Urology

Men: Get the lowdown on prostate cancer

Al Roker's recent diagnosis of prostate cancer has put this disease—and testing for it—back in the spotlight.

According to the American Cancer Society (ACS), about 1 in 9 men will be diagnosed with prostate cancer during their lifetime. For African American men, the number is even higher—1 in 7.

Prostate cancer is second only to lung cancer as the leading cause of cancer death in American men. Still, most men diagnosed with prostate cancer won't die from it. That's because prostate cancer is often very slow-growing, and men who get it are more likely to die of something else.

Finding prostate cancer

Most prostate cancers are diagnosed as a result of screening with either a digital rectal exam or prostate-specific antigen (PSA) blood test. Prostate cancer usually doesn't cause symptoms in its early stages.

PSA in the blood is measured in nanograms per milliliter (ng/mL). The likelihood of having prostate cancer rises with the PSA level. But there is no firm number that indicates prostate cancer. Some, but not all, doctors use a cutoff point of 4 ng/mL or higher when deciding whether a man should undergo further testing.

If your doctor suspects prostate cancer, the most likely next step is a prostate biopsy, in which small samples of prostate tissue are removed and sent to a lab for analysis. 

Staging and treating the cancer

If the biopsy results don't show cancer, you may not need further testing for now. But if the biopsy results indicate cancer, the next step is determining what grade the cancer is. Almost all cancers are grade 3 or higher. The highest grade is 5.

Prostate tumors usually have different areas within them with different grades. To score the cancer, a doctor takes the two areas that make up most of the cancer and assigns a grade to each area. These two grades are added up to give a Gleason score.

The first number is the grade that makes up most of the cancer. If a Gleason score is written as 3+4=7, for example, it means that most of the tumor is grade 3 and a smaller area is grade 4. And the tumor in its entirety is a grade 7. 

Cancers with a Gleason sore of 6 or less are considered low-grade tumors. Gleason scores of 8 to 10 are considered high-grade tumors.

If a prostate cancer is small and low-grade, a doctor might suggest actively monitoring it to see if it grows. Other treatment options include:

• Surgery.
• Radiation therapy.
• Chemotherapy.
• Hormone therapy.
• A combination of the above.

It's important to thoroughly review all your treatment options with your doctor.

Screening recommendations

The ACS recommends that men work with their doctors to make an informed choice about getting screened with a PSA test. This discussion should occur at:

• Age 50 for men at average risk for prostate cancer who are expected to live at least 10 more years.
• Age 45 for men at high risk. This includes African American men and men with a father or brother diagnosed with prostate cancer before age 65.
• Age 40 for men at higher risk. This includes men with more than one first-degree relative who was diagnosed with prostate cancer at an early age.