Expert discusses prostate cancer risk factors, screening
President Donald J. Trump recently spoke in recognition of National Prostate Cancer Awareness Month, saying that although the disease is the second cause of cancer death among men, there is “good reason” to be optimistic about defeating the disease.
“The rate of new prostate cancer cases in the United States has fallen nearly 6% on average each year over the past decade. During this same time, the rate of deaths due to prostate cancer has also fallen by more than 3% on average each year,” Trump said in a statement. “Men diagnosed with prostate cancer are living longer lives than ever thanks to innovative research and improvements in cancer treatment.”
He also encouraged discussions between doctors and patients about the risk for developing the disease.
In conjunction with Prostate Cancer Awareness Month, Healio Family Medicine spoke to Adam B. Murphy, MD, assistant professor of urology at Northwestern University Feinberg School of Medicine, Chicago, about how primary care physicians should help their patients understand the risk factors for prostate cancer, how to broach the subject with patients who may be hesitant to discuss it, and more. – by Janel Miller
Question: What are some common risk factors for prostate cancer?
Answer: Age is the biggest risk factor. It’s estimated that between 30% and 50% of all Americans aged between 50 and 80 years get prostate cancer just because they’ve lived long enough. In addition, men in their 60s and early 70s are most commonly diagnosed. Family history is another risk factor, as is being black. Men of West African ancestry are 60% more likely to develop prostate cancer than other men. Additional less established risk factors include certain genetic mutations such as the BRCA1 or BRCA2 gene that is commonly associated with breast cancer, and other modifiable risk factors, such as eating excessive red meat and dairy products, smoking more than a pack of cigarettes a day, and consuming more than two alcoholic drinks per day.
Q: Who should be screened for prostate cancer?
A: Patients who have an average risk for prostate cancer should begin getting screened for the disease around age 55. These screenings can stop at age 70 in most cases. This is because most men in America don’t live too much beyond 80, and thus, it doesn’t make sense to screen beyond age 70 because you need a 10-year life expectancy to benefit from prostate cancer treatment. If you have a man who has a lot of longevity in their family (eg, they live to 100), you might want to keep screening.
Men with a family history of prostate cancer under age 65 or black men may begin screening at age 40 to assess whether their PSA level is above median for their age. If it is higher, then they may benefit from regular screenings. If it is lower than median levels, then they may be able to wait until age 45 or 50. Research is needed to clarify the proper intervals for high risk men.
Q: What are the prospects for surviving prostate cancer?
A: The best way to ensure survival from prostate cancer is detecting the disease early. If the disease is caught early — that is, the patient’s prostate-specific antigen (PSA) test results come back with a score of less than 10 or if during a rectal exam, there are no nodules or only tiny nodules — the 5-year cancer survival rate is 100%, and the 10-year survival rate is 98%. If prostate cancer is caught at a late stage where the cancer has spread to organs far from the prostate’s location or to the patient’s bones, the survival rate drops to 30%.
It’s also important to note that a patient with prostate cancer is more likely to die from a heart attack or stroke than he is from prostate cancer. So, the same advice you would give to a patient to fend off heart disease — eating plenty of healthy foods and partaking in lots of exercise, avoiding drinking and smoking, etc. — should be given to patients with prostate cancer.
Q: There are data suggesting that not all men like to visit their doctor. How does a PCP broach a subject like prostate cancer with their patients?
A: The discussion about prostate cancer needs to be right up there along with heart disease, diabetes and other screen-detected cancers in elderly men. PCPs should consider discussing the benefits, risks and guidelines of all of these screen-detected conditions at the same time. For patients who are apprehensive about taking the PSA test or undergoing the rectal exam, these exams usually only needs to be done annually to biannually.
Disclosure: Murphy reports no relevant financial disclosures.