Along with other leading medical organizations, The American Cancer Society recommends informed decision-making when it comes to screening for prostate cancer. What this means is that every man should make his own decision, along with his medical care providers, about whether to be screened.

Screening or testing to find a disease in people without symptoms can help find some types of cancer early, when it’s more easily treated. But for some men, the risks of prostate cancer screening may outweigh the benefits. Asking questions is an important step in deciding whether to be screened.

Q: What are the screening tests for prostate cancer?

A: There are 2 main screening tests for prostate cancer

The PSA test is a blood test to check the level of prostate-specific antigen in your blood. Most healthy men have levels under 4 nanograms per milliliter of blood. But everybody is different, and a lower PSA level doesn’t guarantee a man is free of cancer, just like a higher level doesn’t mean he has cancer.

For the digital rectal exam (DRE), a doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that may need to be tested for cancer. This test may be done with the PSA or the PSA may be done alone.

Q: What if the results are not normal?

A: If the results of the PSA and/or DRE suggest that you might have prostate cancer, your doctor will do a prostate biopsy to find out. A sample of prostate tissue is removed using a needle and sent to a lab, where a specialist will look at it to see if it contains cancer cells.

Q: At what age should I have my first screening test?

A: The American Cancer Society recommends men learn as much as they can about prostate cancer screening risks and benefits and discuss the information with their doctor before deciding whether to be tested at all. Men at average risk of prostate cancer should have this discussion starting at age 50. Men at higher than average risk should have the discussion starting at age 40 or 45.

Q: Who is at higher than average risk for prostate cancer?

A: African American men and men who have a father, brother, or son who were diagnosed with prostate cancer when they were younger than 65 are at high risk. Men with more than one of these close relatives diagnosed before age 65 are at even higher risk.

Q: Why shouldn’t all men be screened for prostate cancer?

A: It seems like it makes sense to check everyone to find out if they have cancer. But screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous cancer that will grow quickly. In addition, studies have not been able to show that annual PSA screening helps men live longer. However, most men who find out they have cancer want to treat it. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life. So, testing really is a decision that men should make after they have all the information.

The Minneapolis Veterans Affairs Health Care System led a 20-year study and found more evidence that surgery for early-stage prostate cancer does not help men live longer than observation. Sometimes observation, which is also called “watchful waiting”, is where doctors monitor a man’s prostate cancer over time to make sure it’s not getting worse. Only then do the doctors consider surgery or other active treatment. Because most prostate cancers grow very slowly and may never cause health problems, this can be a good option for many men. .

The study, which also included research teams from across the US, used data from the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The study compared treatment with surgery to treatment with observation in 731 men with prostate cancer that had not spread beyond the prostate. Approximately half the men (364) were assigned to surgery to remove the prostate. The other half (367) were assigned to observation. The men in the observation group received surgery or other active treatment only if tests or symptoms indicated their prostate cancer might be growing.

When it first bean in 1994, the average age of the men in the PIVOT study was 67. After a follow-up of 20 years, 61% of men in the surgery group had died; 7% of them died from prostate cancer. In the observation group, 67% of them died; 11% from prostate cancer. The differences between the two groups was found to be non-significant.

The men in the surgery group, however, were more likely to have side effects that needed treatment. In the surgery group, 17% reported urinary incontinence compared with 4% of the observation group, and 15% reported erectile dysfunction compared with 5% of the observation group. The study was published July 13, 2017 in the New England Journal of Medicine.

Key takeaways

Some previous studies have also found no difference in survival between men who have surgery and men who use observation. However, others have found that those who have surgery might live longer. According to the study’s authors, the combined results from the studies show:

Long-term, death from prostate cancer is low among men with early-stage prostate cancer who are treated with observation.

Men with intermediate-risk prostate cancer who have long life expectancies are more likely to see a survival benefit from surgery.

Even though men with high-risk disease may have a poor prognosis, surgery may not help them live any longer.

Surgery seems to help keep the cancer from coming back, but most cancer recurrences don’t cause problems. Therefore, the benefits of slowing cancer growth through surgery are unclear.

Long-term side effects from surgery can include incontinence, erection problems, and other complications, some requiring treatment.

Cancer mortality drops another 1.7%

The US death rate from cancer has declined steadily over the past 2 decades, according to annual statistics reporting from the American Cancer Society. According to the ACS, as of 2015, the cancer death rate for men and women combined had fallen 26% from its peak in 1991. This decline in deaths translates to nearly 2.4 million averted during this time period.

The rate of new cancer diagnoses decreased by about 2% per year during the most recent decade of available data, in men and stayed about the same in women.

Cancer Statistics, 2018 published in the American Cancer Society’s journal CA: A Cancer Journal for Clinicians, estimates the numbers of new cancer cases and deaths expected in the US this year. The estimates are some of the most widely quoted cancer statistics in the world. The information is also released in a companion report, Cancer Facts and Figures 2018, available on the interactive website, the Cancer Statistics Center. A total of 1,735,350 new cancer cases and 609,640 deaths from cancer are projected to occur in the US in 2018.

The drop in cancer mortality is thought to be mostly due to two major factors; steady reductions in smoking and advances in early detection and treatment. A decline in consumption of cigarettes is credited with being the most important factor in the drop in cancer death rates. However, tobacco remains by far the leading cause of cancer deaths, responsible for nearly 3 in 10 cancer deaths.

Major cancer types: Lung, breast, prostate, and colorectal cancer

The overall drop in cancer death rates is largely due to decreasing death rates for lung, breast, prostate, and colorectal cancers.

Prostate cancer death rates declined 52% from 1993 to 2015 among men. Routine screening with the PSA blood test is no longer recommended because of concerns about high rates of over-diagnosis (finding cancers that would never need to be treated). Therefore, fewer cases of prostate cancer are now being detected.

Lung cancer death rates declined 45% from 1990 to 2015 among men and 19% from 2002 to 2015 among women. From 2005 to 2014, the rates of new lung cancer cases dropped by 2.5% per year in men and 1.2% per year in women. The differences reflect historical patterns in tobacco use, where women began smoking in large numbers many years later than men, and were slower to quit.

Breast cancer death rates declined 39% from 1989 to 2015 among women. The progress is attributed to improvements in early detection.

Colorectal cancer death rates declined 52% from 1970 to 2015 among men and women because of increased screening and improvements in treatment. However, between 2006 and 2015, the death rate among adults younger than 55 increased by 1% per year.

The FDA (US Food and Drug Administration) has recently approved the drug Erleada to treat men with prostate cancer that has not yet spread, but has a quickly rising PSA level while on treatment with hormone therapy, causing a big concern for cancer growth and spread. Erleada is the first FDA-approved treatment for this high-risk type of prostate cancer which is called non-metastatic castration-resistant prostate cancer.

The way Erleada works is that it blocks the effect of androgens, a type of hormone, on the tumor. Research has shown that androgens such as testosterone can help tumors grow.

The FDA based its decision to approve Erleada on a randomized clinical trial of 1,207 men with high-risk non-metastatic, castration-resistant prostate cancer. The trial measured the amount of time that the patients’ tumors did not spread (metastasize). While all of the men in the trial received hormone therapy, only some also received Erleada. The group of men who received Erleada had no metastasis for an average 40.5 months compared to metastasis in 16.2 months for the group of men who did not.

Erleada was approved under the FDA’s new priority review program. This new program is designed to speed up approval of drugs that would significantly improve the safety or effectiveness of treating, diagnosing, or preventing a serious condition.

Common side effects of Erleada include high blood pressure, fatigue, diarrhea, rash, nausea, joint pain, weight loss, falls, hot flashes, decreased appetite, fractures and swelling in the limbs. Additional possible side effects could include falls, fractures, and seizures.

A major concern of many cancer survivors is whether they will have to face cancer again. When a cancer comes back after treatment it is technically a “recurrence”. However some survivors may develop a new and unrelated cancer which is termed a “second cancer”.

Men who are being treated for prostate cancer can indeed get another cancer, and in fact they might be at higher risk for certain types including cancers of:

• The small intestine
• Soft tissue
• Bladder
• Thyroid
• Thymus
• Melanoma of the skin

In addition, men who are treated with radiation therapy also have a higher risk of:

• Rectal cancer
• Acute myeloid leukemia (AML)

It is believed that the higher risk could be related to the dose of radiation.

There are ways to lower the risk of getting a second cancer

Prostate cancer patients can take steps to lower their risk of second cancers. One example is that prostate cancer survivors should do their best to stay away from all tobacco products and tobacco smoke. Smoking has been shown to increase the risk of bladder cancer after prostate radiation, as well as increase the risk of many other cancers.

There are other steps to take to help maintain overall good health:

• Get to and stay at a healthy weight
• Stay physically active
• Eat a healthy diet focusing on fresh foods
• Limit alcohol to no more than two drinks per day

As an added bonus, taking steps may also lower the risk of other types of health issues.

There are decades of research that show that yoga can reduce the emotional and physical fatigue brought on by cancer treatment. Scientists reported in 2017 that this is also true specifically for men undergoing treatment for prostate cancer. Researchers found that men who took a yoga class twice a week during prostate cancer radiation treatment reported less fatigue, fewer sexual side effects, and better urinary functioning than men who did not.

The research team that studied this connection enrolled 50 men ages 53 to 85 who were diagnosed with early or advanced non-metastatic prostate cancer. Of them, 22 were assigned to yoga classes and the rest did not participate in yoga. All the men received scheduled radiation treatments; 29 of them were also on hormonal therapy, and 19 had been treated previously with surgery. The yoga and control groups were evenly balanced with respect to various cancer treatments as well as treatments for side effects.

Eischens yoga was the type of yoga assessed in the study. It focuses on holding and maintaining poses, and is accessible for all body types and experience levels. The yoga sessions each lasted 75 minutes. The men in the nine-week study were asked to rate their fatigue, sexual and urinary symptoms before, during and after the study ended.

The male participants in the yoga group reported improving or stabilizing symptom scores over time, whereas men in the non-yoga group reported worsening symptoms. The study authors speculated that yoga improves erectile and urinary function by strengthening core muscles and improving blood flow.

“If I eat a healthier diet can it help me fight prostate cancer?” This is a question men newly-diagnosed with prostate cancer often ask their doctors.

There have been several studies that have shown that in countries where men eat a typical “Western” diet containing a large amount of meat, the incidence of prostate cancer, especially aggressive prostate cancer, is higher than in countries where plant-based foods are a primary part of the diet.

Although researchers are currently studying the subject, there a no definitive answers between the correlation of prostate cancer and diet.

There was a federally-funded national study where investigators looked at whether a diet that’s higher in plant-based foods and lower in animal-based foods than the typical “Western diet would help control tumor growth in men with early-stage prostate cancer.

This study called The Men’s Eating and Living (MEAL), included men 50-80 years old who had small, low-grade tumors and who opted to have their condition followed closely (active surveillance) rather than undergoing immediate treatment. The researchers randomly assigned participants telephone counseling support to tell them how to achieve the dietary MEAL goals or to a control group that received standard dietary advice for Americans.

The study participants in the MEAL group were instructed to eat nine servings of fruits and vegetables daily — significantly more than the three to four servings consumed each day by the typical American man — as well as two servings of whole grains and one serving of beans or other legumes. The participants in the control group received information regarding a standard healthy diet.

The initial results of the study showed that men with prostate cancer can sustain a healthier eating pattern. However there was no significant effect of the MEAL diet on two-year clinical progression among men on active surveillance for prostate cancer. Longer term benefits are still possible.

Patients who have suffered a heart attack and plan to undergo prostate cancer treatment, may want to weigh the risks and benefits of androgen deprivation therapy (ADT). ADT decreases the amount of androgens in the body, which prostate cancer needs to grow and survive. This therapy is also often used in combination with radiation therapy. The combination of these two therapies has been shown to prolong survival in men with unfavorable-risk prostate cancer—defined as cancer with two or more high-risk factors, such as a PSA level between 10 and 40 ng/mL, a Gleason score of 7 or higher, or biopsies with 50% or higher cancerous cells.

A study in The Journal of the American Medical Association suggests that men who had a prior heart attack can experience increased risks of having another fatal heart attack if they undergo both radiation therapy and ADT.

Researchers compared overall survival and death from prostate cancer, fatal heart attack, and other causes in a group of 206 men with unfavorable-risk prostate cancer. The men received either radiation alone, or radiation and six months of ADT. The researchers also categorized the men into subgroups based on other health conditions, including heart disease.

After a 16-year follow-up, researchers found that among the subgroup who had a previous heart attack, treatment with both radiation and ADT reduced their 15-year survival rate to 8%, compared with 20% for those who were treated only with radiation.

These findings may suggest that doctors should rethink using this combination of therapies on men with known heart disease.

Your current health and your level of concern about cancer are both big factors in the answer to this question.

Despite what the experts suggest, many men are continuing to opt for annual PSA tests. Surprisingly this includes a large number of men in their 70s. According to a recent study, more than half of a group of men 75 and older in the study had PSA tests and biopsies.

Even though these men have placed their hope in the value of early diagnosis and treatment, they stand to gain less from PSA testing than younger men. Routine PSA screening across ALL ages leads to life-saving treatment for cancer in about one in every 1,000 men screened.

Guidelines for ages

American Urological Association (AUA) age guidelines: The AUA does not recommend routine PSA screening for men 70 or older or with a life expectancy of less than 10 to 15 years. Screening may be considered in men ages 55 to 69 with the knowledge that it will prevent about one cancer death for every 1,000 men screened.

Expert guidelines don’t recommend PSA screening in men 70 and older. Because of their more limited lifespan, these men are less likely to benefit from early detection of low-risk cancer. One reason is that there may be simply less time for the condition to become life threatening in most men.

American Cancer Society (ACS) age guidelines: The ACS does not recommend PSA testing for men with no symptoms who are not expected to live more than 10 years (because of age or poor health).

Having a chronic health condition also reduces the potential benefit of early diagnosis and treatment even further, since it tends to shorten lifespan. In contrast, an exceptionally healthy man in his 70s may choose to keep having PSA tests, betting on a longer life-span that provides more time to benefit from early detection.

Some patients find that adjusting to a “new normal” after treatment can be challenging

The end of cancer treatment is often a time to rejoice. Patients are relieved to be finished with the demands of treatment and are looking forward to putting the experience behind them. When the treatment ends it can still take time for patients to recover. They may have permanent body scars, and many patients are not able to do some of the things that they easily did in their “pre-cancer” life.

However, even though their treatments are “over”, many patients continue to feel sad and worried. They are focused on concerns about whether the cancer will come back. Emotional scars from going through so much trauma are common. Cancer patients many times view themselves “differently” and think that friends and family members also look at them in a new way.

Here are some tips that cancer patients may find helpful in dealing with the “new normal”:
1. Get good follow-up care from your physicians
2. Ask for help developing a wellness plan that includes ways to take care of your physical, emotional, social and spiritual needs.
3. Consider complementary/alternative medicine to prevent illness, reduce stress, or prevent or reduce side effects and symptoms.
4. Some patients find that couples counseling, faith or spiritual counseling or family support programs are helpful.
5. State and local governments offer many services that include home care services that help with housework or cooking.
6. Strength-building exercises can help you feel better and can improve mood.
7. Exercise of all types can help people reduce stress and feel less tense and happier.
8. Cancer support groups can help you share feelings and concern and can reduce the feelings of loneliness.