Early Detection & Prevention

Prevention of Prostate Cancer

The exact cause of prostate cancer is unknown.  Current risk factors for prostate cancer include:
Family History: A man with a father or brother who developed prostate cancer has a twofold-increased risk for developing it. This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected three or more family members.
Age: Risk increases with age and after the age of 69 the chance of developing prostate cancer becomes more common than any other cancer in men or women.
African American Ethnicity: African Americans are more likely to develop prostate cancer and have more than twice the risk of dying from it
Where you live: Men who live north of 40 degrees latitude (north of Philadelphia, Columbus, Ohio, and Provo, Utah) have the highest risk for dying from prostate cancer of any men in the United States
Diet: Obesity and smoking may increase your risk of prostate cancer
Chemical exposure:  Men with exposure to agent orange and toxic chemicals (ie: fire fighters) have been found to have an increased incidence of prostate cancer.

Risk Factors for Aggressive vs. Slow-Growing Prostate Cancer
More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.  Risk factors for aggressive disease include:

Body mass index: a measure of obesity, is not linked to being diagnosed with prostate cancer overall.  In fact, obese men may have relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume.  However, obese men are more likely to have aggressive disease.

Smoking: has not been thought to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer, but not for low-risk prostate cancer.

Diet: lack of vegetables in the diet is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.

Other risk factors for aggressive prostate cancer include:

  • Tall Height
  • Lack of exercise and sedentary lifestyle
  • High calcium intake
  • African-American race
  • Family history
  • Agent Orange exposure

Symptoms

Unfortunately, there are often no early warning signs of prostate cancer and without regular screening; prostate cancer can go undetected for years.  In some cases, as the tumor grows it may exert pressure on the urethra, blocking the flow of urine from the bladder causing urinary symptoms. Occasionally the first warning sign may be blood in the urine. Note: symptoms may not occur until the cancer has developed to an advanced stage. 

Typical symptoms of prostate cancer:

  • NONE
  • Frequent urination (especially at night)
  • Weak urinary stream
  • Inability to urinate
  • Interruption of urinary stream (stopping and starting)
  • Pain or burning on urination
  • Blood in the urine or ejaculate
  • Bone pain in the hips, ribs or back
  • Back pain

Screening

Because there are no early warning signs for prostate cancer men may choose to undergo a screening for the disease.  Screening for prostate cancer does not provide a diagnosis, it provides valuable information to aid in finding the disease early.  Screening commonly involves two tests: the prostate specific antigen (PSA) blood test, and the digital rectal exam (DRE).

New tests or markers under development and may aid in the detection of prostate cancer. A biomarker is a biological molecule found in blood, body fluids, or tissues that is a sign of a normal or abnormal condition or disease. Markers may also be used to see how the body responds to a treatment for a disease.

Click Here for Screening Guidelines

Digital Rectal Exam (DRE)
A Digital Rectal Exam (DRE) is a quick and safe screening technique in which a physician feels the prostate by inserting a gloved, lubricated finger into the rectum. This simple procedure allows your physician to determine whether the prostate is enlarged, has lumps, areas of hardness or other types of abnormal texture.  The entire prostate cannot be felt during a DRE but a significant portion can be examined including the area where most prostate cancers are found.  While this examination may produce momentary discomfort, it causes no significant pain.

Prostate-Specific Antigen (PSA) Test
Used in addition to the digital rectal examination (DRE), a prostate-specific antigen (PSA) test increases the likelihood of prostate cancer detection. PSA is a substance produced by bot normal and cancerous prostate cells.  When prostate cancer grows or when prostate diseases are present, the amount of PSA in the blood often increases. 

The normal PSA range is most commonly considered to be 0-2.5ng/mL.  It is important to track how your PSA level changes over time.  If you PSA level is rising, regardless of the result value, your doctor may recommend a prostate biopsy.

It is important to know that there are several possible causes of a high PSA level that are not cancer. One is benign enlargement of the prostate called benign prostatic hyperplasia (BPH), and the second is prostatitis.  A high level of PSA in the bloodstream may be a warning sign that prostate cancer is present. But since other kinds of prostate conditions may also cause high PSA levels, PSA testing by itself cannot confirm the presence of prostate cancer. A high PSA level only indicates the possibility of prostate cancer and the need for additional evaluation by your physician. Conversely, a low PSA level does not always mean that prostate cancer is not present. An early stage of prostate cancer may be present that has not yet caused the PSA to increase in the bloodstream; it is for this reason that tracking your PSA blood test result over time is important.  There are also additional PSA tests available that your physician may recommend.

  • Percent Free-PSA Ratio
  • PSA Density
  • PSA Velocity
  • PSA Doubling time
  • Prostate Health Index (still under development)

Prevention:
A healthy heart diet helps with prostate cancer.  Diet is one of the most impactful efforts to reduce or delay their risk of developing prostate cancer. 

  • Eat fewer calories or exercise more so that you maintain a healthy weight.
  • Try to keep the amount of fat you get from red meat and dairy products to a minimum.
  • Watch your calcium intake.  Do not take supplemental doses far above the recommended daily allowance.
  • Eat more fish - evidence from several studies suggest that fish can help protect against prostate cancer because they have "good fat" particularly omega-3 fatty acids.
  • Try to incorporate lycopene rich foods or foods like cooked tomatoes that are cooked in olive oil, and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals.  Soy and green tea are also potential dietary components that may be helpful.
  • Avoid smoking, drink alcohol in moderation or none at all.
  • Avoid over-supplementation with mega vitamins.  Too many vitamins, especially folate, may "fuel the cancer", and while a multivitamin is not likely harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish and healthy oils you likely do not need a multivitamin. 
  • Relax and enjoy your life.  Reducing stress in the workplace and home will improve your survivorship and lead a longer and happier life.

If you are age 50 or over, if you are age 40 or over and African American, or if you have a family history of prostate cancer you need more than a good diet guarantee.  You should consider a yearly rectal exam, PSA test and you should discuss the risks and benefits of these screening procedures with your doctor.