Half of Us Will Face This Cancer One Day

In medical school, we were taught that if men lived to 120, every single one would get prostate cancer.

That was a few years (all right, decades) ago, but it's still true. As we're living longer, we're seeing growth in the number of men diagnosed with prostate cancer.

Right now, about one in nine men will receive a prostate cancer diagnosis in his lifetime. But only one in 41 will die from prostate cancer. The vast majority of these cancers are slow-growing. The rest will die of other causes. In fact, about two-thirds of men who die after age 70 have undiagnosed (and not deadly) prostate cancer at the time of their deaths.

We get asked plenty of questions about prostate cancer. So today we wanted to walk through what it is, the common treatment options, and what you should ask your doctor.

What causes prostate cancer?

The prostate is a gland that sits just below the bladder. It's responsible for forming some of the fluid that makes up semen. For younger men, it's about the size of a walnut, but it can grow with age.

Prostate cancer starts in this gland. Cancer is an uncontrolled growth of cells that destroy healthy tissue. Typically, prostate cancer grows very slowly – that's why we're seeing more cases as men live longer. But the good news is that for many folks, you will die of something else before prostate cancer kills you.

My dad had prostate cancer. Am I at risk of getting it, too?

According to the American Society of Clinical Oncology, the chances of inheriting prostate cancer are only about 5%. But the closer relatives you have who developed prostate cancer, the more your risk increases. However, other factors are bigger players. For instance, your risk increases with age. In fact, over 80% of cases are diagnosed in folks who are 65 or older.

Other factors include genetics on your mom's side. If women in your family had hereditary breast and ovarian cancers, you could have a genetic predisposition to more aggressive prostate cancer.

Race and ethnicity are also a factor. African American men have a higher risk than white men. Hispanic men have lower rates than white and black men. Asian men have the lowest risk; However in many parts of urbanized Asia, prostate cancer is on a steep rise. But Hispanic men have a lower risk than other races. And it appears that more urban areas have higher rates of prostate cancer. One suggestion is that the Western diet and less physical activity contribute to prostate cancer, though there is limited evidence for these.

Finally, one last risk factor is only for veterans. Exposure to the chemical Agent Orange in the Vietnam War increases your risk for developing cancer, including prostate cancer.

What are the symptoms of prostate cancer?

Here are six common symptoms:

  • Frequent urination
  • Hesitancy with urination
  • Erectile dysfunction
  • Burning with urination
  • Pain in the lower back
  • Stiffness in the upper legs

If you have one or more of these symptoms, don't hesitate to tell your doctor, especially if you have any of the other risk factors for prostate cancer.

How does my doctor test for it?

Each year, get a digital rectal exam ("DRE"). This is where the doctor will manually feel your prostate to note any changes in texture or any lumps.

Years ago, I recommended getting a prostate-specific antigen ("PSA") test every year. But I've since learned more about the high rate of false positives and now warn my readers about their dangers.

PSA tests are notorious for giving false-positive results because benign factors can cause elevated PSA levels. Inflammation, infection, recent ejaculation, and even riding a bike can increase your PSA levels.

Studies show the PSA is unlikely to reduce your chance of dying from prostate cancer... Most men die of something else because of the disease's extremely slow progression. A positive PSA test can also lead to overtreatment. The treatments for prostate cancer can lead to worse side effects than the cancer itself... including impotence and heart problems.

In fact, the U.S. Preventive Services Task Force, a testing watchdog that evaluates evidence to back up tests and procedures, rates the PSA test as a C for men between 55 and 69. A C grade means there's limited evidence and the test should only be recommended for men at high risk of prostate cancer. For men 70 and older, the grade is a D – not recommended. If you have the risk factors and need a PSA, ask about getting it more than once before receiving a diagnosis.

What are the treatments for prostate cancer?

About 30% of men with prostate cancer have a simple treatment: watch and wait. Called active surveillance, it means these folks simply keep a close eye on their cancer and PSA levels. Many don't need any treatment.

A 2015 study using data from Johns Hopkins found that fewer than 1% of men with low-risk prostate cancer on active surveillance died from prostate cancer. A similarly small number progressed to a metastatic phase of cancer, where treatment is more difficult.

But some forms do require treatment.

You should know, however, that most treatments can lead to incontinence and erectile dysfunction... sometimes permanently. You'll need to discuss with your oncologist what the best standard of care is for your type of cancer and how to manage any side effects.

What about immunotherapy? You keep talking about this – is there anything for prostate cancer?

Immunotherapy is a new field of treatment that trains your body's immune system to fight and kill cancer. Currently, there is a vaccine form that targets prostate cancer. It's considered when other forms of treatment, like hormone therapy, haven't worked. If you want to discuss it with your doctor, ask about Sipuleucel-T.

Is there anything I can do to lower my risk of prostate cancer?

There are a few things that men can do to lower their risk of prostate cancer:

  • Ejaculation more than 12 times a month lowers the risk... 21 times a month is thought to be ideal.
  • Exercising, even walking 30 minutes a day, lowers your cancer risk.
  • Increase your intake of tomatoes, which are high in lycopene. That's known to fight prostate cancer.
  • Get selenium in foods like in Brazil nuts, oysters, cashews, lobster, shrimp, and sunflower seeds.
  • Eat plenty of vegetables that lower cancer risk, like cabbage, broccoli, Brussels sprouts, onions, and carrots

How do I find the best cancer care?

If you need more than active surveillance, we recommend looking into a cancer center that specializes in prostate cancer. There are eight Specialized Programs of Research Excellence (SPOREs) organized by the National Cancer Institute for prostate:

Fred Hutchinson Cancer Research Center | Website | (206) 667-5000
Johns Hopkins Kimmel Cancer Center | Website | (410) 955-8964
Memorial Sloan Kettering Cancer Center | Website | (212) 639-2000
Northwestern University | Website | (312) 695-0990
University of California, Los Angeles | Website | (310) 794-7700
University of Michigan | Website | (800) 865-1125
University of Texas/MD Anderson Cancer Center | Website | (855) 346-3954
Weill Cornell Medicine | Website | (646) 962-6184

This list really just touches on the basics. I hope you can take this primer on prostate cancer and arm yourself with more research before talking with your doctor. Remember, each case is different, so there's no one-fits-all treatment for cancer. But with new strides in immunotherapy, we might soon see an end to prostate cancer deaths.

As always, I encourage you to share this with anyone in your life who might face prostate cancer. The more you know, the better you can take charge of your health.

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Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
December 3, 2019