Prostate Cancer
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In The
 Copyright (C) 2019 Steven A. Johnson, M.D., P.A.
Click here to read an essay by Dr. Johnson critical of the recommendation by the U.S. Preventive Task Force to stop screening for prostate cancer with PSA.

Steven A. Johnson, M.D.

Prostate cancer is the most common cancer in American men and the second leading cause of cancer death. A man has about a 7 percent chance of being diagnosed with prostate cancer in his lifetime. The risk of prostate cancer increases two-fold if your father or brother has had prostate cancer. It is also more common among African-Americans.
Early prostate cancer causes no symptoms. However, prostate cancer must be diagnosed in the early stages in order to be curable. This is why it is important for men over age 50 (and certain men over age 40) to have an annual screening examination for prostate cancer. The screening examination should include a physical examination of the prostate and a PSA blood test. In most cases, your PSA should be below 4.0. However, younger men and certain higher risk patients should have a PSA below 2.5
While prostate cancer may be suspected based on the physical examination or the PSA results, the diagnosis must be confirmed with a prostate biopsy. Prostate biopsy is commonly performed in association with a prostate ultrasound to confirm or rule out prostate cancer. During the procedure, an ultrasound probe is place in the rectum to visualize and measure the prostate. After the imaging portion of the procedure, a small biopsy needle is passed through the probe to obtain several samples of prostate tissue. The procedure can be completed in 3-5 minutes. Patients should be off all blood thinners prior to the procedure to minimize the risk of infection. Enemas are sometimes recommended to improve the quality of the ultrasound image but have not been shown to lower the risk of infection.
Early prostate cancer is curable in a high percentage of cases (75-85%). There are many treatment options for early prostate cancer including surgical removal, cryoablation (freeze therapy) and radiation therapy.
Advanced prostate cancer can be treated but it cannot be cured. Treatment in these instances is centered on hormone suppression therapy. Prostate cancer feeds off the male hormone. By taking medication to stop the production of male hormone, the prostate cancer can be forced into remission. Patients commonly remain in remission on medication for 2-5 years. Chemotherapy is also commonly used now when treating advanced prostate cancer.

Special consideration regarding prostate cancer is given to patients with less than a 10 year life expectancy. Since early prostate cancer in older men (over age 80) is often slow growing, many urologists recommend stopping PSA screening after age 80 as long as the prostate examination is normal. In these men, an early, slow growing prostate cancer is not likely to shorten a man's life or interfere with the quality of his life. Therefore, even if early prostate cancer were to be diagnosed at this age, it would probably not need to be treated.