There is a common saying: “Prostate cancer “is a disease you live with, not a disease you die from.” Fortunately for many prostate cancer patients, there is a lot of truth in this statement. Prostate cancer commonly grows so slowly that many patients are symptom-free for years after their initial diagnosis.
The “Good” News about Prostate Cancer
While some prostate cancers can be more aggressive and fast-growing, these are the exception, not the rule. The ten-year survival rate for prostate cancer is 93 percent. The five-year survival rate is almost 100% for men ages 40-80. The survival rate decreases for those diagnosed below age 40 but these diagnoses are thankfully rare. In 99% of cases, prostate cancer is curable if it is found, diagnosed and treated early. Prostate Cancer: A Chronic Illness | ONS
The Bad News about Prostate Cancer
If the good news about prostate cancer is that it is slow-growing, the bad news is that it is extremely common. The second popular saying about this disease is “Every man who lives long enough will eventually get prostate cancer.” Unfortunately, research has shown that this saying is also true. This does not mean that all men get it, as many men don’t live that long. However, for every 100 men, about 13 will eventually have prostate cancer and about 2 to 3 of them will die from it.
There are three primary risk factors for prostate cancer. The most important of these is age. 6 out of 10 men are 65 or older when first diagnosed with the disease. While some men get it at a younger age, it is unusual for someone below age 40 to get prostate cancer. The average age of diagnosis is 66.
Men with a family history of prostate cancer are more likely to get it themselves. A man whose father or brother has a history of prostate cancer is twice as likely to develop the disease. Having more than one relative with prostate cancer also increases the risk, as does having relatives who were diagnosed at a younger age. Genetic tendencies towards prostate cancer can come from relatives on either the mother’s or father’s side of the family. Having relatives with certain other types of cancer, such as breast, ovarian or pancreatic cancer, can also increase a man’s risk.
African American men are twice as likely to die from prostate cancer as other men. First, they are likely to develop it at a younger age. Secondly, the disease is often diagnosed at a later state in African American men, as opposed to being caught earlier when it is more treatable. Who Is at Risk for Prostate Cancer? | CDC
Prostate cancer often has no symptoms, which is why regular cancer screenings are so important. While there is some disagreement about which screening is best, there is no disagreement that some type of screening should be done on a regular basis. For most men, screenings should begin at age 55.
African American men should be screened beginning at age 45. This is also the recommended age for anyone with a family history of prostate cancer in a first-degree relative (a father, sibling or son). Depending on the age at which a man’s relatives first developed prostate cancer, the recommended age for a first screening is sometimes even younger.
Prostate cancer can affect a man’s ability to urinate by either increasing frequency or decreasing or interrupting the rate of flow. It can cause bleeding, pain in the rectum and pain and stiffness in the lower body. Impotence is another possible symptom. For a more complete list of symptoms visit: What Are the Symptoms of Prostate Cancer? | CDC
Prostate cancer is frequently diagnosed in a routine screening. Screenings my be done with a digital rectal exam or with a blood test known as a “Prostate specific antigen” or PSA test. If a screening test indicates that cancer may be present, more involved tests are usually performed. These include:
A prostate biopsy- In this test some cells are physically removed from the prostate and examined for cancer.
An imaging test- This can include an MRI, a CT or computer tomography, scan or an ultrasound through the rectum.
Part of the diagnosis process is to determine not just if you have prostate cancer, but, if you do, how aggressive it is. This process is known as “grading” the cancer. The “grade” of the cancer is measured according to the “Gleason Score”, which has a maximum score of 10. The higher the score, the more aggressive the cancer. In some cases, the Gleason Score is being replaced with a “Grade Group”, in which the highest “group” rating is 5 (the most aggressive rating).
“Staging” is another aspect of prostate cancer diagnosis. To “stage” the cancer is to find out how far and where the cancer has spread.
Treatment for prostate cancer varies according to how advanced and aggressive the cancer is. Since prostate cancer is usually slow-growing, many doctors initially recommend a period of “active surveillance” or “watchful waiting”. During active surveillance, the only “activity” is closely monitoring the cancer. If it begins to progress, the doctor will be alerted and ready to begin further treatment.
Once prostate cancer begins to progress, there are multiple different methods of treatment. These can include chemotherapy, surgery, radiation and hormone therapy. Which type of treatment is used depends on many different factors, including the age and overall health of the patient, how far and where the cancer has spread (if it has), how aggressive the cancer is, and what risks and side effects are considered acceptable by the patient. The decision of how to treat the cancer should be made by the patient and the doctor together. It is very important that patients feel that all of their questions have been answered so that they can make informed decisions.
Some prostate cancer treatments can cause side effects that may seriously impact the patient’s quality of life. These side effects include incontinence and impotence. Fortunately, these side effects can sometimes be treated with success. It is sometimes possible for some side effects to go away on their own.