September is Prostate Cancer Awareness Month, a time to get the facts about this disease affecting more than 3 million men worldwide each year. One in nine men in the United States will diagnose prostate cancer in 2018, according to the Prostate Cancer Foundation.
Should I worry about prostate cancer?
Prostate cancer is a mystery.
Autopsy studies suggest that if a man lives long enough, he will probably eventually develop prostate cancer.
In addition, the vast majority of men with prostate cancer will never know they have it, and will not die from it with the disease.
Approximately 165,000 men will be diagnosed with prostate cancer in the US this year, 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, the five-year survival is almost 100 percent. But when the cancer occurs with a widespread disease, the five-year survival is only about 30 percent.
Most prostate cancers are slow-growing and have very little effect on men. But some are serious and can lead to death.
Should I be examined for prostate cancer?
If prostate cancer leads to long-term survival, should not every man be screened for prostate cancer?
Currently, the screening includes a prostate-specific antigen PSA (a blood test) and a rectal exam. Urologists recommend doing this in every man every year from the age of 50. This is revised to 40 years old for men with a family history of prostate cancer or the African American.
Screening should be discontinued if a diagnosis of prostate cancer will not affect the patient.
PSA and Rectal Examination Screening find both the slow-growing and aggressive prostate cancer. With many prostate cancers growing slowly, many men are diagnosed with the type of cancer they will die from, and not among the men who may be rescued by prostate cancer screening.
In addition, most men with abnormal PSA tests have no prostate cancer. Screening can lead to invasive procedures such as biopsies that are at risk of bleeding, infection and pain.
Screening tests find cancers that are both fast-growing and slow-growing, but they are not perfect and can sometimes lead to other invasive procedures. Many men have these procedures that 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 the amount of disease found on the biopsy. The urologist will then work with the patient to evaluate the illness in relation to the other health problems of the man.
Some men need surgery. Some need radiation. Some need hormone therapy and other men do not need treatment.
In this disease, it is extremely 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 very personal and there is often no clear medical answer to the best.
The need for treatment or the type of treatment often depends on the particular patient. The treatment itself involves risks, so the assessment of the risks must be evaluated against the benefits of the treatment.
How do I make the right decision in prostate cancer?
Find a urologist who will discuss with you all prostate cancer issues, 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 Northwest Medicine Glenview Ambulatory Care Center. To make an appointment, call (847) 535-7657 or visit nm.org for more information.