Published: Mar. 21, 2006
Updated: Dec. 2, 2010
Prostate cancer is one of the most common types of cancer for men. According to the American Cancer Society, more than 232,000 men will be diagnosed with prostate cancer this year.
Daniel George, MD, director of genitourinary medical oncology at Duke Cancer Institute, answers questions about the risk factors and treatments for the disease.
Who should be tested for prostate cancer?
Men should get an annual prostate-specific antigen (PSA) test and a digital rectal exam (DRE) after reaching the age of 50.
Men who have a family history of prostate cancer or who are African American should begin annual testing at age 40.
Since there are few symptoms of early-stage prostate cancer, it’s important to get the tests performed annually so the disease can be diagnosed early, when the five-year survival rate is 99 percent.
How reliable are these tests?
As with many medical tests, those for prostate cancer are not perfect. Many men may have elevated levels of PSA in their blood, but do not have prostate cancer. Some men may get a negative reading on the DRE but still have the disease. That’s why it’s best to have both tests done annually.
Are there things I can do to reduce my risk of getting the disease?
The biggest risk factor is simply being a male. One in six men will develop prostate cancer at some point in his life.
A family history of prostate cancer also plays an important role. Also, for unknown reasons, African American men are two-and-a-half times more likely to get prostate cancer as white men.
There has been quite a lot of research conducted investigating how diet impacts the rate of developing prostate cancer. There’s no definite conclusion, but many researchers believe that high-fat diets increase the risk. Men in Western countries have a higher occurrence of prostate cancer than those in Asian nations, and some researchers speculate it is because of diet.
Some researchers hypothesize that taking anti-oxidants such as omega 3 or hormonal modifiers may lower the risk, but at the present time, I do not believe there’s been enough research to prove that.
How do you decide the proper treatment for those who are diagnosed with prostate cancer?
Prostate cancer is a slow-growing disease. A majority of men with prostate cancer will not die from the disease.
Since it is slow growing, patients will usually have time to discuss with their doctor and family what action -- if any -- should be taken. There is a huge variation of disease progression -- from a few years to decades.
For those very slow-growing cases, we usually suggest active surveillance. With this course of action, we monitor PSA levels regularly. Assuming the PSA levels do not rise significantly, we don’t do anything. We usually recommend active surveillance to those patients who have other health problems as well as those who are older.
For those men who receive treatment, there are several options. First, there’s surgery to remove the prostate gland. There are also several types of radiation that will kill the cancer. Some doctors may even suggest freezing the prostate gland.
Those who are at a high risk for having the disease spread may get hormonal therapy or have testosterone reduction in addition to local therapy.
What does the future hold for prostate cancer research?
In the future, we hope to better sub-classify prostate cancers according to their genetic profiles in order to separate those cancers likely to spread from those that are not.
In addition, a better understanding of these genetic features may lead to more specifically targeted treatments for certain types of prostate cancer.