When caught early, prostate cancer is highly treatable.
Depending on personal risk factors, major medical groups recommend patients and doctors discuss beginning screening – with a simple blood test – between ages 40 and 50.
Robert Reiter, MD, chief of the Division of Urologic Oncology at the David Geffen School of Medicine at UCLA and a member of the UCLA Health Jonsson Comprehensive Cancer Center, is a leading prostate cancer researcher and surgeon. He discussed screening, treatment options and promising research underway at UCLA.
Q: How common is prostate cancer?
Dr. Reiter: Prostate cancer is still the most commonly diagnosed non-skin cancer in American men. It’s expected that more than 290,000 men will be diagnosed each year. It’s a very common problem.
Q: What are the initial symptoms?
Dr. Reiter: For the most part, prostate cancer doesn’t cause any symptoms. It’s really silent until it becomes extremely advanced. Then it can cause bone pain, difficulty urinating, weight loss and loss of appetite. That’s really not until almost the end stages of disease. It makes screening really the only way to detect it early, when it’s potentially curable.
Q: What are the major risk factors for prostate cancer?
Dr. Reiter: The No. 1 risk factor is family history, genetics. If a man has a first-degree male relative – a father, a brother – with prostate cancer, that man has twice the incidence of prostate cancer compared to the general population. The more family members, the higher that risk. The genetic risk can also be from the BRCA 1 or 2 gene associated with cancers in women like breast and ovarian. Not only is it associated with an increased incidence of prostate cancer, but prostate cancers that have that mutation or inherited predisposition tend to be more aggressive. Genetics probably accounts for at least 70% of prostate cancer cases. It may be the most heritable of cancers that exist.
The other risk factor is being African American. African American men have the highest incidence of prostate cancer among different ethnic populations. It’s not really completely understood why.
Q: What are the prostate cancer screening recommendations for prostate-specific antigen, or PSA, testing?
Dr. Reiter: If you don’t have a family history or are not African American, start at age 50. There’s debate about whether once a year or every two or three years, but that’s something to discuss with your physician.
If you do have a family history or are African American, the recommendation is to get a PSA at age 40. It turns out a PSA at age 40 is a really strong predictor of future risk. If that PSA is less than 1 or 1.5, you probably can wait to test again until 45 or 50, but if higher than that, test yearly. The benefits of screening seem to be greatest for younger men, who are less than 70.
Q: How is prostate cancer diagnosed?
Dr. Reiter: PSA testing is step No. 1. If the PSA is increasing or elevated then generally we get an MRI of the prostate or additional urine and blood tests to assess the likelihood or risk that someone has prostate cancer. If the MRI shows something abnormal, then the patient undergoes a biopsy to determine yes or no and what kind.
Q: Will most patients need treatment if they are diagnosed?
Dr. Reiter: It’s probably 50/50. Thirty to 50% don’t need treatment or at least don’t need immediate treatment – they can be monitored. It depends on age and the grade of the cancer. The pathologist will evaluate the biopsy and give the cancer essentially a grade and it goes from 1 to 5. Ones and some 2s are so slow growing that they don’t require treatment and can be monitored. Three to 5 is more aggressive disease.
Q: What is the rate of survival?
Dr. Reiter: It’s generally not a lethal cancer for most men. It can be highly curable through screening if it’s caught early before it has metastasized. Men are living longer and longer because our treatments have evolved so much over the last 20 years. Most of the news is good.
But it is the second leading cause of cancer death in men and that number has actually increased over the last decade to about 34,000 deaths a year. We have an aging population and this is still a disease that has oftentimes a very long natural history. As men live longer, they run a higher risk of dying from it.
Q: What are the treatment options available at UCLA Health?
Dr. Reiter: For localized disease or early stage, the options run the gamut from surgery to remove the entire prostate, robotic surgery, various forms of radiation therapy and a new form that’s called focal therapy or partial gland therapy, and medical therapies or medications. It all depends on the stage of the disease when it’s diagnosed.
Q: What are some of the potential side effects from treatment?
Dr. Reiter: Impotence, sexual dysfunction, urinary incontinence, changes in bowel habits and fatigue. Those are the ones that are most common. The rate of side effects is significantly lower at UCLA than almost any other center in the country. Robotic surgery definitely adds precision and has reduced many of the side effects, but it doesn’t abrogate them all, unfortunately.
Q: What promising research into prostate cancer is underway at UCLA Health?
Dr. Reiter: There’s a lot. There are many clinical trials available here that are both UCLA initiated but also trials available nationwide and internationally because there’s so many promising therapies now. We have a lot of trials in the area of diagnosis. We have a number of trials looking at PET imaging for a more accurate diagnosis for early-stage disease. There are some exciting trials being run in radiation oncology. We have a number of experimental things such as developing an immunotherapy or vaccine for prostate cancer. We have research across the entire breadth of the field involving urology, medical oncology, nuclear medicine and radiation therapy.
Q: What else is important for patients to know about prostate cancer?
Dr. Reiter: Be aware of the disease because a lot of men aren’t aware and don’t like to talk about it. If you’re diagnosed, it’s critical to get multiple opinions or be sure the person you’re seeing is knowledgeable about all of the options and not pushing one thing. It’s good to read trustworthy websites like the Prostate Cancer Foundation or UCLA Health because there’s so much controversy about how to manage the disease. My biggest hope is that there will be fewer men suffering from the disease and dying from the disease.
