DEAR MAYO CLINIC: I know prostate cancer is common, but I’m not sure who is most at risk or whether there are symptoms to watch for. When should men consider screening? And if cancer is found, what treatments are available, and what side effects should patients expect? 

ANSWER: About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, making it one of the most diagnosed cancers in men. The good news is that most cases are found early, and patients often do well with treatment. 

Prostate cancer develops when cells in the prostate gland grow out of control. Several factors can increase the risk of developing the disease, including age and family history. Your risk increases as you get older and also may be higher if a father, brother or grandparent has been diagnosed. Black men have a higher risk of developing prostate cancer and are more likely to develop aggressive disease. Genetics also can play a role. For example, an inherited change in the BRCA2 gene, which is often associated with breast cancer, also can be linked to aggressive prostate cancer. 

Knowing these factors is important because many early prostate cancers cause no symptoms. Urinary problems, such as trouble urinating, may raise concerns, but they are often caused by an enlarged prostate, which is common as men age. Blood in the urine or semen, unexplained weight loss or bone pain can occur with aggressive or advanced disease; however, the goal is to find the cancer before symptoms develop.  

Prostate cancer screening

Screening generally begins around age 50, while men at higher risk may consider starting earlier, closer to 40 or 45. Your overall health, life expectancy and personal preferences also can help you and your healthcare team decide whether screening makes sense. Asking about screening does not necessarily mean you will need a biopsy or other procedure. 

One of the main screening tools is a prostate-specific antigen, or PSA, blood test. PSA is a substance made by the prostate that can be measured in the blood. A high level can signal a problem, but it does not always mean cancer is present. Because PSA levels can rise and fall, the test may be repeated to confirm the result. Additional testing may include other PSA measurements, biomarker tests or a prostate MRI. A digital rectal exam also may be recommended in certain situations, but it is becoming less common for routine screening. 

If a biopsy is needed, small tissue samples are taken from the prostate and examined. The results show whether cancer is present and whether it is low grade, high grade or somewhere in between. That information helps determine what comes next. A diagnosis does not always mean you need treatment right away. Many low-risk cancers and even some intermediate-risk cancers can be safely watched through active surveillance. 

With active surveillance, the care team closely watches the cancer rather than starting treatment. This can include PSA testing every six months to a year, periodic prostate MRIs and repeat biopsies. The approach can help some men avoid or delay treatment side effects without compromising outcomes. 

Treating prostate cancer

When treatment is needed, options include surgery to remove the prostate or radiation. Radiation can be delivered by a machine that directs it at the prostate or through small radioactive seeds, called brachytherapy. Focal therapy is a newer option for some patients. It targets cancer in one area while leaving the rest of the prostate alone.  

Each option has different potential downsides to consider. Surgery and radiation, for example, can have similar results for controlling cancer but different side effects. Urinary leakage and erectile dysfunction are two common concerns, while radiation also can cause rectal or bowel irritation. Talking through these differences with your care team can help you decide what is best for you.  

For advanced disease, treatment may include therapies that work throughout the body, including hormone deprivation therapy and some chemotherapies. Surgical techniques and radiation also have become more precise and less invasive, which can lead to faster recovery. Advances in managing side effects also help patients maintain a good quality of life after treatment. 

When found early, prostate cancer is highly treatable and often curable. Because many men have no symptoms in the early stages, ask your healthcare team whether screening makes sense for you. A simple conversation could make a big difference. 

 Adam R. Miller, M.D., Urology, Mayo Clinic, Rochester, Minnesota

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