Prostate cancer is a common concern among male patients particularly as they get older. This “Movember” is the perfect time to discuss your risk and screening options with your primary care physician or urologist. During this month-long event, men around the country grow mustaches to raise awareness about important topics in men’s health like prostate and testicular cancers as well as mental health.

Nearly 1 in every 8 men in the U.S. are affected by prostate cancer. When the disease is found in the beginning stages it is almost always treatable. Most cases that are found early are recognized during routine screenings.

Prostate cancer generally does not cause symptoms in the initial stages. However, men with more advanced disease may experience signs such as:  

• Blood in semen
• Decreased size and strength of the urine stream
• Difficulty with urination
• Discomfort in the pelvic area
• Erectile dysfunction

When should you be screened for prostate cancer?

Screening guidelines for prostate cancer can be confusing. There is no one rule that applies to everyone. Instead, every patient is evaluated differently based on their risk factors and family history of disease. 

“It is important to establish a relationship with a primary care physician and talk openly with them about your risk and family history,” says Gordon Brown, DO, a urologist at Summit Health. “Together, you can develop a plan for screening that makes sense for you.”

Certain factors increase the risk of developing prostate cancer. These risk factors will influence when to start screening, explains Dr. Brown, as well as the frequency of screening.  

• Aging
• A family history of prostate or breast cancer
• Obesity
• Race/ethnicity — black males are at a much higher risk 

“We support screening of our male patients after appropriate informed discussions of benefits and risk of screening and proper evaluation of their risk factors,” explains Dr. Brown. 

As a general guideline The American Cancer Society recommendations the following for PSA screening after a shared decision to screen is made with your doctor.

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative — father or brother — diagnosed with prostate cancer younger than age 65.
• Age 40 for men at even higher risk of developing prostate cancer including those with more than one first-degree relative who had prostate cancer at an early age.  

Types of prostate cancer screenings

There are a few screening methods for prostate cancer. PSA is the most common. Your physician may recommend the following tests: 

• Digital rectal exam (DRE) — A gloved, lubricated finger is inserted into the rectum to feel for any changes in the shape size or texture of the prostate.

• Prostate-specific antigen (PSA) test — A blood sample is taken to analyze the levels of PSA in the bloodstream. If the level is high, it may be an indication that the prostate is inflamed, infected, enlarged, or cancerous.

If there are suspicious findings on your rectal exam or your PSA is high, your physician may send you for additional tests. The most common diagnostic tools for prostate cancer are MRI imaging and an ultrasound-guided needle biopsy that takes a sample of the prostate tissue and examines it for any changes.

Treatment options for prostate cancer 

Prostate cancer grows very slowly. When the disease is found at an early-stage multiple treatment options exist, including active surveillance — a wait-and-see approach — for low-risk and very low-risk patients. Active surveillance means the tumor is monitored closely for any growth with a combination of biopsy, MRI, and regular PSA testing. Patients with more aggressive early-stage disease may benefit from surgery or radiation-based treatment options.

“When we catch prostate cancer this early, it doesn’t necessarily require knee-jerk treatment,” explains Molly Gabel, MD, chair of radiation oncology at Summit Health. “Patients can choose to watch it closely and get treatment when it is convenient for them. It really empowers the patient to make a decision that is best for them.”

Summit Health’s new PSMA PET/CT scan, which is located at the Berkeley Heights, Florham Park, and Clifton campuses helps improve treatment plans in men who are already diagnosed with prostate cancer. This advanced form of imaging helps localize prostate cancer in a way that was not previously possible, allowing oncologists to select more targeted therapies. 

“We are detecting more diseases than ever before,” says John McCormick, MD, a radiologist at Summit Health who specializes in nuclear medicine. “This advanced form of imaging helps localize prostate cancer in a way that was not previously possible, allowing oncologists to select more targeted therapies.”

Treatment options for prostate cancer include:

• Surgery. A prostatectomy is the surgical removal of the prostate gland, surrounding tissues, and lymph nodes. Summit Health’s urological surgeons offer many minimally invasive and robotic approaches that can reduce side effects like incontinence and sexual dysfunction.

• Radiation therapy. This treatment uses high-energy beams to kill cancer cells. Summit Health is one of the first facilities in New Jersey to offer Pluvicto — a targeted therapy that delivers radiation treatment and can help prolong the lives of patients with metastatic castrate resistant disease, an advanced form of prostate cancer.

• Hormone therapy. Prostate cancer cells feed and thrive on the male hormone testosterone. The purpose of hormone therapy is to stop the body from producing testosterone so that the cancer cells grow more slowly or die.

• Cryoablation. This technique uses an X-ray-guided needle to insert special gasses into the tumor that freeze the cancer cells and then heat them up again. The cycle of freezing and heating destroys the cells, as well as a small portion of surrounding healthy tissue.

• Chemotherapy. This treatment is used to kill any cancer cells remaining after surgery or shrink a tumor as much as possible before surgery. 

• Immunotherapy. This biological therapy enlists the patient’s own immune system to fight cancer cells. The treatment involves taking the immune cells, genetically modifying them in a lab to combat cancer and then injecting them back into the body intravenously.

If you have questions about prostate cancer screening, or any symptoms you may be experiencing, we encourage you to discuss them with your primary care provider or urologist.