to other parts of the body. Diagnosis involves a combination of digital rectal exams, PSA tests, and biopsies. Treatment options for prostate cancer may include surgery, radiation therapy, hormone therapy, or chemotherapy. Distinguishing between these conditions is crucial, and a proper diagnosis is essential to determine the appropriate course of action.
The most common risk factors of prostate cancer include:
The diagnosis of prostate cancer typically involves a series of steps to determine whether a patient has malignant growth in the prostate gland. Following are the tests that your doctor might suggest:
1. Blood tests for prostate cancer: The Prostate-Specific Antigen (PSA) test measures the protein levels produced by the prostate gland, serving as a vital tool in screening for and monitoring prostate cancer. Typically recommended for men over 50, the PSA test can help detect prostate cancer in its early stages; that is when treatment is most effective. While a normal PSA level is generally considered four nanograms per milliliter or lower, various factors can influence PSA levels, leading to false positives and false negatives. Consequently, an elevated PSA reading often triggers further diagnostic steps, such as a digital rectal examination (DRE) and a prostate biopsy, to ascertain the presence of cancer.
However, the use of PSA screening has sparked debate due to its limitations and the potential for overdiagnosis. One should undergo PSA testing after carefully discussing it with a healthcare provider, considering individual risk factors and the overall benefits and risks associated with the test.
2. Prostate Biopsy: A prostate biopsy is a crucial medical procedure employed to diagnose prostate cancer definitively. It is typically recommended when there are elevated PSA levels or suspicious findings during a DRE. During a prostate biopsy, a urologist or radiologist uses a thin, specialized needle to extract small tissue samples from the prostate gland, typically through the rectum or perineum. These tissue samples are then analyzed by a pathologist to determine the presence of cancer cells and to assess their aggressiveness using the Gleason score.
While a biopsy is considered the gold standard for prostate cancer diagnosis, it’s not without its potential risks, which can include bleeding, infection, or discomfort. The decision to undergo a prostate biopsy should be made in close consultation with a healthcare provider, considering individual risk factors, potential benefits, and the need for accurate diagnosis when prostate cancer is suspected.
3. Digital Rectal Examination for prostate cancer: During a DRE, a healthcare provider, typically a urologist or primary care physician, inserts a gloved, lubricated finger into the patient’s rectum to feel the prostate gland. The examination is relatively quick, lasting only a few seconds. While it may be slightly uncomfortable, it is generally not painful.
The primary purpose of a DRE is to assess the shape, size, and texture of the gland and to check for any abnormalities that may be indicative of prostate cancer or other prostate-related conditions. It is often used as part of a comprehensive evaluation for prostate cancer.
While a DRE can identify some abnormalities, it has limitations. It can miss small or deep-seated tumors, and the assessment of the prostate’s condition is subjective, varying from one healthcare provider to another. Therefore, it is usually used as part of a broader evaluation that includes PSA testing and other imaging procedures.
Staging and grading are essential components of diagnosing and characterizing prostate cancer.
These two factors, staging, and grading, are crucial for treatment decision-making, as they help healthcare providers understand the severity of the disease and its potential to grow and spread, ultimately guiding the choice of the most appropriate treatment for each individual diagnosed with prostate cancer.
Treatment options for prostate cancer vary depending on several factors, including the stage and aggressiveness of the cancer, the patient’s overall health, and individual preferences.
Early-stage prostate cancer is also known as localized prostate cancer. It is a condition where cancer cells are confined to the prostate gland without having spread to surrounding tissues or distant parts of the body. Typically asymptomatic, it is often detected through routine screening, such as PSA tests and digital rectal examinations.
Treatment options for early-stage prostate cancer range from active surveillance for low-risk cases to surgical removal (prostatectomy) or radiation therapy for more aggressive forms. Hormone therapy may also be used in combination with radiation in select cases.
Active Surveillance:
Active surveillance is an approach to managing low-risk or early-stage prostate cancer that closely monitors the cancer’s progression rather than immediately pursuing aggressive treatment.
It is typically recommended for men with small, low-grade tumors that are unlikely to grow rapidly or pose an immediate threat to their health. Instead of undergoing surgery or radiation therapy, individuals on active surveillance undergo periodic check-ups, including regular PSA tests, DREs, and occasional prostate biopsies, to monitor any changes in the cancer’s behavior. If there are signs that the cancer is becoming more aggressive or progressing, treatment options may be reconsidered. Active surveillance offers several benefits, such as avoiding potential side effects of immediate treatment, but it requires a commitment to ongoing monitoring and a strong doctor-patient partnership to make informed decisions about when or if treatment is necessary.
It is a suitable option for those who prefer to maintain their quality of life while keeping the option for curative treatment available if needed.
Here are the primary treatment options for prostate cancer:
Leaving prostate cancer untreated can have serious consequences, as the cancer may continue to grow and potentially spread to other parts of the body. Here are some key points about the potential outcomes of untreated prostate cancer:
The timing for prostate cancer screening is a subject of discussion among medical experts, and the decision should be individualized based on various factors, including age, risk factors, and personal preferences. However, here are some general guidelines for when to consider seeing a doctor for prostate cancer screening:
