Prostate cancer: A disease full of questions
September is Prostate Cancer Awareness Month, a time to get the facts about this disease which affects more than 3 million men every year, worldwide. One in 9 men in the United States will be diagnosed with prostate cancer in 2018, according to the Prostate Cancer Foundation.
Should I be worried about prostate cancer?
Prostate cancer is an enigma.
Autopsy studies suggest that if a man lives long enough, he will likely ultimately develop prostate cancer.
Additionally, the vast majority of men with prostate cancer will never know they have it, and will die with the disease but not from it.
Approximately 165,000 men will be diagnosed with prostate cancer this year in the U.S., but only 30,000 will die from it.
Survival with prostate cancer is longer and better than ever due to new treatments recently developed. If the cancer is found early, five year survival is almost 100 percent. But if the cancer presents with widespread disease, five-year survival is only about 30 percent.
Most prostate cancers are slow-growing and have very little impact on men. But a few are severe and can cause death.
Should I be screened for prostate cancer?
If finding prostate cancer early leads to long survival, shouldn't every man be screened for prostate cancer?
Currently screening involves a prostate-specific antigen PSA (a blood test) and a rectal exam. Urologists recommend this be done in every man annually starting at age 50. This is revised to 40 years old for men with a family history of prostate cancer or who are African-American.
Screening should be discontinued when a diagnosis of prostate cancer will have no impact on the patient.
PSA and rectal exam screenings find both the slow-growing and the aggressive prostate cancers. Since many more prostate cancers are slow-growing, many more men are diagnosed with the cancers they will die with rather than the men who are potentially saved by prostate cancer screening.
Additionally, most men with abnormal PSA tests do not have prostate cancer. Screening can lead to invasive procedures such as biopsies which have risks of bleeding, infection and pain.
Screening tests find cancers that are both fast-growing and slow-growing, but they are not perfect and can at times lead to other invasive procedures. Many men will have these procedures who do not have prostate cancer.
Should I be treated for prostate cancer?
If a man is diagnosed with prostate cancer, how does he know if he has early or aggressive prostate cancer?
His urologist will evaluate the aggressiveness and amount of the disease found on the biopsy. The urologist will then work with the patient to evaluate the disease in the context of the man's other health issues.
Some men need surgery. Some need radiation. Some need hormonal therapy, and other men need no treatment.
In this disease it is vitally important to treat the patient more than the disease. The treatment of prostate cancer can have significant side effects such as impotence and incontinence.
The decision to treat prostate cancer is highly personal, and there is often no clearly correct medical answer for what is best.
The need for treatment or the type of treatment to have often depends on the individual patient. Treatment itself is associated with risks, so evaluation of the risks versus benefits of being treated must be evaluated.
How do I make the right decision for me about prostate cancer issues?
Find a urologist who will discuss with you all issues surrounding prostate cancer, from the need for screening to the risks and benefits of treatment options.
• Michael McGuire, MD, is a urologist at Northwestern Medicine Lake Forest Hospital and Northwestern Medicine Glenview Outpatient Care Center. To book an appointment, please call (847) 535-7657, or go to nm.org for more information.