Who Is More at Risk, Why Don’t We Have a Screening Program For All Men, How Is It Diagnosed, What Treatments are Available
The prostate is a small walnut-shaped gland located under the bladder and surrounding the urethra. The gland is part of the male reproductive system and is mainly responsible for the production of semen – the fluid that carries the sperm.
The formation of a tumor (abnormal, malignant cell growth) is referred to as prostate cancer. Sometimes the abnormal uncontrolled cell growth does not remain confined and may start to spread.
Prostate Cancer is generally a slowly progressing disease; the majority of men do not experience any marked symptoms and live with it for the rest of their lives without it spreading to other parts of the body and becoming life-threatening. However, high-grade cancer can spread very quickly and can prove to be fatal, therefore early diagnosis and management is the key to survival.
What Tests are Available for Detection of Prostate Cancer?
It is often very hard to detect since it normally grows very slowly and does not cause any other health problems. Moreover, some of the tests (such as PSA used for early screening of prostate cancer) may not yield accurate results and can prove to be misleading. This can lead to unnecessary treatment which can result in nasty side effects.
The most commonly used tests for detection are PSA blood test and digital rectal examination. However, both of these test do not diagnose, they are only helpful for detecting changes in the prostate gland.
- Prostate Specific Antigen (PSA) Blood Test
PSA is actually a protein made by the prostate cells as well as by cancerous cells. In order to measure the levels of PSA, a blood test is used. If the results of the blood test are above the normal range for your age or if they are rising rapidly, this may indicate the possibility of cancer. A high PSA level does not necessarily mean cancer since other prostate diseases can also raise the PSA levels in the blood.
- Digital Rectal Examination (DRE)
Although not recommended as a routine test for men with no symptoms, the DRE is used to check the size, shape, and any abnormalities. DRE can be uncomfortable for some patients, but it is rarely painful. The examiner inserts a gloved lubricated finger into the rectum to probe any abnormalities. Presence of abnormalities does not always indicate prostate cancer, similarly, the absence of any abnormalities also does not rule out the chances of prostate cancer.
- Magnetic Resonance Imaging (MRI) Scan
A specialised type of MRI is used for men suspected of having prostate cancer; it is called the mpMRI or multi-parametric MRI scan. The mpMRI combines the results of three MRI scans to show a clearer image of the abnormal areas. The mpMRI scan is usually recommended to help work out if a biopsy is needed and on which area to perform a biopsy (if needed). The mpMRI scan is also used to find out whether cancer has spread from the prostate to other nearby areas.
If the results of the above tests indicate the presence of abnormalities in the prostate, a biopsy is performed. Small amounts of tissues from different parts of the prostate are taken using a specialised needle. These samples are then examined by an expert pathologist to see if cancer cells are present or not.
Who Is More at Risk?
While it is still unclear what causes prostate cancer, your risk of developing prostate cancer can increase because of the following risk factors:
- Age – prostate cancer is most commonly diagnosed in men aged 60-79 and is very rare among men under 45.
- Genetics – a person has a higher risk of developing prostate cancer if his brother or father had it. Certain ethnic groups are at a higher risk because of their genetic makeup. In the US it is 60% more common and deadly among black men than white or non-Hispanic men.
- Geographical Location – people living in North America, the Caribbean Islands, Australia, and northwestern Europe are at an increased risk for reasons unknown.
- Diet – a diet rich in high-fat products or red meat is linked with increased risk of developing prostate cancer, but the links are weak and not confirmed yet.
- Obesity – some studies link obesity to be one of the risk factors of prostate cancer, however, there is no clear-cut evidence linking the two.
- Medication – use of certain medications such as NSAIDs is linked with the reduction of prostate cancer, while some studies suggest the use of NSAIDs to be a high-risk factor of death from this disease.
Why Don’t We Have a Screening Program for All Men?
Screening refers to testing a person for the early stages of cancer or any other disease before he/she starts to experience any symptoms. Screening for cancer patients is usually recommended if:
- the results of the screening tests are reliable
- the benefits would outweigh the risks
- screening tests have good value for money
The simple answer to the question “why don’t we have a screening program for all men” for prostate cancer is that we do not yet have any reliable enough screening test to use. The most commonly used tests for detection of prostate cancer are PSA blood test and digital rectal examination. However, both of these results do not diagnose cancer, they are helpful only for finding out changes in the prostate gland. Moreover, some of the tests (such as PSA used for early screening of prostate cancer) may not yield accurate results and as mentioned before can prove to be misleading.
Prostate Cancer – What Treatments are Available
Depending on your age, health status, and the stage of prostate cancer, your doctor will develop an appropriate treatment plan for you. Since it is a slow progressing cancer, many patients do not experience any symptoms or long-term issues, so treatment is not necessary. Treatment options for men with prostate cancer might include:
- Active Surveillance of Prostate Cancer
- Radiation Therapy
- Hormone Therapy
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