Prostate cancer is the most common non-skin cancer in men, affecting approximately 1 in every 8 men in their lifetime. The incidence is even higher among African American men.
Jeffrey Albaugh, Ph.D., APRN, CUCNS
Editor, Core Curriculum for Urological Nursing, Society of Urology Nurses & Associates; Director, Sexual Health/NorthShore University Health System
In the early stages of the disease, when the cancer is still in the prostate, men typically don’t experience symptoms, so early detection is important. Treatment, usually by surgery to remove the prostate or radiation to kill the tumor, can be highly effective when done before the disease spreads to other parts of the body.
Early detection is achieved through regular prostate cancer screening. That usually consists of a combination of a prostate-specific antigen (PSA) blood test and a digital rectal exam performed by the patient’s primary care provider. Most men should get a baseline PSA test at age 50 unless they have risk factors such as a family history or they are African American (in which case, screening may occur around ages 40-45). Informed decisions about screening should be shared between the primary provider and patient. If initial screening indicates suspicion, further screening tests may be indicated to determine the need for a biopsy.
If screening indicates that there may be a problem, then more intensive follow-up is necessary for a definitive diagnosis. That should include a prostate MRI or micro-ultrasound followed by a targeted biopsy of the prostate gland or tissue. The guided biopsy, along with other tests, determines if there is cancer, how aggressive it is, and if it has spread. Even if cancer is found, not all prostate cancers have to be treated. Men with low-grade prostate cancer that is found early may be eligible for active surveillance of the cancer without further intervention. That means continuing to monitor the cancer on a regular basis to verify that it is not growing or spreading. In fact, active surveillance is the preferred treatment program for very low and low-risk prostate cancer under various national and international guidelines and may be appropriate for selected favorable intermediate-risk patients.
Support for treatment
Even if treatment is needed, the rate of survivorship is very high. Unfortunately, however, treatment of prostate cancer with surgery or radiation often results in undesirable side effects such as sexual dysfunction and urinary incontinence. These side effects can impact quality of life for men and their partners. It is critical for patients to work with an interdisciplinary healthcare team to understand all the available options and their respective side effects, and to chart the best possible course of action. It is also important to seek peer support groups, such as those sponsored by AnCan and ZERO, to hear from patients who have experienced the various forms of treatment and develop realistic expectations for quality of life post-treatment.
Navigating prostate cancer treatment is challenging, no doubt. If you are among the millions of men who have to face this disease, many factors should be considered when determining the best way to move forward: your PSA score, the cancer pathology from your biopsy, your age and health status, and your concerns about sexual function and urinary continence. It will be important to have an excellent healthcare team to guide you through each step from screening through treatment choices and managing the after-effects of treatment. Always get more than one expert medical opinion across disciplines (urology and radiation oncology) to help you determine the best course of action. Information and publications on this and many other urological conditions are available, including my book “Reclaiming Sex and Intimacy After Prostate Cancer,” which is free to download at www.drjeffalbaugh.com or on the Society of Urologic Nurses and Associates (SUNA) website.