U.S. Sen. Thom Tillis is scheduled to undergo surgery for prostate cancer in early April. While the North Carolina politician said his cancer was “detected relatively early,” too many men are discovering their prostate cancer when it’s already at an advanced stage, one expert says, and confusing advice – and embarrassment – appear to be to blame.
Q: What can men do to identify early prostate cancer?
A: The cells of the prostate gland make the protein called prostate specific antigen, or PSA. Your doctor can measure PSA with a simple blood test. If the PSA levels start to rise, it could mean you have prostate cancer, benign prostate conditions or even an infection. No specific PSA value can definitively confirm or exclude prostate cancer. Monitoring for changes in the PSA over time can provide important diagnostic information. Additional testing like direct prostate assessments and prostate biopsies are used in conjunction with the PSA to diagnose early prostate cancer.
Q: Why is it so important for men to be diagnosed early with prostate cancer, in particular?
A: A man diagnosed with early stage prostate cancer has a higher likelihood of having the disease cured as compared with a patient diagnosed later with more advanced disease. Early stage prostate cancer can be cured over the course of months with a combination of surgery, radiation treatment and medications. Patients diagnosed with advanced stage disease benefit from a combination of treatments that typically involves years of therapy. Today, it is common to diagnose men with advanced stage prostate cancer.
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Q: What caused the shift of more patients coming in at a later stage of the disease?
A: In the early 1990s, professional societies issued guidelines supporting prostate cancer screening that resulted in more men being diagnosed with early stage prostate cancer. These men were treated aggressively. However, studies at that time did not show that early aggressive treatment saved lives.
Prostate cancer screening is now controversial due to conflicting data regarding the impact of early treatment saving lives. Current medical guidelines recommend “informed decision-making” or “shared decision-making” that involves a conversation between men and their doctor regarding the risks and benefits of undergoing prostate cancer screening. Unfortunately, due to many factors, these thorough conversations do not occur as frequently as they should. This one factor has led to delays in diagnosis of prostate cancer, so it is then found at a more advanced stage.
An additional benefit to early detection of prostate cancer is that in many cases patients can be closely followed by their doctor and only receive treatment when the cancer is at risk of progressing beyond a curable stage. There are many men diagnosed with prostate cancer who do not require therapy immediately, if at all, during their lifetime.
Q: What do you tell patients who are diagnosed?
A: When diagnosed with prostate cancer, men usually have several acceptable options for treatment.
Management decisions are made based on characteristics of the patient, stage and the aggressiveness of the prostate cancer. Cancer treatments are tailored to the individual rather than a "one size fits all" approach. Various options include active surveillance without any treatment, surgery, radiation therapy, testosterone suppression and medications in the form of pills or infusions.
Deciding on a treatment is often hard for patients. In medicine, it is common for the doctor to make a specific treatment recommendation. It can be overwhelming for men to make the “right” treatment choice for themselves. This is where "shared decision-making" between a patient and his physician is critical.
Q: What is the biggest misconception about prostate cancer?
A: The misconception I hear a lot is that prostate cancer is slow-growing, and you will die with it rather than because of it. This statement is true in many cases. However, many men die each year from advanced prostate cancer.
In 2020, about 192,000 new cases of prostate cancer were reported in the United States and 33,000 men died as a direct result of this cancer. Despite these numbers, it is important to note that the prostate cancer mortality has been decreasing over the past 30 years.
Q: Are patients sometimes uncomfortable talking about prostate cancer or getting tested?
A: Absolutely! Prostate cancer screening receives less attention in the popular media than other types of cancer, and, as a result, men can be embarrassed to talk about their prostate health. There is also fear that prostate cancer treatment will lead to incontinence and impotence. These are certainly real concerns. Some men require temporary testosterone suppression, while others with earlier forms of prostate cancer will only require testosterone suppression for a limited time.
My recommendation is to talk to your doctor about your concerns and not to avoid what you fear. These discussions provide important information to allow you to make informed decisions about your health.
Q: Are there any groups of people who should especially be made aware of prostate cancer?
A: Groups at higher risk for prostate cancer include men with an extensive family history of cancers and African American men.
Q: When should someone get tested? Is there an age when that should happen for everyone?
A: The United States Preventive Services Task Force advises men between the ages of 55 and 69 to have a discussion with their doctor about the risks and benefits of prostate cancer screening. Men with an extensive family history of cancer may consider prostate cancer screening as well.
Q: Are there any recent trends in terms of treatment options going on now that you’ve used to treat prostate cancer patients? I know this question gets a bit technical.
A: Many treatment options for prostate cancer can be tailored to the needs of a specific patient. Treatment options beyond surgery, including multiple oral medications, are often considered before intravenous chemotherapy. The goal in cancer treatment is to provide the biggest benefit to our patients with the least risk of causing side effects. A few nonchemotherapy options for prostate cancer include pills that manipulate androgen receptor signaling (Zytiga, Xtandi, Erleada), "bone targeting" radiation treatment (Xofigo) and immunotherapy (Provenge). Advances in medical research bring additional treatment options for cancer every year.
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