Prostate Cancer—Prevention, Risk Factors and Treatment

It wouldn’t be right not to talk about prostate cancer, a disease that only affects men, especially during November while it’s Men’s Health Awareness Month. 

In 2016, more than 180,890 men will be diagnosed with prostate cancer, the second leading cause of cancer death in men. Next to skin cancer, prostate cancer is the most common cancer in American men.  

“Men’s health and prostate cancer are topics that many tend to shy away from, but they need to be discussed more openly,” said Soroush Rais-Bahrami, M.D., assistant professor in the University of Alabama atBirmingham Department of Urology and founding member of the UAB Program forPersonalized Prostate Cancer Care. “One out of eight men will be diagnosed with prostate cancer in his life.”

The prostate is a reproductive gland in men located between the bladder and the penis. The fluid from the prostate is discharged into the urethra at the time of ejaculation as part of the semen to nourish and stabilize sperm for reproductive purposes.

Prevention

Men should begin screening for prostate cancer at age 50. This can be done during their annual exam with a discussion about prostate cancer risks factors. A blood test can be done to measure a biomarker called prostate-specific antigen (PSA) to identify a man’s risk of prostate cancer, along with a digital rectal exam. Once a blood test shows signs of higher PSA levels, a tissue biopsy is required to help determine the grade and stage of the prostate cancer.

“Many men do not know their family history of prostate cancer because men tend not to talk about their health concerns, even with children and other family members,” Rais-Bahrami said. “It is important to discuss family history due to the significantly higher risk for men with a first-degree relative who has been diagnosed with prostate cancer.”

Signs and Symptoms

Symptoms of prostate cancer are rare, and many men show no symptoms before being diagnosed. In advanced stages, symptoms may affect quality of life and may show in one of the following ways:      

• Problems urinating or the need to urinate more frequently, especially at night
• Blood in the urine or semen
• Trouble getting an erection
• Pain in the hips, back (spine), chest (ribs), or other areas the cancer may have spread
• Weakness or numbness in the legs or feet

Most of these symptoms are more likely to be caused by something else, but it is still important to discuss with a doctor, especially to determine risk factors.

Risk Factors

Some risk factors are controllable and others are not. According to the American Cancer Society, the following are some risk factors for prostate cancer:

Age: The chance of having prostate cancer increases rapidly after the age of 50. About 6 in 10 cases are in men over the age of 65.

Race: Prostate cancer occurs more often in African American men. African American men are also twice as likely to die from prostate cancer than white men.

Family History: Having a father or brother with prostate cancer more than doubles a man’s risk of developing it. The risk is much higher for men who have several relatives with prostate cancer.

Other risk factors may include: diet, obesity, smoking, inflammation, and some sexually transmitted infections.

Treatment

“Treatment is based on the patient’s overall health and what works best in treating the patient to ultimately cure the cancer and help the patient preserve an excellent quality of life,” Rais-Bahrami said.

In the earliest stages of low-grade prostate cancer, and with the consultation of a physician, men can opt for active surveillance, which is when the doctor does not prescribe immediate treatment, but watches the cancer cells closely to postpone treatment with curative intent, perhaps for years. Other treatment options include: 

• Surgery, which includes removing the entire prostate gland and occasionally regional lymph node tissues
• Radiation therapy, or beams of radiation focused on the prostate
• Hormone therapy, which reduces levels of male hormones to stop them from affecting prostate cancer cells
• High-intensity, focused ultrasound therapy, or high-energy sound waves that destroy cancer cells
• Cryosurgery, or the use of extreme cold temperatures to freeze and kill cancer cells

“Prostate cancer is a treatable disease and can be cured if caught in early stages,” Rais-Bahrami said. “This is why it is important to receive routine screenings and have early detection when present.”

To help with personalized care of patients, UAB offers magnetic resonance imaging and ultrasound fusion-guided biopsy. The image fusion allows doctors to target a direct tissue sampling of an individual based on imaging areas of concern that can be tested for prostate cancer.

Current Research

New research for prostate cancer is on the horizon, including the ongoing search for better biomarkers that indicate the presence of prostate cancer. At UAB, prostate cancer research is focused on advanced imaging and biomarker development, and hopes of defining the best way toward focal therapy of prostate cancer. UAB has become one of two beta sites in the United States to receive the iSR’obotTM Mona Lisa machine. This machine helps surgeons diagnose prostate cancer in earlier stages with imaging guidance and provides precise location mapping to help with targeting cancer cells for treatment.