When Charles McDowell was diagnosed with prostate cancer almost two decades ago, he and his doctor, Dr. P.R. Unni, a board certified urologist at Methodist Hospitals, discussed what to do next.
“He gave me a prostate exam because I was having some symptoms,” says McDowell who lives in Gary. “We talked about it after we got the results and I decided to have the operation. I didn’t want to take any chances.”
McDowell still returns for his regular prostate exam and later had to undergo radiation therapy but he describes himself as “doing well ever since.”
According to the Prostate Cancer Foundation, one of the leading philanthropic organization funding and accelerating prostate cancer research globally, the older a man is the more likely he will be diagnosed with prostate cancer. Although only 1 in 10,000 men under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 14 for ages 60 to 69. Over 65% of all prostate cancers are diagnosed in men over the age of 65. The average age at diagnosis of prostate cancer in the United States is 69 years. After that age, the chances of developing prostate cancer become more common than any other cancer in either men or women.
“Prostate cancer is something most men will get when they get older,” says Dr. Bennett Caces, MD, PhD, a board-certified specialist in oncology and hematology at Ingalls Health System. “Every 90-year-old who passes away for whatever other reason, if you open them up 7 or 8 out of ten will have some type of prostate cancer.”
Currently, says Caces, there’s an upswing in general practitioners performing prostate-specific antigen (PSA) tests as a screener to detect higher levels of prostate cancer cells in the blood. The patient is then often referred to an urologist where even if overall the patient is doing very well with no other symptoms, a biopsy will be performed to determine whether it’s an aggressive form of prostate cancer that needs to be treat right away or slow growing and just needs monitoring.
Though the test is simple, the decisions following a positive test aren’t according to Caces.
“It gets into the psyche of the patient,” he says. “You’re sitting there and the doctor says you have prostate cancer but we’re not going to treat can cause anxiety. Some people who are biopsied and have slow growing prostate cancer still want to be treated.”
Other factors to consider in deciding whether to get a PSA test when no symptoms are apparent include the stress from the knowledge of having a slow-growing prostate cancer that doesn't need treatment and deciding to opt for surgery, radiation or other treatments that cause side effects more harmful than untreated cancer. Some side effects significantly impact lifestyles including urinary incontinence and/or bowel dysfunction. Besides that the treatments lower testosterone levels which impacts erectile functioning.
“Men who are getting treatment may experience fatigue, loss of libido and hot flashes,” says Caces. “These are some of the challenges in deciding what action to take. Life expectancy is one of the factors. If a person has an aggressive form of prostate cancer but whose life expectancy is less than ten years may not elect to have further treatment.”
PSA elevations don’t always mean prostate cancer either. Instead high levels might indicate an inflammation of the prostate. False-positives are also common. According to the Mayo Clinic’s Website, only about 1 in 4 men with a positive PSA test turns out to have prostate cancer.
“I would say one of the most important things is for a patient who has a high PSA level to sit down with their doctor and discuss what it means,” says Caces, “and consider other factors in their lives before making any decisions.”