Prostate Cancer
Prostate cancer is the second leading cause of cancer in men – an estimated 1 in 8 males at some point will have to deal with the malady. Even worse, the Lancet Commission on Prostate Cancer has estimated that the number of new cases will double between 2020 and 2040. Despite these somewhat frightening numbers, fewer men are dying from the disease.
Increased Awareness and Screening
Dr. T.J. Tipton of the Roper St. Francis-affiliated Urology Associates of Charleston, whose practice specialties include urologic cancers, said much of this situation has do with screening. He added that for better or worse, the disease has been “en vogue” in recent years – prominent people have been diagnosed with prostate cancer or have had prostate issues, bringing more attention to the ailment. Last year, Britain’s King Charles III underwent a procedure to treat an enlarged prostate, and in May former President Joe Biden was diagnosed with an aggressive form of prostate cancer.
“OJ Simpson passed from prostate cancer, which is really uncommon. You don’t see a lot of people dying of prostate cancer. Dying with prostate cancer is common,” stated Dr. Tipton.
Over his 12 years in urology, seven with Roper and five in his residency, he’s seeing more patients showing up requesting screenings – even those with no symptoms. “Just saying, ‘Hey, I had a friend who had this issue,’ or ‘I saw on the news they said to get checked.’ So I think there’s just a lot more public awareness out there,” said Dr. Tipton. “And just like anything, early detection is important.”
Risk Factors and Early Signs
Risk factors for prostate cancer are mainly hereditary, according to Dr. Tipton, so those with a genetic predisposition for the disease have a higher likelihood of contracting it. Additional risk factors include smoking or, for example, being exposed to chemicals such as Agent Orange during the Vietnam War.
For high-risk individuals, doctors start screening between the ages of 45 and 50, earlier than the normal 50 to 55. Genetic testing is available, which can be particularly beneficial for someone with multiple family members who have had aggressive prostate cancers or developed prostate cancer at an early age.
“It’s always kind of nature versus nurture. Prostate cancer is more so the nature – it’s your genes,” explained Dr. Tipton.
Prostate cancer can be tricky because symptoms might not show up during the early stages of the disease. “Oftentimes, if you have symptoms related to prostate cancer, it’s advanced at that point,” said Dr. Tipton. “A lot of patients have prostate symptoms. So, just to be clear, most folks that come in with urinary frequency or waking up at night to void several times or a weak stream – that sort of thing is common with age. The prostate gets larger as we get older. Prostate cancer doesn’t usually cause a lot of symptoms. If it’s advanced, sometimes it can cause obstructive-type symptoms. Prostate cancer goes to lymph node and bone and could cause some swelling or, very commonly, bone pain.”
He recommended that men start getting an annual prostate exam around age 50 but added that those with no risk factors and a prostate-specific antigen test that’s low, normal or stable can sometimes be checked every other year.
Prostate Cancer Treatment Options
Treatment options differ depending on whether the cancer is localized or has spread beyond the prostate. Common treatments for localized prostate cancer are either surgery or radiation. They both work well but can produce side effects, Dr. Tipton noted. Surgery can cause erection or leakage problems, whereas radiation can give rise to gastrointestinal symptoms.
Medications for more advanced prostate cancers can be used in a treatment called hormone ablation therapy, which reduces testosterone production. “The prostate is fueled by testosterone, and so we take advantage of that pathway – similar to how breast cancer is very much hormone-sensitive, too. We target that pathway and give men medications that specifically lower the testosterone intentionally and block testosterone’s impacts on the tissue, which significantly improves outcomes in advanced prostate cancer patients,” Dr. Tipton elaborated.
Ample medications that treat prostate cancer have emerged within the past decade, but most are accompanied by unwanted side effects. He emphasized that “early detection and treatment of prostate cancer before it gets too advanced is imperative.”
Besides medication, there is a small role for chemotherapy when the condition is “really advanced and other treatment options have failed,” said Dr. Tipton. Some immunotherapy options for advanced prostate cancer are being trialed as well.
Can You Prevent Prostate Cancer?
While some studies have shown links between diet and prostate cancer, Dr. Tipton said it’s difficult to determine what role food plays because hereditary factors are so important. “It’s a spectrum,” he clarified. “Some folks have very little risk of prostate cancer.” Others are so high-risk that even a healthy lifestyle won’t prevent them from getting prostate cancer.
“I tell folks to limit the red meat – I don’t say avoid – limit the processed foods and eat a diet high in fruits and veggies. And minimize the sugar,” Dr. Tipton said. Avoiding smoking and chemical exposure can also lower your prostate cancer risk. “But I also sort of give that caveat that prostate cancer is a very strongly hereditary thing, so, even if you’re doing those things, we need to monitor,” he added.
Additional sources: webmd.com/prostate-cancer/advanced-prostate-cancer-rise; health.ucdavis.edu/news/headlines/prostate-cancer-cases-expected-to-surge-in-the-next-15-years/2024/09; thelancet.com/commissions-do/prostate-cancer-surge-in-cases
By Colin McCandless
