The prostate is a small gland in men that makes fluid to carry sperm. It is located under the bladder and wraps around the urethra, the tube that carries urine out of the body. Prostate cancer is the most common type of non-skin cancer found in American men.
Most prostate cancer is slow growing. So, while a man's chance of getting prostate cancer sometime in his life is about one in six, his risk of death from it is much lower.
Changes to the screening recommendations for prostate cancer as well as changes to the approach to treatment have led to some misunderstandings. Here are some common questions and answers surrounding prostate cancer.
Q. I've heard, "Men die with prostate cancer, not because of it." What does this mean?
A. Many forms of prostate cancer may grow slowly and many men with localized prostate cancer live with the disease for years without symptoms. These men, who tend to be in older age groups, may die from other medical conditions and not their prostate cancer.
Q. Why doesn't my doctor think screening is necessary?
A. Screening tests, which are performed to find disease in people without symptoms, may have certain risks. It is important that the benefit for screening outweighs the risks. When screening for prostate cancer was evaluated, it was found that only a small number of men would benefit from the screening and decrease the number of deaths from the disease. Most prostate cancer is so slow growing that often the treatment can cause more side effects than does the disease. In many cases, finding prostate cancer may not improve your health or help you live longer. For that reason, most of the nation's top health experts do not recommend screening in symptom-free men of any age.
Q. Do major medical groups all agree on prostate cancer screening?
A. There are some differences of opinion among medical groups. The U.S. Preventive Services Task Force, the American Urological Association (AUA), the American Cancer Society, the American College of Physicians and the National Comprehensive Cancer Network have all concluded that the potential harms of prostate cancer screening outweigh the potential benefits in most cases. Still, especially at certain ages, the decision is highly influenced by personal preferences.
While the USPSTF recommends against prostate screening, many medical organizations support a practice of shared decision-making between you and your doctor. The differences in these groups' recommendations are generally about the age at which screening should be discussed, or about instances or ages when it might be beneficial.
Other differences of opinion involve benefits of screening at various ages in high-risk men such as those with a family history of prostate cancer or those of African American descent. And one group has come out in favor of more rigorous monitoring in some men after prostate cancer has been detected.
Q. What is shared decision-making?
A. Screening for prostate cancer requires balanced information about the pros and cons of screening. It is important that you and your doctor are both open and active participants in any decision-making regarding screening and any possible treatment. So talk with your doctor about the risks and benefits for you.
Q. What do the terms "watchful waiting" and "active surveillance" mean?
A. If you have been diagnosed with prostate cancer, your doctor may recommend one of these two approaches depending on your individual circumstances. When either of these approaches is recommended, it doesn't mean you're doing nothing about the cancer. It means you are having regular checkups to monitor any growth or spreading of the cancer or a change in any symptoms.
"Watchful waiting" means your doctor is carefully observing the status of your tumor. "Active surveillance" is a more intensive approach. It involves more frequent checkups and possibly more tests by your doctor. If the cancer spreads to other tissues, your doctor will discuss options for treatment.
These approaches might be recommended when the tumor is believed to be very slow-growing or when the risk of treatment outweighs the benefits. Both types of observation can go on for years, with the cancer never growing to a stage where treatment is necessary.
It should be noted that some doctors use "watchful waiting" and "active surveillance" interchangeably. Be sure to ask your doctor exactly what he or she means if one of these approaches is recommended.
Q. What are some possible symptoms to be aware of?
A. If you have any of the following symptoms, it's a good idea to check with your doctor:
- Difficulty starting or stopping the flow of urine
- Increased or more frequent urination at night
- Interrupted flow or decreased force in the urine stream
- Burning or pain when urinating
- Blood in the urine or semen
- Pain in the back, pelvis or upper thighs
- Weakness or numbness in the legs or feet
Most of these signs can be caused by conditions other than cancer. You and your doctor can discuss possible causes and whether the symptoms need to be treated.
Q. What is involved in prostate cancer screenings?
A. There are three common types of prostate screening tests:
- PSA blood test. PSA is a protein made by the prostate gland. Many men with prostate cancer have an increased level of PSA.
- Digital rectal exam. Your doctor or nurse will feel your prostate gland with their finger through the wall of your rectum.
- Biopsy. If the PSA or digital rectal exam is not normal, your doctor may recommend a biopsy.
The PSA blood test is not as accurate as it could be, with a high percentage of false positive results. These false results can lead to men having additional tests or surgery, which could have some long-term side effects. It's important to talk to your doctor about all your options so you know the risks and benefits.
Q. Will I be able to have an erection after prostate surgery?
A. Surgery to remove a cancerous prostate growth can damage nerves that control erections. After surgery, most men will have some erectile dysfunction (ED). This will vary based on your age, how large your tumor was, the type of surgery you had, and whether you experienced ED before surgery. ED may be helped with medications, injections and certain devices.
You also may experience an unwanted leakage of urine, called urinary incontinence or UI, and other unpleasant side effects, which could significantly affect quality of life.
You and your doctor should decide together whether or not prostate cancer screening is right for you and, if so, when to begin and how frequently to have the screening done.
Susan G. Warner contributed to this report.
Created on 10/26/2007
Updated on 09/17/2013
- National Cancer Institute. Risks of prostate cancer screening.
- U. S. Department of Health & Human Services. Screening for prostate cancer.
- Centers for Disease Control and Prevention. Prostate cancer.
- U.S. Preventive Services Task Force. Screening for prostate cancer.