If you have heard the words “You have prostate cancer” from your doctor, many thoughts and questions probably ran through your mind.
- Why me?
- What exactly is prostate cancer?
- How bad is it?
- Do I need treatment and if so, what are the options?
- Will I be able to work? Have sex?
- Am I going to die?
It would take volumes to answer these questions. However, here are some thoughts on each of them that can serve as launching points for further discussion between you and your physician and family.
This is a common question regardless of what disease someone develops. Check out these statistics and see where you fit into the picture.
- Prostate cancer affects 1 out of every nine men during their lifetime.
- In 2019, an estimated 174,650 new cases of the disease will be diagnosed in American men, and about 31,620 men will die of the disease, according to the American Cancer Society.
- Prostate cancer is rare among men younger than 40, as the average age at the time of diagnosis is about 66
- Sixty percent of cases occur in men aged 65 or older.
- Older age is a main factor in the development of the disease.
Why did you get prostate cancer? That’s difficult to say. Genetics and ethnicity play a role, as the disease is at least 60 percent more common among black men than non-Hispanic white men. Other risk factors include age, location (more frequent in North America, northwestern Europe, Australia, and the Caribbean islands), and family history.
For example, if your father or brother has had prostate cancer, you have twice the risk of developing the disease than do other men without this family history. The risk is slightly higher if your brother rather than your father has had the disease.
A few other risk factors for prostate cancer include:
- Diet: Research indicates that eating a diet that contains high-fat dairy or red meat may increase a man’s chances of developing prostate cancer.
- Obesity: The obesity risk seems to operate at two levels. One is that obesity itself is linked to the development of the disease, and another is that it increases a man’s risk of dying of advanced prostate cancer.
- Agent Orange: Men who were exposed to Agent Orange during the Vietnam War appear to be more prone to develop aggressive prostate cancer. This relationship is still being explored by researchers.
What exactly is prostate cancer?
Prostate cancer is the uncontrolled growth of cells in the prostate gland. When mutations of DNA occur, they can cause the cells in the prostate gland to grow abnormally and out of control. Eventually those cells can develop into a tumor.
How bad is it?
The stage at which prostate cancer is discovered is important because it determines if and how treatment should occur, which treatments are most appropriate for you, and what you can expect along this journey with prostate cancer.
Prostate cancer is generally a slow-growing disease. Currently, nearly 3 million men in the United States alone are living with prostate cancer.
That’s not to say prostate cancer isn’t a very serious disease and doesn’t demand immediate attention. However, the type of attention depends on the stage of cancer, age of the patient, overall health, life expectancy, and the quality of life the patient desires.
- T0: No evidence of a tumor in the prostate
- T1: Although a doctor cannot feel changes in the prostate during examination, a tumor may be discovered during surgery or needle biopsy for another prostate problem, such as an enlarged prostate.
- T2: The tumor is confined to the prostate and is large enough to be felt during a digital rectal exam.
- T3: The tumor has grown through the prostate on one or both sides of the prostate. It also may have expanded into the seminal vesicles, which are the tubes that transport semen.
- T4: The tumor has not grown or it has grown into the rectum, pelvic wall, of other nearby structures except the seminal vesicles, external sphincter, or several other areas.
The bottom line is, your doctor should explain to you the extent of the disease. To make that determination, clinicians use a range of diagnostic tools, including the PSA, digital rectal exam, prostate biopsy, biomarker tests, PCA3, and transrectal ultrasound test.
Do I need treatment and if so, what are the options?
You and your doctor will work together to determine whether your prostate cancer requires treatment. The choice of treatment, if any, depends on the severity of the disease.
For many men, and especially the majority who show an early, slow-growing cancer, a treatment approach called Active Surveillance is sometimes recommended. This involves regular monitoring of the disease using various tests but no active treatment unless there is progression. Other main options may include:
- Surgery in the form of prostatectomy (removal of the prostate) for cancer that has not spread beyond the prostate
- Chemotherapy, the use of drugs for prostate cancer that has spread beyond the gland. It is sometimes used along with hormone therapy
- Hormone therapy, also known as androgen deprivation therapy, for cancer that has spread too far to be cured using surgery or radiation, before radiation to help make treatment more effective, or along with radiation for men at greater risk of cancer returning after treatment
- Radiation, which may be used as the first treatment for low-grade cancer limited to the prostate, along with hormone therapy for cancer that has spread beyond the prostate, or in advanced cancer to help keep it under control
- Cryotherapy, or the use of extremely cold temperatures to freeze and kill prostate cancer cells, may be used for early-stage disease. It is sometimes used if cancer has returned after radiation therapy.
Will I be able to work or have sex with prostate cancer?
For the vast majority of men, having prostate cancer does not end their ability to continue working or engaging in sex, although depending on the severity of the disease, they may need to make adjustments in both of these areas. For example, men who undergo chemotherapy may experience side effects from treatment that cause them to lose time at work because of nausea, fatigue, or weakness.
The ability to have sexual intercourse while living with prostate cancer can depend on the treatment. Prostatectomy and radiation, for example, are associated with a significant risk of experiencing erectile dysfunction and urinary incontinence.
However, men who become stressed over their diagnosis, even if they have low-risk disease and are on active surveillance, may experience performance anxiety. Therefore, men with prostate cancer who are concerned about their ability to continue sexual activity should discuss their concerns not only with their partners but with mental health professionals if necessary so they can find ways to continue their sex lives.
Am I going to die?
According to the American Cancer Society, about 1 man in 41 will die of prostate cancer. Once a man has been diagnosed with prostate cancer, the five-year relative survival rate for different types and stages of the disease are as follows. If the five-year relative survival rate for a specific stage of the disease is 90 percent, it means that men with prostate cancer are, on average, about 90 percent as likely as men without the disease to live for at least five years after diagnosis.
- Localized (no sign of disease outside of the prostate), nearly 100%
- Regional (cancer has spread to nearby structure or lymph nodes), nearly 100%
- Distant (cancer has spread to bones, lung, liver, or other distant parts), 30 percent
Even though prostate cancer is the second leading cause of cancer death among American men, most men who have been diagnosed with the disease don’t die from it.
Men who have been diagnosed with prostate cancer need to educate themselves and their families about the disease. Consultation with one or more trusted physicians is recommended, and men should continue to stay abreast of the latest findings and research in the area of prostate cancer and treatment.
American Cancer Society. Key statistics for prostate cancer