The exact cause of prostate cancer is unknown.  Current risk factors for prostate cancer include:

Age: The risk of prostate cancer increases with age.

Race: African American men are more than twice as likely to be diagnosed with prostate cancer and to die from the disease.

Family History: Men with a father or brother with prostate cancer have a higher risk of developing the disease.

Genetic Mutations: Inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast, ovarian and prostate cancer in some families.

Diet: Studies indicate there may be a link between diet and the cause or prevention of prostate cancer.

Chemical Exposure: Exposure to certain chemicals such as pesticides and herbicides may have higher than average rates of prostate cancer.  Veterans who were exposed to the defoliate Agent Orange are 49% more likely than non-exposed veterans to be diagnosed with prostate cancer.

Firefighter:  Recent studies show that firefighters are at a 28% greater risk to develop prostate cancer compared to the general population.

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.  However, it may be a risk factor for aggressive 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.

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 during 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 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 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 0-1.5ng/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. However, 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

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.

PCEC recommends a baseline PSA and DRE for all men at age 40. Based on this initial assessment, PCEC recommends that men establish an early detection follow-up schedule as stated:

  • At risk men: African-American men, men with a family history of prostate, breast or ovarian cancers, BRCA gene mutation, men who have been exposed to certain chemicals known to causes cancer or men over the age of 65.
  • Men with a baseline PSA result greater than 1.5ng/ml or greater should be monitored and evaluated.  If the baseline PSA result is below 1.5 ng/ml men should be tested every five years.

 

Prostate cancer is a disease that is most successfully treated when it is detected early on.  As the research community explores various methods to detecting the disease, PCEC continues to encourage men to play an active role in their health by looking to those trusted sources of prostate cancer testing – the PSA and DRE.

~Dr. E. David Crawford
Head of the Urologic Oncology Department at the University of Colorado Health Sciences Center
Founder/Chairman of PCEC

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