Learn the Facts About Prostate Cancer
“Most people don’t think prostate cancer is going to happen to them, unless their father or brother had it,” says Oliver Sartor, MD, a professor of medicine and urology at the Tulane University School of Medicine in New Orleans.
However, given that about 164,000 men in the United States will be diagnosed with the disease in 2018, according to the American Cancer Society (ACS), it’s likely that you or someone you know will be affected. Prostate cancer is the second leading cause of death from cancer in American men, right behind lung cancer.
But while it’s a serious disease, and it does take lives, most men don’t die from it. In fact, the ACS says that more than 2.9 million Americans who’ve been diagnosed with prostate cancer are still alive today.
Despite this prevalence, myths and confusion abound when it comes to understanding your own personal level of risk, and what to do when your doctor says you have prostate cancer.
“The diagnosis [of prostate cancer] almost always hits people out of the blue,” Dr. Sartor says. “It’s not what you plan on, and of course it’s very disruptive. For many men, prostate cancer creates a general cognitive dissonance: Why me? What did I do wrong? What am I going to do about it now that my life is being threatened?”
When talking about prostate cancer, high emotions often kick in. “What I see all the time,” Sartor says, “is people overestimating the deadliness of prostate cancer. There are some pretty bad cancers out there, and I’m not saying prostate cancer can’t be bad. But people don’t tend to discriminate about what their prognosis might be compared to someone else with the ‘big C.’ There is sort of a sense of impending doom that certain patients may have — which may or may not be true.”
Hopefully we can help people understand that prostate cancer is not a death sentence for the majority of us, Sartor says. In the end, most men die with prostate cancer, not of prostate cancer. One way to clarify things — bust the myths and beat prostate cancer — he says, is to learn more about what prostate cancer is, how it’s treated, and who’s at risk for it.
Myth: Prostate Cancer Is for Older Men
Fact: While it’s true that the majority of men diagnosed with prostate cancer are older, it can (and does) strike younger men, too. About 40 percent of all cases occur in men younger than 65, according to the ACS. “It’s not uncommon at all for men in their fifties and some in their forties to have prostate cancer,” says Sartor. (It’s rare in men younger than 40, however.)
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The exact age you should start getting regularly screened for prostate cancer is still an area of confusion and debate. At least start talking to your doctor about PSA (prostate-specific antigen) testing once you’re 50 years old, the ACS recommends. The exception to this is if the disease runs in your family, in which case it’s a good idea to start PSA screening earlier, at age 40 or 45.
Myth: My Dad Had Prostate Cancer, So I Will, Too
Fact: “If a man has one relative with prostate cancer, say a father or brother, his chances of getting it are two times higher than someone who doesn’t have this history,” says John Wei, MD, a urology professor at the University of Michigan in Ann Arbor. Two family members with prostate cancer hike the risk five-fold.
But not everyone with a family history of prostate cancer will get it themselves. If prostate cancer runs in your family, talk with your doctor about when to start regular PSA tests; your healthcare provider might be more aggressive about recommending follow-up testing.
Myth: Prostate Cancer Isn’t Deadly
Fact: While the five-year survival rate with prostate cancer is very high — 90 percent, according to the ACS — it’s still the second leading cause of cancer death in men. The only cancer that kills more men is lung cancer.
Most prostate cancers are what doctors call “indolent,” which means that they grow slowly and can often be actively monitored over the course of many years without other treatment. But sometimes prostate cancer is aggressive, and grows quickly.
“While most men don’t have a prostate cancer that’s fast and deadly,” acknowledges Sartor, it does exist. And you won’t know which type you have until it’s thoroughly checked out.
In other words, assuming prostate cancer isn’t serious — and not having further testing because of this misconception — could be a downright deadly way of approaching the illness.
The dangers and risks of prostate cancer aren’t distributed evenly among American men, either. The U.S. Department of Health and Human Services’ Office of Minority Health reports that African-American men are 2.3 times as likely to die from prostate cancer as compared to non-Hispanic white men.
Myth: If the Cancer Comes Back, It Can’t Be Treated Again
Fact: Recurrence of prostate cancer can be wrenching. But just because a cancer comes back doesn’t mean you can’t reach remission again. What it does mean is that you’ll likely have to try another approach to treatment.
“Your first cancer cure is always the best,” says Sartor. “But you do have a possibility for cure if it comes back — particularly if you’ve had an initial radical prostatectomy, in which case if you catch [the recurrence] early, you can radiate and get a pretty good cure rate.”
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Sartor adds that one of the reasons he often recommends surgery before radiation is for this reason — so that people get a second chance at cure if the cancer comes back and they monitor their condition appropriately.
Myth: PSA Tests Are Bad for You
Fact: Some prostate cancer experts recommend against regular PSA testing, but not necessarily because of the test itself — which is just a simple blood test. PSA screening certainly isn’t perfect, but it doesn’t pose any actual danger to your health. The real hazard is anxiety and sometimes faulty decision-making when it comes to interpreting and acting on PSA results. According to the ACS, PSA levels usually go above 4 when prostate cancer develops. However, a PSA level between 4 and 10 results in a prostate cancer diagnosis only about 25 percent of the time.
Causes of a high PSA can range from things like bicycling to ejaculation. As a result, some men are given invasive biopsies that aren’t needed. Or, if they do have cancer, they may be treated aggressively for slow-growing tumors that might never have caused any issues.
Which is not to say that PSA tests aren’t valuable or that they can’t save lives. In the years since they’ve been widely used, says Dr. Wei, prostate cancer diagnoses have gone up — but “the death rate is going down.” This is at least in part because PSA tests lead to more investigation, which can find cancer early when it’s more receptive to treatment. Talk with your doctor about whether — and how often — you should be screened for prostate cancer.
Myth: If You Have a Low PSA, You Don’t Have Prostate Cancer
Fact: PSA levels can be useful in diagnosing prostate cancer, but they’re really only one piece of the larger puzzle. The PSA test is far from perfect, Sartor says. He draws a parallel between low PSA readings and negative mammograms in women. “If you have a negative mammogram, it’s not 100 in terms of excluding cancer. The probability is less, but likewise just because your PSA is relatively low, you can’t interpret that to mean that there is no cancer present.”
However, the opposite can also occur: Sartor described a different scenario in which one of his patients — a very bright and accomplished attorney — has a biopsy after getting an elevated PSA, and the biopsy came back negative. “After this negative result he figured he didn’t have cancer, and waited three to four years before having his PSA tested again,” Sartor says. Now he has prostate cancer that has spread to other parts of his body. In other words: metastatic disease. “He took the negative biopsy as literally meaning he doesn’t have cancer, and it turned out badly for him.”
To get the most complete picture of your prostate health, you need to get other diagnostic tests as well. This may mean getting a biopsy. But that standard is changing, says Sartor, citing a major study published in The New England Journal of Medicine in March 2018 and The Lancet in February 2017 that point to the value of a special type of MRI imaging called multiparametric magnetic resonance imaging.
“While the biopsy is still the gold standard when it comes to the diagnosis of cancer, this MRI can add localization and help streamline the efficiency of the biopsy,” he explains. “It can tell you where to put the needle and also, in some patients, tell you that a biopsy is not required because the probability of cancer is very low.”
Myth: Prostate Cancer Treatment Always Causes Impotence
Fact: According to research published in the December 2014 issue of the International Journal of Urology, there’s been progress in developing models to predict erectile dysfunction after localized treatment for prostate cancer. Sartor says avoiding impotence depends on many factors, including the skill of the surgeon who is operating on you. But as surgical techniques are improving, people are recovering faster and having fewer side effects.[Read: 10 Warning Signs of Pancreatic Cancer that You Must Know]
According to Sartor, one year after surgery, approximately 25 percent of patients will say their function is fine, 25 percent will have mild dysfunction, 25 percent will have moderate dysfunction, and 25 percent say they have severe dysfunction.
Age can also be a complicating factor, adds Wei: “As men get into their sixties and seventies, a lot of them already have some compromise of sexual function.” Prostate cancer treatment certainly won’t correct this problem, but it also isn’t likely to make it significantly worse for most men.
Myth: Prostate Cancer Treatment Always Causes Incontinence
Fact: Next to sexual function, men worry most about urinary incontinence as a result of prostate cancer treatment. Sartor says sexual side effects are more common than the urinary side effects the year after surgery. “The majority of people do not have significant urinary problems.”
If you do have bladder problems, you’re more likely to face minor leakage than major accidents — and in most men, the situation is temporary or treatable.
To help ensure the best outcome after surgery, Sartor recommends looking for a surgeon who has performed the procedure many times — surgeons who are on their 900th procedure, for example, not their 41st. “Experience does matter,” he says. “It’s important to consider.”
Myth: You’ll Insult Your Doctor if You Get a Second Opinion
Fact: Seeking a second opinion isn’t bad manners — it’s good sense. Even doctors themselves ask for help and input from their colleagues. “There’s nothing wrong with talking to several doctors to get to that comfort zone that you deserve before undertaking a significant procedure,” Sartor says.
You should feel free to ask for second opinions about everything from your diagnosis to your treatment options. Don’t sacrifice your own well-being for fear of hurting your doctor’s feelings.