What is prostate cancer?

Prostate cancer is the most common malignancy in men and the second leading cause of cancer death after lung cancer.

In 2012, over 1.1 million new cases and 307,000 deaths were reported in the United States.

One man out of seven will develop prostate cancer in his life.

The prostate is a small gland located deep inside the groin, between the base of the penis and the rectum. It weighs around 1 ounce (30 grams), and it is important for fertility. The prostate gland surrounds the urethra, the tube through which urine passes out of the body. It is possible to feel the prostate gland by placing a finger into the rectum and pressing toward the front of the body.

Symptoms of prostate cancer

Most people with prostate cancer have symptoms only in the advanced stage when it is too late for effective treatment. The cancer usually grows slowly and silently inside the prostate. The Prostate Specific Antigen (PSA), a blood test, might be the only sign of this cancer while non-symptomatic. Usually, the local progression is the cause of early disease manifestation like lower urinary obstructive symptoms (painful, urgent and frequent urination), bloody urine, and upper urinary obstructive symptoms (renal blockage and failure). The symptoms onset may also due to distant metastasis (mostly backbone pain, bone fractures).

Early diagnosis, before the symptomatic disease, is crucial for a good treatment outcome and survival.

Prostate cancer screening

Prostate cancer screening is the process used to detect prostate cancer before it causes symptoms. When we detect prostate cancer early, it may be easier to treat and cure before it spreads. However, it is unclear if early detection really reduces mortality rates in the global population (mass screening), because of potential unclear screening results. Let us see why.

The Prostate Specific Antigen (PSA) is the blood test that we use to screen prostate cancer. Unfortunately, it is not the perfect cancer marker. The PSA test might be abnormal when the prostate enlarges (benign prostate enlargement), or when it inflames (prostatitis). It means that increased PSA does not necessarily mean you have prostate cancer. However, we can say that the higher the PSA, the greater the likelihood of having prostate cancer. Above 10 ng/ml, PSA is highly suggestive for prostate cancer.

We are aware then, that PSA may have false positive and false negative results when it is below 10 ng/ml (the most frequent scenario nowadays).
False positive screening PSA results (have abnormal results even when a man does not have cancer) can lead some men to get prostate biopsies (with risks of pain, infection, and bleeding) when they do not have cancer.

Moreover, false negative PSA results (normal results even when a man does have cancer) can give some men a false sense of security even though they might actually have cancer.
We must also say that even in patients who get an early diagnosis of prostate cancer, there is the probability of having diagnosed a disease with such slow progression that it does not cause the patient's death (harmless cancer).

Then, to optimise the benefits and the risks of the screening we should consider enrolling only high-risk patients (opportunistic screening) who are aware about the possible benefits and harms of screening.

The preliminary discussion with the doctor about the individual cancer risk and the balance between risks and benefits of being screened is the first correct step of the screening process itself.

When and who should be screened for prostate cancer?

The discussion about screening should take place at:

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
  • Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Where can I get prostate cancer screening?

Through most of the Mediclinic facilities, we can provide the excellent expertise of our urologists who will discuss your prostate cancer risk with you as well as the potential individual benefits and risks of the screening.