According to the National Cancer Institute, prostate cancer is the second most common type of cancer among men in the United States. In fact, one in six men are diagnosed with prostate cancer in their lifetime. Men with certain risk factors are more likely than others to develop the disease. Published data suggests that one of the most important factors in treating prostate cancer is early diagnosis and accurate treatment by experienced surgeons. Before a treatment plan is determined, however, it is important to understand the disease and to research all the options available.back to top
Understanding Prostate Cancer
- Prostate cancer strikes 1 in 6 men in their lifetime.
- Nearly 220,000 patients in the United States will be diagnosed with prostate cancer in the next year.
- With early diagnosis and treatment, survival rates are over 90%.
- Early recovery of continence and potency is possible, with the latest medical advancements and surgical experience.
Prostate Cancer Risk Factors
- Age: Age is the main risk factor for prostate cancer, and the disease is rare in men younger than 45; only 1 in 10,000 men under age 40 will be diagnosed. However, with advanced screening, men as young as 30 have been diagnosed and treated for prostate cancer. The chance of getting prostate cancer goes up sharply as a man gets older. In the United States, more than 65% of all prostate cancers are diagnosed in men over the age of 65.
- Family History: A man's risk is higher if his father or brother had prostate cancer. This risk is further increased if the cancer was diagnosed in family members at a younger age (less than 55 years of age) or if it affected three or more family members.
- Race: Prostate cancer is more common in African American men than in white men, including Hispanic white men. It is less common in Asian and Native American men.
- Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk for prostate cancer. These prostate cells look abnormal under a microscope.
- Diet: Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk for prostate cancer. Men who eat a diet rich in fruits and vegetables may have a lower risk.
- Sexual Activity - High levels of sexual activity or frequent ejaculation have been rumored to increase prostate cancer risk. This is untrue. In fact, studies show that men who reported more frequent ejaculations had a lower risk of developing prostate cancer.
- Vasectomy- A vasectomy was originally thought to increase a man's risk, but this has since been disproven.
- Medications - Several recent studies have shown a link between aspirin intake and a reduced risk of prostate cancer by 10-15%. This may result from different screening practices, through a reduction of inflammation, or other unknown factors.
- Alcohol - There is no link between alcohol and prostate cancer risk.
- Vitamin E - Recent studies have NOT shown a benefit to the consumption of vitamin E in the prevention of prostate cancer.
There are many things that men can do to reduce or delay their risk of developing prostate cancer. Why is prostate cancer so common in the Western culture and much less so in Asia, and why when Asian men migrate to western countries the risk of prostate cancer increases over time? It is believed the major risk factor is diet – foods that produce oxidative damage to DNA. What can you do about it to prevent or delay the onset of the disease?
- 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. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
- 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. Avoid trans fatty acids (found in margarine).
- Try to incorporate cooked tomatoes that are cooked with olive oil, which has also been shown to be beneficial, along with 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 for many reasons. Alcohol in moderation, if at all.
- Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer.
- What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may "fuel the cancer", and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin.
- Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
- A yearly rectal examination and PSA test will also go a long way in early detection or diagnosis.
Early diagnosis and Screening
Should I Be Screened?
It's important for each man to talk with his doctor about whether prostate cancer screening is right for him. Those in the medical community who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects.
Ultimately, decisions about screening should be individualized based on a man's level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer.
When to Start Screening
When to start screening is generally based on individual risk, with age 40 being a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate cancer at a young age).For otherwise healthy men at high risk (positive family history or African American men), starting at age 40-45 is reasonable.
Guidelines differ for men at average risk. Some recommend an initial PSA and DRE at age 40, and others recommend starting at age 50. In general, all men should create a proactive prostate health plan that is right for them based on their lifestyle and family history.
You can find a useful resource for making these decisions at the U.S. Centers for Disease Control and Prevention site.
Screening and Biopsy
A prostate cancer screening may reveal results that prompt a doctor to recommend a biopsy. There are many other supplementary tests and considerations that can help a man who is undergoing screening decide if a biopsy is necessary, including:
Lower vs. higher free PSA test
PSA velocity (rate of rise over time)
PSA density (PSA per volume of prostate)
Prior biopsy findings
Digital rectal exam results
Different forms of PSA (i.e. bPSA, pro-PSA)
In general, a lower free PSA (percentage) indicates a higher risk of finding cancer at biopsy, as does a higher PSA velocity and PSA density. Discuss these individual tests with your doctor to make screening decisions that are best for you.
Where Can I Find Free Prostate Cancer Screening?
Local hospitals and local prostate cancer support groups usually either offer screening or have a list of places you can go for screening. The Prostate Conditions Education Council also lists screenings: Click Here
How could you benefit from the International Prostate Cancer Foundation's (IPCF) research program?
More than 240,890 men were newly diagnosed with prostate cancer in 2011 in the United States alone, and more than 33,720 men will die. Despite advances associated with modern medicine, improvements in prostate cancer-related mortality have been marginal at best and mortality has, as a matter fact, increased among African-American obese patients. These data suggest that new lines of research are needed to provide improved understanding of the molecular alterations associated with the currently poor prognosis of prostate tumors. This understanding is expected to subsequently facilitate optimal delivery of current state-of-the-art care and to identify completely novel therapeutic treatment strategies. Delivery of personalized medicine through biomarker-guided clinical intervention, as well as through the discovery of novel therapeutics, is needed to decrease the significant morbidity and mortality as well as economic burden associated with prostate cancer.
Systematic sequencing of protein-coding genes has lead to the identification of novel mutated genes involved in several cancer types, especially in prostate cancer. Significantly, the advent of next-generation sequencing makes these types of analysis highly feasible in prostate cancer biology and oncology. In addition, these methodologies allow for the complete assembly of prostate cancer genomes, including the identification of gene fusions as well as mutations within regulatory regions of genes. Next-generation sequencing also allows identification of genetic signatures that when combined with clinical correlates are expected to be of significant value in prostate cancer diagnosis and prognosis.
Dr. Patel and his team are now collaborating with Dr. Kristiina Vuori MD. PhD. and Dr. Ranjan J. Perera Ph.D. at the Sanford-Burnham Institute for Medical Research to apply these novel advance genomics and epigenomics technologies to identify gene based molecular markers for early prostate cancer detection in men. This team is proposing a study using next-generation DNA sequencing to identify stage-specific molecular markers (genomics and epigenomics) for accurate prostate cancer classification, with the objective of providing enhanced prognostic accuracy for the widely used Gleason scoring methodology. Their investigation focus will be on newly diagnosed prostate cancer patients with Gleason scores 6 (Gleason grade 3+3) and 7 (Gleason grades 3+4, and 4+3). This is based on the notion that Gleason score 7 predicts for a significantly more aggressive cancer than Gleason score 6, thus underscoring the need for an accurate diagnosis. They hope to apply advanced computational methods (bioinformatics and statistics) to associate the identified molecular markers with Gleason scores, providing greater sensitivity in Gleason score 6 and 7 classification. In the future, the identified genomics and epigenomics-based molecular signatures will be further validated in prospective patient outcome studies, to fully evaluate their prognostic potential.