Prostate cancer is one of the most common types of cancer. Prostate cancer occurs in the prostate gland, a small organ in the male reproductive system that produces fluid that makes up a part of semen. Some types grow very slowly and require minimal or no treatment, while others can be more aggressive.
In its early stages, prostate cancer may have no symptoms. More advanced prostate cancer symptoms can include:
“The vast majority of prostate cancer screening is done in the absence of symptoms,” explains Kyle Morawski, MD, MPH, an internal medicine doctor at Mass General Brigham Integrated Care. “Starting at the age of around 50 years old, we start having these conversations about screening.”
If a patient has a family history of prostate cancer in close blood relatives like a father, uncle, or grandfather, then they might benefit from earlier screening. “It’s important to discuss your family’s history with these types of cancer with your primary care provider,” says Dr. Morawski. “You and your doctor can discuss the pros and cons of screening, and what matters to you as a patient.”
Current guidelines recommend screening through a blood test which checks levels of prostate-specific antigen (PSA). If a patient has a high PSA level, they might need further testing to determine if it’s prostate cancer. “There is a known risk of a false positive with high PSA levels,” says Dr. Morawski. “Patients should not immediately assume they have prostate cancer.”
There are different options for additional screening, including re-testing PSA levels after several months or a year, a prostate MRI or ultrasound, or a biopsy. A patient’s primary care provider usually initiates screening and coordinates with a urologist if further care is needed.
The two biggest risk factors are family history and age, with men older than 50 being at higher risk. Other elements like overall health, diet, exercise habits, and environmental factors may contribute to a person’s overall risk, but there isn’t strong evidence according to Dr. Morawski.
“It’s thought that the best way to decrease your cancer risk is by increasing your overall health, including a healthy diet, exercise, and maintaining your optimal weight,” says Dr. Morawski.
Prostate cancers are rated according to the Gleason scoring system, which predicts whether the cancer is likely to grow and how fast it will spread. Treatments can include radiation, surgery, and chemotherapy.
“There’s a lot of different things to consider before pursuing one course of treatment or the other,” explains Dr. Morawski. Sometimes treatment may cause more harm than good. A good working relationship with your PCP, so that you can participate in shared decision making about what matters to you, is what’s most important.”