What Made You Think You Had Prostate Cancer?

Wednesday, June 20, 2018 - 9:44am

“I’m African-American, and my father had it, too.”

“Nothing! I had a PSA test and my level was very high.”

“I had trouble urinating, and very little would come out.”

Recognizing signs and symptoms of illness is always a good idea, but when it comes to cancer, and especially prostate cancer, symptoms are often vague, difficult to discern from normal, or don’t appear at all until the cancer advances.

Be sure to tell your doctor if you experience urinary symptoms such as difficulty starting to urinate, decreased flow, or blood in the urine, or if you have bone pain, pelvic area discomfort or swelling in your legs, so they can be evaluated. For most men, these symptoms are more commonly due to benign conditions such as an infection or enlarged prostate.

If you’re worried about prostate cancer, talk to your doctor about having a PSA test. Pioneered here at Roswell Park, the PSA test was a game-changer in prostate cancer early detection. Originally developed to monitor progression of prostate cancer in men already diagnosed with the disease, it became a useful tool along with a digital rectal exam (DRE) for screening. This test measures the level of a protein called prostate-specific antigen (PSA) in a blood sample. Elevated levels may indicate the presence of cancer, but other noncancerous conditions such as prostatitis, urinary tract infection, constipation or even riding a bicycle may elevate PSA, too. In general, the higher the PSA level (with a continuous rise in PSA over time), the more likely prostate cancer is present.

Who should consider testing for early detection of prostate cancer?

You should have a discussion with your primary physician about when and if you should undergo screening tests. This discussion should include whether you have any risk factors for the disease, such as:

  • African-American race
  • Family history (a father or brother with prostate cancer diagnosis)
  • A known genetic mutation in the BRCA1 or BRCA2 genes

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While prostate cancer is quite common — about 50% of men over age 50 already have cancer cells in their prostate gland — not all prostate cancers require treatment right away, and some never do. Many prostate cancers grow very slowly (these are called indolent or insignificant or autopsy-type), and these can be safely monitored for years, so you begin treatment only if the cancer progresses. Aggressive prostate cancer, however, requires appropriate and timely treatment before it advances to nearby tissues, organs and lymph nodes, to avoid missing the window of opportunity for cure. Early-detection testing finds both aggressive and indolent cancers, and careful surveillance with PSA, prostate exams, prostate MRI scans and biopsy is essential to distinguish a slow-growing prostate cancer from an aggressive and potentially fatal form.

When should I undergo testing?

If you decide that early detection of prostate cancer is right for you, the guidelines of the National Comprehensive Cancer Network (NCCN) recommend PSA testing and digital rectal exams, as follows:

  • Baseline testing at age 45 (to compare with later years’ results).
  • Continue regular testing at 1- to 4-year intervals, dependent upon your baseline or previous PSA level, your age and your risk factors.
  • Discontinue PSA screening at age 75.

What’s the bottom line?

Prostate cancer is usually slow-growing but can be fatal. How best to detect and treat the fatal type of prostate cancer remains controversial. Men at higher risk for aggressive prostate cancer should consider the use of PSA for early detection.