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 family history of prostate, breast, ovarian, colon or pancreatic cancers may be at an increased risk of prostate cancer.

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.

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

Prostate-Specific Antigen (PSA) Test

For the majority of men, prostate cancer at presentation has no symptoms that can be directly tied to their cancer.  Many might present to their doctors with urinary complaints, such as a reduced or restricted stream, frequency of urination, or getting up at night (nocturia).  But this is more than likely as a result of an enlarging prostate or BPH (Benign Prostatic Hyperplasia), a non cancerous condition and a natural function of aging.   What normally prompts a referral to the urologist to look for prostate cancer is either an abnormal finding on digital rectal exam (DRE), such as a lump or firmness of the prostate on physical exam, or an elevation of a blood test called PSA (Prostate Specific Antigen).  As the name implies, PSA is prostate specific blood test, but not prostate cancer specific.  PSA is a protein that is produced by the cells of the prostate, cancerous or non-cancerous, that can be measured in the blood. 

Since its inception, PSA has been thought of as a "screening" test for prostate cancer.  Ideally, an optimal screening test detects a disease (in this case prostate cancer) when abnormal or elevated and rules out disease when the test is normal.  PSA should NOT be thought of as a screening test.  There are many false positives (the blood test is elevated, but no cancer on biopsy) and false negatives (the blood test is normal, but there is cancer on biopsy) when using the published range of 0 to 4, making it not a great screening test by definition.  Thus, it should be understood that an elevated PSA level does not mean that one has prostate cancer, but only suggests that something is affecting the prostate gland causing the blood test to rise.

In 2012, there was significant controversy regarding PSA testing in the United States.  Much of this centered around the facts that many cancers being diagnosed were of a lower risk, these patients when followed did not die of prostate cancer and thus treatment for these tumors was not always necessary.  Additionally, there was mounting data bringing in the question of 0 to 4 as "normal".  Currently, the National Comprehensive Cancer Network (NCCN) recommends that after discussion on the merits of an early detection program, especially those with a significant family history of cancer and African Americans, a baseline DRE and PSA should be obtained at age 45.  If the baseline value is > 1.0 ng/dl, every 1 to 2 year testing should be carried out, monitoring significant changes in the test.  If the value is < 1.0 ng/dl, consideration can be given to repeating every 2 -- 4 years.  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

PSA testing should be suspended if the likelihood of dying from another ailment would result inside that 10 year period.  Most agree that beyond 75 years of age, this becomes particularly meaningful and a full discussion should be undertaken regarding the merits of PSA testing. 

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.

Prevention

Diet is one of the most impactful efforts to reduce or delay their risk of developing prostate cancer.  A heart healthy diet also helps with treatment recovery and possible nonoccurence.

  • 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.

Early detection saved my life.  More men need to know about their risk, and their opportunities to get screened.

~ Keith Wegen, prostate cancer survivor

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