Just as women know to be concerned about breast cancer, men need to be aware of their risk for prostate cancer. Prostate cancer is the most common cancer in men, with an even higher incidence in Black men. But many men don’t know their risk factors or when to get screened.
We talked to UNC Health urologist Matthew Nielsen, MD, and learned three things men need to know about prostate cancer.
1. Black men are at a higher risk of getting prostate cancer.
Located just below the bladder and in front of the rectum, the prostate is part of the male reproductive system. This walnut-sized gland surrounds the urethra and produces fluid that makes up a part of semen.
Prostate cancer occurs when there is an abnormal growth of cells that originated in the prostate gland. If the cancer is in a later stage, this growth of abnormal cells can spread to other parts of the body.
“The risk of prostate cancer in a man’s lifetime in the United States is 1 out of 8,” Dr. Nielsen says. “Men with a greater risk than that are men who have male blood relatives who have had prostate cancer and Black men, even those who did not have relatives with prostate cancer. The risk of prostate cancer diagnosis in the lifetime of a Black man is 1 in 6, and Black men’s risk of dying from prostate cancer is twice that of white men.”
This is why Black men and men with a family history of prostate cancer should begin prostate cancer screening at age 45, while men of other races with low to moderate risk can begin at age 50.
2. Improved screening options for prostate cancer are available.
Prostate cancer is usually slow-growing and has no symptoms unless it’s very advanced. Cancer screening means looking for cancer before it causes symptoms and when it’s easier to treat. Men can be screened for prostate cancer with a PSA (prostate-specific antigen) blood test, which can be done at a primary care provider’s office.
“PSA is a protein made by the prostate. The PSA test measures the amount of this protein in the blood. PSA levels can be higher in men who have prostate cancer,” Dr. Nielsen says. “There are many things that could cause the PSA level to be higher, such as age, an enlarged prostate or a UTI, but if a man has an elevated PSA, it could be a very, very early signal of prostate cancer.”
Sometimes doctors repeat the blood test because false positives can happen. If PSA levels remain high, you’ll be referred to a urologist, a medical specialist of the urinary tract and the male reproductive tract.
A urologist will go over your medical and family history and decide whether to pursue further testing, Dr. Nielsen says.
Until recently, the main option for further testing was prostate biopsy.
Now, there is an additional, noninvasive test called a prostate MRI that can be more helpful. A doctor will use imaging equipment to identify suspicious areas that might require a biopsy, which can then be more targeted.
3. Even if prostate cancer is detected, your doctor may not recommend immediate treatment.
The overwhelming majority of men who are identified with prostate cancer through a PSA test have cancer that is in the prostate only, meaning it has not spread, Dr. Nielsen says.
Treatment options for these patients include surgery to remove the prostate gland completely or various forms of radiation therapy.
“Both options are very effective for prostate cancer,” Dr. Nielsen says. “However, for a relatively large number of men who are diagnosed with prostate cancer through the PSA tests, the likelihood of that cancer causing harm in their lifetime is really low.”
For these patients, the best option may be active surveillance, a care strategy where a cancer is monitored carefully to delay or avoid treatment in people who don’t need treatment right away.
This strategy is used in situations where delaying treatment for cancer won’t cause harm and, in many cases, can help someone avoid treatment and its potential side effects entirely.
“With active surveillance, we are taking a man who has a very treatable, potentially curable type of prostate cancer and holding off on the risks and potential harms of treatment because our research has taught us that with the information we can get from the biopsy and other tests that most men with that type of cancer can be followed for years without ever having any progression of their disease,” Dr. Nielsen says. “Active surveillance is not doing nothing. It’s really careful, continued reassessment of the risk of the cancer in that individual patient over time.”
Most men determined to be candidates for active surveillance are able to continue that monitoring plan for their lifetime, but a small fraction of them may end up needing treatment at a later time.
“With the early detection of prostate cancer with PSA screening, we have a six-to-seven-year jump on finding it,” Dr. Nielsen says, “so the window to gather information and make a decision while keeping a patient out of harm’s way is a wide one.”
If you’re concerned about your cancer risk, talk to your doctor. If you do not have a doctor, find one near you.