By Edward M. Soffen, MD
Aside from skin cancer, prostate cancer is the most commonly diagnosed cancer among men in the United States, according to the American Urological Association.
In fact, more than 288,000 new cases of prostate cancer were diagnosed last year alone.
Fortunately, a range of safe and effective treatment options are available.
At Penn Medicine Princeton Health, radiation oncologists are using advanced techniques to treat prostate cancer and reduce complications, including bowel problems.
Some Men at Greater Risk
While prostate cancer is common, there are certain factors that put some men at greater risk than others. These include:
- Age. As men grow older, their risk for prostate cancer increases. Prostate cancer is rare in men under the age of 50.
- Family history. Men with a grandfather, father or brother who have had prostate cancer have a higher risk.
- Race. Prostate cancer occurs more often in African American men than white men, and it occurs at an earlier age in African American men. In fact, one in six African American men will be diagnosed with prostate cancer in their lifetime, according to the American Urological Association.
Men should speak with their physician about their risk for prostate cancer and whether they should be screened for the disease.
Symptoms
Early-stage prostate cancer often does not have any symptoms. When symptoms do occur, they can be similar to conditions like benign prostate hyperplasia commonly known as enlarged prostate and may include:
- Blood in the urine or semen.
- Frequent urination (especially at night).
- Painful ejaculation.
- Pain in the back, hips or pelvis that doesn’t go away.
- Pain or burning during urination.
- Trouble urinating.
- Weak or interrupted flow of urine.
If you experience symptoms of prostate cancer, see your healthcare provider for an evaluation.
Diagnosis and Treatment
To diagnose prostate cancer, doctors will perform a medical exam and blood tests, along with a digital rectal exam. Depending on the results, they may order additional tests, such as:
- Imaging tests, such as MRI, CT scan and ultrasound.
- MRI-ultrasound fusion biopsy.
- Prostate biopsy.
Treatment for prostate cancer is highly individualized and depends on a variety of factors such as age, health, extent of the disease, lifestyle and life expectancy.
Because prostate cancer is a slow-growing cancer, active surveillance is often recommended, especially for older men or men with other serious health conditions that may limit their lifespan.
In addition to active surveillance, the two main treatment options for prostate cancer are surgery to remove the prostate and radiation therapy.
Advanced Techniques Reduce Radiation Risks
For men who undergo radiation therapy for prostate cancer, bowel problems are a common complication. This is due to the proximity of the prostate to the rectum, which leaves the rectum exposed to some radiation during treatment.
As a result, diarrhea, rectal bleeding and rectal leakage can occur. Though these problems often resolve over time, they can affect quality of life, and in rare cases bowel problems may be permanent.
At Penn Medicine Princeton Health, radiation oncologists are using a balloon implant system to help protect the rectum from radiation and reduce the risk of complications.
Using minimally invasive techniques and guided by ultrasound, doctors place a small (four centimeters long and three centimeters wide) balloon between the prostate and the rectum that when filled with a sterile solution creates space between the two organs.
By creating the space, the balloon helps prevent radiation to the rectum. The balloon, which maintains its size and shape during treatment, naturally biodegrades over time.
Most men report feeling the balloon for the first few hours after placement and then their body becomes used to it. Doctors may prescribe a stool softener for a day or two after the balloon is placed.
Screening Recommendations
Guidelines for prostate cancer screening differ, which is why it is important to have a conversation with your doctor about your risk and any symptoms you may be having.
Whether to get screened is a highly personal decision and should be based on a thorough understanding of the risks and benefits and made in consult with your physician.
The American Urological Association updated its guidelines last year and recommends that:
- Prostate cancer screening may begin between the ages of 45 and 50.
- Men at increased risk, including men with Black ancestry, germline mutations and strong family history of prostate cancer, should be offered prostate screening beginning between the age of 40 and 45.
- Clinicians should offer regular prostate cancer screening every two to four years for people aged 50 to 69.
The Association recommends that a blood test to measure the level of prostate specific antigen (PSA) in the blood should be used as the first screening test. If PSA levels are newly elevated, the test should be repeated prior to additional testing, such as imaging and biopsy.
It is important to note that an elevated PSA does not confirm a diagnosis of prostate cancer.
While prostate cancer is a significant health concern for men, advances in medicine have made treatment safer. Men should talk with their doctor about screening for prostate cancer and if diagnosed with the disease, should understand the treatment options and ask about ways to protect against treatment complications.
To find a physician with Penn Medicine Princeton Health or for more information on the Penn Medicine Princeton Cancer Center, call (888) 742-7496 or visit www.princetonhcs.org.
Edward M. Soffen, MD, is board certified in radiation oncology and is a member of the medical staff at Penn Medicine Princeton Health.