To screen or not to screen? Here’s what you need to know about prostate cancer, and why screening for it is such a personal choice. Prostate cancer is one the most common cancers among males. According to the American Cancer Society (ACS), about one in nine men will be diagnosed with prostate cancer during his lifetime. Luckily, this type of cancer can grow slowly, and most men diagnosed with prostate cancer do not die from it; according to ACS, it has the best survival rate among all cancers.
First of all, what exactly is a prostate?
The prostate, a walnut-sized gland located directly below the bladder and in front of the rectum, is part of the male reproductive system that produces secretions to protect sperm.
What are the risk factors?
In addition to a family history of prostate cancer, age is a key risk factor. The older a man is, the higher his risk is of developing prostate cancer. Men in their 40s have a risk of just one in 200,000, while it jumps to 12 per 100,000 in their early 50s; men in their 60s have a 12 out of 10,000 chance of being diagnosed with prostate cancer. In addition, African-American males are at higher risk of developing the disease.
Diet and lifestyle can also play a role. People who are obese, eat excessive amounts of meat or food high in animal fat, men who began having sex at an early age, have a history of sexually-transmitted diseases or multiple sexual partners, also have an increased risk of prostate cancer. A healthy lifestyle, with lower meat consumption, therefore, goes a long way in helping to prevent prostate cancer and other types of cancer.
To screen or not to screen?
This is a controversial question when it comes to this type of cancer, particularly because it’s normally slow to develop and is often without symptoms. In fact, because most cases are slow-growing, it’s possible that many men will die from other ailments without ever realising they even have prostate cancer.
“There are different camps for and against prostate cancer screening. According to Singapore’s Ministry of Health cancer screening guidelines, there is insufficient data to support prostate cancer screening in our local population,” says Dr Zee Ying Kiat, Senior Consultant in Medical Oncology at Parkway Cancer Centre. “Instead, doctors may adopt a shared approach to decision-making for male patients who express an interest in prostate cancer screening. Men who are between 50 and 75 years old may be offered screening for prostate cancer after discussing both the potential benefits and risks associated with the screening, whereas men who may be at higher risk, such as those with strong family histories of prostate cancer, for example, may be offered screenings at an earlier age.”
Those in favour of testing for prostate cancer argue that early detection outweighs any discomfort and stress involved. Screenings may include a digital rectal examination (DRE) or a prostate-specific antigen (PSA) test, which is the most common initial assessment for this type of cancer. The PSA test examines the level of PSA – a protein produced by the cells in the prostate gland – in one’s blood; the higher the level, the more likely cancer is present, although other factors may cause elevated PSA readings, too. If cancer is suspected, a transrectal ultrasound or prostate biopsy – removal of sample tissue – may be done for further evaluation.
Some people, however, feel that testing for prostate cancer does more harm than good, since this kind of cancer is often not life threatening. For instance, men may go through unnecessary follow-up tests, biopsies and other treatments, and could experience anxiety over a false-positive PSA test. It really comes down to personal choice, and is something that should be discussed with your healthcare professional.
Early prostate cancer often does not cause any symptoms. However, Dr Zee says that more advanced prostate cancers can sometimes cause symptoms such as:
- Problems passing urine, including frequent urination – especially at night – painful urination, and difficulty starting and maintaining a steady flow of urine.
- Blood in one’s urine.
- Pain in the hips, spine, ribs or other areas from cancer that has spread to the bones.
- Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord.
Dr Zee also notes that other conditions can also cause similar symptoms. For example, trouble with passing urine is more often caused by benign prostatic hyperplasia (BPH) than prostate cancer. Still, he says, it’s important to tell your doctor if you have any of these problems so that the cause can be found and treated, if needed.
In some cases, because prostate cancer may take many years to progress, doctors may choose to simply monitor the tumour rather than treat it immediately. This is because treatment depends on factors such as the stage of the cancer, symptoms, age, and the general health of the patient. The development of a treatment plan by a multi- disciplinary team – including surgeons, pathologists, radiologists, medical and radiation oncologists, radiologists, social workers and nurses – to diagnose, treat and manage the condition has shown to improve the outcome for patients with cancer. Some treatment options may include the surgical removal of the prostate gland, radiation therapy, hormonal therapy and chemotherapy. It really depends on how aggressive the cancer is, and whether or not the cancer is localised or has spread.
Of course, every case is distinct, and treatment options must be customised to the individual. Each option has its advantages and disadvantages, and should be discussed with a healthcare professional.
Written in collaboration with:
Parkway Cancer Centre
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