Early Detection
Preventable risk factors for prostate cancer are unknown,
and effective measures to prevent this disease have not been determined. Screening for and
treating disease at an early stage have been proposed to reduce the risk of dying of
prostate cancer. However, scientific evidence is insufficient to determine if screening
for prostate cancer reduces deaths or if treatment of disease at an early stage is more
effective than no treatment in prolonging a man’s life. Currently, health
practitioners cannot accurately determine which prostate cancers will progress to become
clinically significant and which will not. Thus, widespread screening and testing for
early detection of prostate cancer are not scientifically justified at this time.
Professional medical organizations are divided on the issue
of screening for prostate cancer. The U.S. Preventive Services Task Force
(USPSTF)
recommends against routine screening but stresses the need for “informed decision
making,” acknowledging that patients who request screening should be given objective
information about early detection and the potential benefits and risks of treatment. CDC
supports the USPSTF recommendations. The ACS recommends that health care providers offer
the prostate-specific antigen measurement annually, beginning at age 50, to men who have
at least a 10-year life expectancy and who choose to have early detection testing. To help
patients make informed decisions about testing, providers should explain the potential
benefits and risks of early detection and treatment. The ACS also recommends that
screening start at a younger age for men in higher-risk groups, such as men with two or
more affected first-degree relatives (e.g., father and a brother, two brothers) or African
American men.
Two commonly used methods for
detecting prostate cancer are currently available to clinicians:
Digital rectal examination
(DRE) has been used for years as a screening test for prostate cancer. However, its
ability to detect prostate cancer is limited. Small tumors often form in portions of the
prostate that cannot be reached by a DRE. Clinicians may also have difficulty
distinguishing between benign abnormalities and prostate cancer, and the interpretation
and results of the examination may vary with the experience of the examiner.
The
prostate-specific antigen (PSA) measurement is a blood test that many
clinicians use, but medical consensus on its use and interpretation has not been reached.
PSA is an enzyme measured in the blood that may rise naturally as men age. It also rises
in the presence of prostate abnormalities. However, the PSA test cannot distinguish
prostate cancer from benign growth of the prostate and other conditions of the prostate,
such as prostatitis. PSA testing also fails to detect some prostate cancers—about 20%
of patients with biopsy-proven prostate cancer have PSA levels within normal range.
Treatment Options
Physicians have become increasingly aware of the
psychosocial aspects of prostate cancer and its treatment. Health professionals are
realizing that the question is not merely how a life can be saved, but also how quality of
life can be preserved. Many community education and support programs are available to help
men and their families make informed decisions that will suit their needs, desires, and
lifestyles.
Appropriate treatment options for men with prostate
cancer are based on the stage of the cancer at the time of diagnosis. Patient outcomes and
the quality of life after treatment are influenced by the patient’s age, the presence
of other medical conditions, and the aggressiveness of the tumor.
When Prostate Cancer Has Not Spread
Several treatment alternatives are available to
patients with early-stage cancer that has not spread beyond the prostate. These include
the following:
Radical prostatectomy,
or complete surgical removal of the prostate, is frequently used for patients younger than
70 years who are otherwise in good health. Complications of radical prostatectomy may
be short- or long-term; 5%–19% of men become incontinent, and 24%–62% become
sexually impotent. The risk for these complications increases with age and with the amount
of damage to nerve and blood supplies during the surgical procedure. Currently, definitive
evidence that this surgical procedure reduces deaths or prolongs life is not available.
Radiation therapy,
or treatment of the tumor site with low levels of radiation, is used for cancer that is
confined to the prostate or surrounding tissue. Some side effects, which can include acute
inflammation of the bladder, rectum, and intestines, are generally reversible. Following
radiation therapy, 25%–44% of men experience some degree of sexual impotence, and
0.5%–7% of men become incontinent.
Watchful waiting,
or no immediate treatment, is also an option for men with prostate cancer because of the
often slow progress of this disease. When this option is chosen, the tumor is evaluated
periodically for changes that suggest rapid growth. Recent studies have found that
watchful waiting may be an acceptable management alternative, particularly for older men
with small low-grade tumors that are unlikely to spread.
When Prostate Cancer Has Spread
Patients with cancer that has spread beyond the
prostate gland may receive radiation and hormonal therapies to inhibit further progression
of the cancer, but most of these tumors eventually become resistant to hormonal therapy.
Some patients with advanced disease may choose to participate in clinical trials of
experimental therapies.
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