10 Things Doctors Want You to Know About Prostate Cancer

Medically Reviewed By William C. Lloyd III, MD, FACS

Written By Lorna Collier on September 1, 2020

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  Keys to Battling a Common Killer

  Prostate cancer survival rates are way up—at 99% a decade after diagnosis—thanks to better detection and treatment. But the disease still ranks as the second-leading cause of cancer death among men, with over 33,000 Americans expected to die from it in 2020, and nearly 192,000 expected to be diagnosed. About one in seven men will face prostate cancer at some point in their lives. So what do doctors want you to know about how to prevent it—or if you have it, to fight it?
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  “Consult your doctor regarding routine screening.”

  “Prostate cancer is only curable when found early,” says Dr. Ashutosh Tewari, chair of urology at Mount Sinai Hospital in New York. Yet, early-stage prostate cancer “has no symptoms.” To find it, the American Urological Association recommends men have screenings with a digital rectal exam and a PSA blood test annually from ages 55 through 70. The routine PSA has become controversial due to mixed research supporting its effectiveness, says Dr. John W. Davis, prostate specialist at the University of Texas MD Anderson Cancer Center, so talk to your doctor to see if this test is right for you.
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  “Family history and African ancestry put you at higher risk.”

  “Men should know their risk group,” says Dr. Davis. Men who have a close family relative—an uncle, brother or father—who had prostate cancer are at higher risk. So are African Americans. If you have either risk factor, get screened starting at age 40 to 45 with a PSA blood test and digital exam.
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  “Not all abnormal test results require a biopsy.”

  The PSA can have high readings for reasons other than cancer, such as prostate enlargement, infection or inflammation, says Dr. Alvin Goh, urologist at Houston Methodist Urology Associates. If these other reasons are ruled out, urologists can do newer tests, such as the urinary PCA3 test or other blood tests, or use MRI and CT scans to see inside your prostate before deciding whether to do a biopsy.
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  “Not all cancers require treatment.”

  At one time, all prostate cancers were treated with surgical removal of the prostate or radiation. But today, low-grade, minimally aggressive tumors are more often treated with a wait-and-watch approach called “active surveillance,” says Dr. Edward Schaeffer, chair of the urology department at Northwestern Memorial Hospital. He calls this the “biggest advance in prostate cancer treatment today.” Doctors will monitor your cancer, leaving it be if it doesn’t grow. This saves unnecessary treatment—and its side effects.
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  “Both radiation and surgery can cause side effects.”

  Erectile dysfunction and urinary problems are common side effects of both surgery and radiation for prostate cancer, says Dr. Schaeffer. However, surgery’s effect on sexual function will be immediate but is likely to be short-lived, while radiation’s effects occur one to two years later and are more likely to be permanent. Both treatments also temporarily affect urinary function: surgery can cause leakage issues while radiation can lead to irritation.
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  “Radiation may not be best for people with certain conditions.”

  Radiation therapy can damage gastrointestinal tissues, leading to significant flare-ups for people with ulcerative colitis or Crohn’s disease, says Dr. Schaeffer. Those with irritable bowel disease also may experience worsened symptoms. People who are on blood thinners—say, for a cardiac stent—risk problems with rectal bleeding post-radiation. Consult your physician if you have any of these conditions and radiation is being considered.
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  “New treatments are on the horizon.”

  “There are a few emerging treatments for prostate cancer that are being investigated,” says Dr. Goh, “but they are not yet what we’d consider standard at this point.” Among them: ablative therapies to remove the prostate either with high-frequency ultrasound or by cryotherapy (freezing the prostate). New targeted medications based on a tumor’s genetic properties also are available but aren’t yet highly effective, says Dr. Schaeffer.
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  “A healthy lifestyle can help prevent prostate cancer.”

  “A classic Western diet that is high in animal fat is a risk feature” for prostate cancer, says Dr. Davis, who recommends eating a heart-healthy diet instead. Besides eating well, Dr. Tewari advises staying physically and sexually active, maintaining a healthy weight, and managing cholesterol. Studies have shown moderate sunlight exposure also reduces prostate cancer risk, says Dr. Schaeffer, so getting outside helps, too.
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  “Supplements do more harm than good.”

  Dr. Schaeffer says studies show selenium and Vitamin E—touted as prostate cancer preventers—haven’t been proven to help. Another study found men who took more than seven vitamins or supplements per day had a “several-fold higher risk of being diagnosed with a lethal prostate cancer.” He recommends you get your nutrients from fresh fruits and vegetables rather than supplements or vitamins.
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  “Ask your doctor for his or her stats.”

  The biggest factor in successful prostate cancer surgery is the experience level of your doctor, says Dr. Schaeffer. “The more experienced the surgeon is in doing the procedure, the better the outcome for the patient.” He advises asking your doctor how often he or she performs the procedure being planned and what his or her success rate is, both in cancer control and in recovery of urinary and sexual function.

10 Things Doctors Want You to Know About Prostate Cancer

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