Before choosing a treatment, it’s important to understand the disease and research all treatment options available to you.
The prostate is an organ at the base of the bladder where the urethra, which is used for urine flow, goes through. Left untreated, prostate cancer can lead to symptoms such as erectile dysfunction, loss of bladder control and pain when urinating. It may also metastasize, spreading cancer cells to other parts of the body.
The American Urological Association (AUA) does not recommend screening in men under the age of 40. Men between the ages of 40 to 54 with the average risk of developing prostate cancer are also not recommended for routine screening. Men between the ages of 55 to 69 should weigh the potential harms of screening with the benefits, considering that prostate cancer mortality is prevented in 1 in every 1,000 men who are screened over a decade. In men who decide to be screened, based on their values and preferences, routine intervals of two years or more are recommended. Finally, routine PSA screening in men 70 years and above, or any man with less than a 10 to 15 year life expectancy, is not recommended.
The AdventHealth Cancer Institute, with the American Urological Association and American Cancer Society’s recommendations in mind, developed the following guidelines. At age 40, men with a life expectancy greater than 10 to 15 years should be considered for prostate screening. Doctors should assist patients in making the decision using the following risk categories. Very high risk men with more than one first degree relative diagnosed with prostate cancer should begin the screening conversation at age 40. High risk men, who are either African American or have one first degree relative with prostate cancer diagnosed before age 65, should begin the conversation at 45. Men with average risk should begin the conversation at age 50. Men who have a life expectancy less than 10 to 15 years should not be screened. The AdventHealth Cancer Institute states that screenings should include a PSA blood test and digital rectal exam and the interval of these tests should be discussed with each patient.
If a PSA score comes back high or a lump is found during the digital exam, the doctor will likely recommend lab tests and an ultrasound biopsy be taken of the prostate. The biopsy is performed via the rectum and is the only way to prove if there is cancer in the prostate. If there is, a Gleason Score is assigned based on the aggressiveness of the cancer found. Together with the lab tests, PSA results and stage of cancer diagnosed, these help the doctor make recommendations for treatment.