Roughly one out of eight men (one in six for Black men) will develop prostate cancer in their lifetime, but your personal risk will depend on a variety of factors.
At Sentara, we encourage men to include prostate cancer screening as a part of their regular health checkups. Screening offers the greatest chance at detecting cancer at an earlier stage. Early detection can mean a quicker recovery and better quality of life. Talk to your primary care provider about their recommendations for screening.
If you or a loved one have been diagnosed with prostate cancer, our multidisciplinary team with board-certified, fellowship-trained physicians work together through our tumor boards to create a personalized treatment plan for your cancer.
Prostate cancer
Prostate cancer is a type of male reproductive cancer. The prostate gland makes fluid for semen and sits below the bladder. The normal size of a prostate is the size of a walnut.
Prostate cancer is when cells in the prostate rapidly grow and divide. Cancer has the potential to spread and invade other areas within the body. This causes damage and prevents proper functioning to the effected organs. Prostate cancer growth rates vary, but most prostate cancers grow slowly.
You might notice certain changes in your body when this cancer develops. Prostate cancer symptoms can include:
- Urinary problems
- Slow/weak stream
- Need to urinate frequently and more at night
- Trouble emptying your bladder completely
- Blood in urine or semen
- Erectile dysfunction
- Pain and weakness
- In the lower back or when ejaculating
- Ribs, hips, and other areas
- This can include numbness in legs/feet and may be accompanied by loss of bowel or bladder control.
- If there is pain, weakness, or loss of function, this is a sign of an advanced disease.
It is also possible that you may not experience any symptoms, which shows the importance of screening. Localized prostate cancer may not show any symptoms and this is when its most treatable.
The causes and risk factors of prostate cancer include ones that are both modifiable (things you can change) and non-modifiable (things you cannot change).
Modifiable risks
- Diet: Studies show high-fat diets increase risk
- Obesity: Combined with diet, obesity increases inflammation which alters the effectiveness of the body’s regulatory cells.
- Smoking/exposures: Known carcinogen (agent that causes cancer)
- Sexually transmitted infections (STI)
- Geography: Most common in North America, Europe, Australia, and the Caribbean. Asian and Pacific Islands have a lower incidence (also diets lower in fat)
Non-modifiable risks
- Age: Older men have a higher risk of developing prostate cancer
- Born male: Prostate cancer is specific to men
- Family history: Males with first degree relatives (father or brother) with prostate cancer or have several family members who were diagnosed at a young age have an increased risk.
- Race: Being African American increases risk - reasons are unclear
Diagnosing and screening
Your provider will talk with you about any symptoms you're experiencing. We begin with a physical examination and learning more about your health history.
If our experts suspect that you have prostate cancer, we may do certain screenings and tests to confirm the diagnosis. These tests include:
- Blood test
- Biopsy
- Digital rectal exam
- Imaging
After diagnosing prostate cancer, our experts will assign a Gleason score to the tumor. Gleason scores are a way of grading prostate cancer depending on how fast it is growing and are used to design your treatment plan.
There are two types of screening that can be done to help diagnose prostate cancer:
- Prostate Specific Antigen (PSA): This first line screening is a blood test used to measure amount of a prostate-specific protein. Higher levels may indicate a need for further testing.
- Supplemental Digital Rectal Exam (DRE): DREs might be used in addition to PSA testing based on shared decision making and/or patient symptoms. A DRE is a manual exam in which a provider manually assesses the size of the prostate. An abnormal DRE may indicate a need for further testing.
It is important to note some limitations to testing:
- Testing is not 100% accurate.
- False positives: There are several conditions that can cause an elevated PSA or enlarged prostate that are not prostate cancer. There are normal elevations in PSA as you age. Further testing and evaluation will be needed if the PSA is abnormal. These tests have potential side effects which could be harmful.
- If cancer is found, screening will not evaluate if the cancer has spread.
Screening and prevention should be discussed with your provider. Factors that may affect the timing of your screening may include personal risk factors, your values and preferences, and the risks/benefits of screening.
Earlier testing may be indicated if you had been identified as having an increased risk, such as a brother or father with prostate cancer.
This shared decision making is recommended to take place at:
- Age 40 for Black men and those with several first degrees relatives (father, son, or brother) who have been diagnosed with prostate cancer at a young age. This is generally before age 65.
- Age 45 to 50 for those with one first degree family member diagnosed with prostate cancer before age 65.
- Age 50 and older, who are at average risk of developing a prostate cancer, have no family history or personal risk factors, and are expected to live 10 years or more.
- Men over aged 70 who have previously undergone prostate screening are encouraged to speak with their provider about continuing prostate screenings. This can be based on age, life expectancy, overall health, family history, and past PSA results.
According to the American Cancer Society (ACS), “Prostate cancer is the most commonly diagnosed cancer in Black men, accounting for 37% of all new cancers… incidence rates are 73% higher in Black men.”
In addition, Black men are less likely to know about screening, have death rates twice as high as their white counterparts, and have the highest prostate cancer death rate of any racial group.
When diagnosed, Black men are more likely to be diagnosed at younger ages with more aggressive disease. Due to the increased risk, Black men could benefit from a risk-adapted PSA screening.
- Discussions about PSA screenings should begin at age 40.
- Baseline testing should between age 40-45 and done annually thereafter.
- Digital Rectal Exams (DREs) can be used as a supplemental screening tool.
Treatment and support services
Our cancer experts develop a personalized prostate cancer treatment plan based on your unique needs. Cancer treatments may include:
Cryotherapy
Radiation therapy for prostate cancer
- Brachytherapy
- External beam radiation
- Stereotactic body radiation therapy
Prostate cancer surgery
- Laparoscopic surgery
- Open surgery
- Robot-assisted laparoscopic surgery
Systemic therapy for prostate cancer
- Chemotherapy
- Hormone therapy
- Immunotherapy
- Targeted therapy
Watchful waiting and active surveillance
Prostate cancer may grow slowly and you may not need treatment right away. Providers may recommend watchful waiting - they will observe you over time and ask you to report any changes in symptoms.
Experts may also recommend active surveillance. This approach means providers will continue to test your PSA level and do digital rectal exams each year. You may also need to have regular biopsies to see if prostate cancer is advancing.
Our experts and partners also research new ways to treat cancer. Please read about our work at 猫咪社区 Research Center.