Posted by Bill Sandweg on 07 August 2023.

Prostate cancer can be aggressive or slow-growing.  It may not be easy to distinguish between the two and there is a substantial risk of overtreatment.

After skin cancer, prostate cancer is the most common form of cancer among men.  One in seven men will develop prostate cancer and, if a man has a family history of prostate cancer, his risk is even greater.  Furthermore, the older a man gets, the greater the risk that he will develop prostate cancer.

While there have been advances in detection, monitoring and treating prostate cancer, because of its location, it remains a difficult cancer to accurately diagnose and stage.  Staging refers to the determination of how advanced a cancer is.  There are ten possible stages for prostate cancer.  Treatment options depend upon accurate diagnosis and accurate staging.

Prostate cancer is usually detected by either palpation of the prostate gland showing physical changes or by use of a prostate specific antigen (PSA) test or both.  Complicating matters is that there are a number of unrelated conditions that can cause elevation of PSA levels.

Elevated PSA levels lead doctors to consider biopsies.  In the biopsy, a needle is inserted into the prostate and a small amount of tissue is extracted for testing.  The sampling may be done at multiple sites in the prostate and is usually ultrasound-guided to make sure the needle is actually in the prostate.

This form of biopsy has its problems.  The tip of the needle may miss collections of cancerous cells and result in an erroneous report of no cancer, a false negative.  Or the needle may locate low malignancy cells while missing more aggressive ones, again resulting in a more benign picture than is actually warranted.

Once cancer is detected, however, it must be graded and staged.  The more aggressive the cancer, the more important it is to treat it aggressively.  On the other hand, if the cancer appears slow growing, especially in an older man, the best current thinking is to carefully watch it and take aggressive action only if the cancer itself becomes more aggressive.  Most older men with slow growing prostate tumors will die of something else before the cancer becomes a problem.

For men diagnosed with slow growing prostate cancer, there can be a lot of societal and family pressure to “do something.”  Since each of the three main treatments for prostate cancer have a greater than 50% chance of leaving the man without a functional erection and with urinary urgency, the decision to proceed with aggressive treatment should be made carefully.  Once aggressive treatment has been undertaken, there is no going back.

The good news is that prostate cancer is highly survivable.  According to the Centers for Disease Control, the five year survival rate for men diagnosed with prostate cancer is just over 97%.  Contrast that with colorectal cancer at 65% and lung cancer at 19%.

Researchers continue to make progress in diagnosing, staging and treating prostate cancer as well as many other cancers.  Among the promising new strategies is immunotherapy in which the patient’s own immune system is essentially turbocharged to enable it to attack the prostate cancer.  Other new therapies and approaches are also being pursued and show a lot of promise.

I hope you never get prostate cancer, but, if you do, don’t despair.  There is a good chance you will be able to outlive it.