What you need to know

By Kathy Hayes

Around age 60, Jack* began waking up in the night urgently needing to urinate. During his annual wellness visit, the doctor performed a rectal exam. Aside from an enlarged prostate, the physician also discovered a concerning firm spot in the prostate, which could indicate cancer. He recommended Jack have a special blood test done and meet with an urologist.

The prostate gland is located just below the bladder in men and surrounds the top portion of urethra, a tube that drains urine from the bladder. The prostate's primary function is to produce the fluid that nourishes and transports sperm, but because the urethra runs through the prostate, an enlarged prostate can cause difficulty with urination.

One in nine men will be diagnosed with prostate cancer during their lifetime. While it is the second leading cause of cancer death in men in the United States, more serious forms of prostate cancer, when detected and treated early, are often curable. Even better, many men have a slower growing form of prostate cancer that can often be watched closely rather than treated.

“Between the ages 45 and 55, men should start having an informed discussion with their primary doctor or urologist about prostate cancer screening and their risk factors,” says Dr. Michael Lee, a UCHealth urologist.

A prostate-specific antigen (PSA) blood test can provide your doctor with an additional piece of information that can be considered with other factors to assess your risk of having prostate cancer. Be aware, though, that a PSA test is not a perfect test. Some men’s PSA may be elevated due to reasons other than cancer, while other men may have a normal PSA, yet they still can have prostate cancer.

Because a man’s risk of developing prostate cancer increases with age, a discussion of the pros and cons of prostate cancer screening becomes more important as men approach their 50s. Other important factors include a family history of prostate cancers and ethnicity: African American males are 76% more likely than white men to develop prostate cancer, and more than twice as likely to die from the disease.

“Urologists frequently consider additional factors, such as their digital rectal exam (DRE), their PSA trend, or even their PSA relative to their age, to determine whether a man has prostate cancer,” says Lee.

If there’s a concerning rise in a man’s PSA levels over time, ongoing PSA testing or even a prostate biopsy may be advised.

“For many men, prostate cancer is so slow growing that it can be observed for some period of time, if not indefinitely,” says Lee.

This strategy of monitoring rather than treating prostate cancer is referred to as “active surveillance.” Regular PSA monitoring, repeat prostate biopsies, and even advanced imaging studies are frequently used to determine whether active surveillance is safe. The ultimate goal is to avoid treatment when possible, while still recognizing men who should seek active treatment to avoid serious complications from prostate cancer or even death.

Recommendations on PSA screening differ among medical authorities.

“My general recommendation is that any male with a life expectancy exceeding 15 or 20 years should consider a PSA screening, especially as they enter into their 50s,” says Lee. “In addition, many experts now believe that PSA screening can safely be done every 2-3 years rather than yearly, assuming that a person’s PSA is comfortably within the normal range with no concerning upward trend.”

Jack’s story has a happy ending. An imaging test showed that he did not have prostate cancer but a different prostate issue that is being managed with inexpensive medications.

*Not his real name.