Understanding Prostate Cancer -- Prevention

How Do I Know If I Have Prostate Cancer?

The best way to detect prostate cancer in its early stages is with regular prostate exam PSA blood test. Because most malignant prostate tumors originate in the part of the gland nearest the rectum, many cancers can be detected during routine rectal examinations. Many doctors recommend an annual rectal exam, supplemented by a prostate-specific antigen (PSA) blood test, starting at age 50 for most men. The screenings are recommended beginning at age 40 for African Americans and those with a family history of prostate cancer.

PSA is a protein whose level tends to increase in the presence of prostate cancer, making it a valuable tool in detecting early prostate cancer. Together, the two screening measures offer the best chance of detecting prostate cancer while it is localized and most treatable. Prostate cancer may also be discovered incidentally during treatment for urinary problems. Because of the possibility of a false-positive PSA reading, it is important to discuss this test with your doctor before having one. An elevated PSA does not mean that you have cancer. Rather, it raises questions that need to be addressed and explained. There are a number of causes of an elevated PSA, and cancer is only one of them.

If routine screening arouses suspicion and/or PSA levels are elevated, a doctor will look at the prostate using an ultrasound instrument inserted in your rectum (transrectal ultrasound). X-rays of the urinary tract, along with blood and urine studies, are performed routinely to aid diagnosis. Performing a biopsy will confirm whether or not cancer is present: Guided by ultrasound images, the doctor inserts a needle into the prostate and extracts small slivers of tissue from the suspicious area. A pathologist then studies the sample under a microscope to determine whether cancer cells are present. In order to determine if the cancer has spread outside the prostate gland, doctors may arrange CT scans, bone scans, chest X-rays, or other imaging tests.

What Are the Treatments?

Since prostate cancer is often slow growing and may not be fatal in many men, some men -- after discussing the options with their doctors -- opt for "watchful waiting." Watchful waiting involves monitoring the prostate cancer for signs that it is becoming more aggressive but otherwise not treating it. This approach is recommended more commonly for men who are older or suffer from other life-threatening conditions. In these cases, the cancer may be growing so slowly that it's not likely to be fatal.

Once the decision is made to treat a cancer, other factors, such as a patient's age and general health, affect the type of treatment given. Decisions about how to treat this cancer are complex, and many men seek a second opinion before making a treatment decision.