Prostate cancer: what you need to know

Certain men may have a higher risk of prostate cancer based on family history or ethnicity or race, and ancestry and should have their first screening discussions at the age of 40.It is estimated that nearly 288,300 men in the United States will be diagnosed with prostate cancer in 2023. Second only to skin cancers, prostate cancer is the most common cancer diagnosed in American men.

“Men’s health and prostate cancer are topics that many tend to shy away from, but they need to be discussed more openly,” said Soroush Rais-Bahrami, M.D., professor at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine’s Department of Urology and co-director of the UAB Program for Personalized Prostate Cancer Care. “One out of eight men will be diagnosed with prostate cancer in his life.”

The prostate is a reproductive gland in men located between the bladder and the penis. The fluid from the prostate is discharged into the urethra at the time of ejaculation as part of the semen to nourish and stabilize sperm for reproductive purposes.

Prevention

Men age 50 or older should be screened during their annual physical exam beginning with a discussion regarding prostate cancer risk. A routine blood test can measure a biomarker called prostate-specific antigen or PSA, which can identify a man’s risk of prostate cancer along with a digital rectal exam and medical imaging studies. Concern based on the PSA blood test level, digital rectal exam or imaging findings can prompt recommendation for a biopsy of the prostate gland, which can be further evaluated to determine the presence of prostate cancer and, if found, the aggressiveness of the cancer.

“Many men do not know their family history of prostate cancer because men tend not to talk about their health concerns, even with their children and other close family members,” Rais-Bahrami said. “It is critical to discuss family history due to the significantly higher risk for men with a first-degree relative who has been diagnosed with prostate cancer.”

Certain men may have a higher risk of prostate cancer based on family history or ethnicity or race, and ancestry and should have their first screening discussions starting as early as age 40.

Diagnosis

Symptoms of prostate cancer are rare, and many men show no symptoms before being diagnosed. Once a blood test shows signs of higher PSA levels, a tissue biopsy is required to help determine the presence, grade and stage of the prostate cancer. 

In advanced stages, symptoms may affect quality of life, ranging from pain in the bones to bloody urine, blood in the semen, blockages in the urinary tract and renal failure.

Once a man has been diagnosed with prostate cancer, Rais-Bahrami recommends asking these questions to learn more about a personalized path toward a cure: 

• How will my personal health be affected?
• What grade or level of aggressiveness is my specific cancer?
• What stage or level of progression does my cancer have?
• Are there any additional staging studies that should be done for me?
• What are all my treatment options?
• What are the side effects of each treatment option?

“When a patient has received a positive prostate cancer diagnosis, it is important he communicates with his family and his doctor about the different types of treatment available and suitable for him to best understand what to expect through this journey of treatment to fight the cancer,” Rais-Bahrami said.

Treatment

The patient and physician should look at the options available to treat his prostate cancer and develop a personalized road map to manage symptoms, preserve quality of life and cure his cancer.

“Treatment is based on the patient’s overall health and what works best in treating the patient to ultimately cure the cancer and help the patient preserve an excellent quality of life,” Rais-Bahrami said. 

In the earliest stages of low-grade prostate cancer, and with the consultation of a physician, men can opt for active surveillance, which is when the doctor does not prescribe immediate treatment, but diligently watches the cancer cells closely to postpone treatment with curative intent, perhaps for years. Other treatment options include:  

• Surgery, which includes removing the entire prostate gland and occasionally regional lymph node tissues
• Radiation therapy, or beams of radiation focused on the prostate
• Hormone therapy, which reduces levels of male hormones to stop them from affecting prostate cancer cells
• High-intensity, focused ultrasound therapy, or HIFU — high-energy sound waves that destroy cancer cells
• Irreversible electroporation, or IRE — targeted electrical energy to cause cancer cells to rupture and die
• Cryosurgery, or the use of extreme cold temperatures to freeze and kill cancer cells

“Prostate cancer is a treatable disease and can be cured if caught in early stages,” Rais-Bahrami said. “This is why it is important to receive routine screenings and have early detection when present.”

If the cancer is diagnosed in later stages and has spread to other parts of the body, it becomes more aggressive and more difficult to treat in most cases.

Soroush Rais-Bahrami, M.D.
Photography: Steve WoodTo help guide personalized care of patients, the UAB Department of Urology offers magnetic resonance imaging and ultrasound fusion-guided biopsy. The image fusion allows doctors to target a direct tissue sampling of an individual based on imaging areas of concern that can be tested for prostate cancer. Additionally, as UAB is a leader in cancer diagnosis and risk stratification, clinical trials done at UAB have led to approval and widespread use of specialized forms of PET imaging to improve the staging of patients with prostate cancer to direct more personalized treatments.

Current research

New research for prostate cancer is on the horizon, including the ongoing search for even better biomarkers that indicate the presence of prostate cancer. Researchers are now searching for prostate cancer biomarkers that have specific implications for improved diagnosis and prediction of cancer aggressiveness and patient prognosis.

“With the serum PSA, a red flag is raised as a potential prostate cancer diagnosis; but it is not specific in diagnosing an individual’s prostate cancer,” Rais-Bahrami said. “Serum PSA can detect abnormalities with the prostate that are not exclusive to prostate cancer. Biomarker research is important to achieve a more individualized diagnosis.”

At UAB, prostate cancer research is focused on development of advanced imaging and biomarker development, integration of new technologies for minimally invasive surgical and ablative therapies, and a significant shift toward offering focal therapy options in appropriately selected cases.

Learn more about prostate cancer care and treatments at the O’Neal Comprehensive Cancer Center at UAB here.