By Edward M. Soffen, MD
After skin cancer, prostate cancer is the most commonly diagnosed cancer among men in the United States.
In fact, one in eight men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society.
Advancements in medicine, however, are helping to personalize treatment and reduce complications.
At Penn Medicine Princeton Health, doctors provide patients with individualized care and offer a range of treatment options, including advanced radiation therapy techniques.
Who’s at Risk?
While prostate cancer is common, some men are at greater risk than others. Risk factors for prostate cancer include:
- Age. Prostate cancer is rare in men under 50.
- Family history. Having a father, brother, or grandfather who had prostate cancer raises your risk for the disease.
- Race. African American men are more likely to develop prostate cancer, and at a younger age. The American Urological Association notes that one in six African American men will be diagnosed with prostate cancer in their lifetime.
What are the Symptoms?
Early-stage prostate cancer usually has no symptoms. When symptoms do occur, they can mimic other prostate issues like benign prostatic hyperplasia (BPH). Symptoms 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.
- Difficulty starting or stopping urination.
- Weak or interrupted urine flow.
If you notice any of these signs, see your healthcare provider for an evaluation.
How is Prostate Cancer Diagnosed?
Doctors use a variety of tests to diagnose prostate cancer. The usual first steps include a medical exam, blood tests, and a digital rectal exam.
Depending on the results, additional testing may be needed and may include:
- MRI, CT scan or ultrasound, among other imaging tests
- MRI-ultrasound fusion biopsy
- Prostate biopsy
What is a Gleason Score?
If a prostate biopsy confirms cancer, doctors will assess the cancer’s aggressiveness using a Gleason score. This scoring system ranges from six to 10 and is based on how abnormal the cancer cells look under a microscope. A 6 indicates a low-grade, slow growing cancer while a 10 indicates a more aggressive, faster growing cancer.
The Gleason score, combined with PSA levels, age, health status, and cancer stage, helps determine the best treatment approach.
How is Prostate Cancer Treated?
Prostate cancer is often slow-growing, and many men—especially older individuals or those with other serious health conditions—may not require immediate treatment. In these cases, active surveillance (monitoring the cancer closely) is recommended.
When treatment is necessary, the two primary options are surgery to remove the prostate and radiation therapy.
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.
Should I Get Screened?
Prostate cancer screening is a personal decision that should be made in consultation with your physician. Guidelines vary, and understanding your risk factors is key. The American Urological Association, recommends the following:
- 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.
Prostate cancer is a significant health concern, but advances in medicine have made treatment safer and more personalized. If you have been diagnosed with prostate cancer, talk with your doctor about treatment options and an approach that is best for you.
To find a physician with Penn Medicine Princeton Health or for more information on 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.
