What men should know about prostate cancer
Prostate cancer is among the most common types of cancer in men. The good news is that it can be cured if detected early. That is why screening is so important
It’s not particularly pleasant, but a digital rectal exam can save a man’s life. Its purpose is to screen for cancer of the prostate gland, the second most frequent malignancy (after lung cancer) in men worldwide in 2020, and the leading one in more than half of the world’s countries, according to the International Agency for Research on Cancer (IARC).
WHO’S ESPECIALLY AT RISK?
“Prostate cancer is a disease of older men,” says Dr Anno Graser, a Munich-based radiologist and prostate specialist. A 35-year-old man has a 0.1 per cent risk of developing prostate cancer within the next 10 years, he notes, while a 75-year-old’s risk is 5 per cent. There were more than 1.41 million cases of prostate cancer worldwide in 2020, or 7.3 per cent of total cancer cases, estimates the IARC, part of the World Health Organization (WHO).
WHAT ARE THE WARNING SIGNS?
Usually there aren’t any. “The body doesn’t recognise that abnormal cells are multiplying uncontrollably, so there are typically no symptoms in the early stages,” explains Dr Olaf Reichelt, chief physician in the Department of Urology and Paediatric Urology at the Helios Clinic in Aue, Germany. This is why screening is so important, he says.
At an advanced stage, bone pain in the lower back, hips and ribs, or difficulty urinating, can occur. By this time, however, the cancer is likely to have metastasized, or spread, to nearby areas such as the spine or lymph nodes in the groin.
HOW CAN IT BE DETECTED EARLY?
One screening method is prostate palpation done by digital rectal examination. Many early cancers are still too small to be felt though. Another method is a prostate-specific antigen (PSA) test. PSA is protein produced by cells of the prostate gland, and prostate cancer often elevates PSA levels in the blood. However, some non-cancerous conditions can also cause the PSA level to rise. The risk of overlooking prostate cancer can be lowered by getting both a digital rectal exam and a PSA test, advises the German Cancer Research Centre's (DKFZ) Cancer Information Service. But it adds: “This also increases the chances of false-positive results for cancer.”
A further screening method is multiparametric magnetic resonance imaging (mpMRI), regarded as the most sensitive and specific imaging technique for the detection and evaluation of prostate cancer.
HOW DANGEROUS IS PROSTATE CANCER COMPARED WITH OTHER CANCERS?
Prostate cancer is among the somewhat less aggressive cancers and curable if it hasn’t reached an advanced stage. It’s accountable for 3.8 per cent of all mortality caused by cancer in men — more than 375,000 deaths annually — and is estimated to be the fifth leading cause of cancer death in men globally, according to the IARC. Prostate cancer is curable about 90 per cent of the time, Graser says. The earlier it’s detected, the better the patient’s prognosis.
WHAT ARE THE TREATMENT OPTIONS?
The type of treatment depends on several factors, including the patient’s age, PSA level, biopsy result and any accompanying illnesses, points out Reichelt. If the patient is between 50 and 75 years of age and his cancer isn’t at an advanced stage, the treatment is usually surgical removal of the prostate or radiation. While advanced prostate cancer is rarely curable, Reichelt says, in many cases it can be kept under control for several years with hormone, chemoand immunotherapy. “Many men don’t die of, but rather with, cancer carcinoma,” he remarks. Doctors may recommend, for example, that an 80-year-old patient with a tumour that’s not very aggressive not be treated at all.