Other than skin cancer, prostate cancer is the most common cancer among men. Although it is rare before age 40, the American Cancer Society (cancer.org) estimates one in nine men will eventually develop the disease by the time they reach retirement.

In 2019, that computes to about 174,650 new cases and about 31,620 related deaths. Prostate cancer can be a serious disease, but it’s important to note that because it is generally slow moving, it’s usually not a death sentence. More than 2.9 million American men diagnosed with prostate cancer at some point are still alive today.

When Should I Be Screened?
Like women and mammograms, there are guidelines for when men should discuss prostate cancer screening with their health care provider. This discussion should take place at:

  • Age 50 for men who are at average risk and are expected to live at least 10 more years
  • Age 45 for African Americans and men with a first-degree relative (father, brother or son) diagnosed with prostate cancer before age 65
  • Age 40 for men with more than one first-degree relative who had prostate cancer before age 65

Screening often begins with a prostate-specific antigen (PSA) blood test. Elevated levels can signal the presence of a tumor or benign prostatic hyperplasia (BPH), an enlarged prostate. A digital rectal exam may also be performed.

If no prostate cancer is found, future screenings are recommended:

  • Every two years for men with a PSA level less than 2.5 ng/mL
  • Every year for men whose PSA level is 2.5 ng/mL or higher

Screenings for men older than 70 are not recommended as their cancers are typically slow growing and they have a greater risk of side effects from prostate cancer therapy as compared with younger men.

What If Something Looks Suspicious?
If early detection tests suggest cancer may be present, the physician will recommend additional testing, such as a transrectal ultrasound and prostate biopsy. A core needle biopsy is the main method used to diagnose prostate cancer. It takes about 10 minutes and is usually performed by a urologist, in the doctor’s office.

If prostate cancer is discovered, patient and physician will examine options based on:

  • The size of the tumor and how far it has spread
  • How quickly the tumor is likely to grow
  • The patient’s age and health
  • The patient’s personal preferences

How is Prostate Cancer Treated?
Since most men with prostate cancer eventually die from other causes, many doctors recommend watchful waiting or active surveillance. Essentially, this is monitoring the cancer and doing nothing unless it changes or causes symptoms.

If the cancer does become aggressive – or if the patient is too uncomfortable with not taking some action – surgery, radiation, high-intensity focused ultrasound (HIFU), hormone therapy, chemotherapy, and/or immunotherapy are all options. Each has possible side effects that should be considered before undergoing treatment.

What Research is Being Done?
In genetics, researchers are working to identify abnormal prostate cancer genes and design medicines to prevent those genes from developing into full-blown cancer.

Dietary scientists are searching for foods to help lower prostate cancer risk. Substances in tomatoes (lycopenes) and soybeans (isoflavones) are looking promising as possible dietary supplements. Some studies show vitamin D lowers the risk of developing more lethal forms of prostate cancer.
Though the PSA test is still preferred, early detection tests continue to evolve. Biopsies are also becoming more precise through new approaches, including color Doppler ultrasound.