In the United States, 1 out of every 9 men will be diagnosed with prostate cancer in his lifetime. Scary news, but here's something positive: The number of deaths due to the disease has plunged an amazing 51 percent from 1993 to 2016, according to the American Cancer Society, due largely to a combination of active surveillance and improved interventions.
"That is the largest fall of any major cancer of either men or women," says Jonathan Simons, MD, an oncologist and the president and CEO of the Prostate Cancer Foundation. While the disease remains the most common cancer among American men other than skin cancer, with an estimated 164,690 new cases diagnosed in 2018, it is largely found in men aged 65 and older, with an average of diagnosis at age 66. Check out some more myths and truths about prostate cancer.
Prostate cancer facts
The prostate is a small gland about the size of a ping-pong ball located in men deep inside the groin, between the base of the penis and the rectum. Its job is to supply the seminal fluid (which mixes with sperm from the testes) in order to help sperm travel. A collection of nerves and blood vessels, called the neurovascular bundle, sits on either side of the prostate and also helps to control erectile function—which is why difficulty with erections is one of the signs of prostate cancer men should never ignore. In addition, the urethra, a narrow tube that connects to the bladder, runs through the middle of the prostate and along the length of the penis, through which both semen and urine travel out of the body. The prostate isn't an essential organ, but it does play an important part in reproductive function.
Prostate cancer occurs when normal prostate cells mutate and grow out of control. But not all prostate cancers are alike. Some are very slow-growing and can take years to develop; others are aggressive and likely to divide and spread to other parts of the body relatively quickly.
Know your risk
Although age plays an important role, "Between 60 and 70 percent of prostate cancer is based on genetics," says Dr. Simons. The disease is more common among African American men, who are 76 percent more likely to develop prostate cancer compared to white men and 2.2 times more likely to die from the disease, according to the Prostate Cancer Foundation.
Knowing your family history is key: Men who have had a relative with prostate cancer are twice as likely to develop the disease; those with two or more relatives are nearly four times as likely to be diagnosed. "There are at least 17 genes that we know of that are associated with prostate cancer today, including the 'breast cancer' genes BRCA1 and 2," says Dr. Simons.
Sounding the alarm
"A big part of the decline in prostate cancer deaths is due to our being able to find the disease early and treat it appropriately," says Rich Wender, MD, chief cancer control officer for the American Cancer Society.
There are two common ways to screen for prostate cancer: The first is a digital rectal exam (DRE), which allows a doctor to physically feel for irregularities. The second is a blood test that measures levels of PSA (prostate-specific antigen), a protein produced by the prostate. If something is wrong in the prostate (such as the growth of cancer cells), more PSA is released. "It's like a smoke detector," explains Dr. Simons. "While PSA will naturally rise as you get older, a sudden increase can signal that there's a fire happening—the growth of cancer cells—that needs attention." It's not an exact science: Normal PSA levels vary and other things can cause it to rise, but it remains one of the most effective ways to screen for prostate cancer, adds Dr. Simons. "Most of the improvement in the reduction of the death rate due to prostate cancer has been early detection through PSA tests."
The Prostate Cancer Foundation recommends that African American men get a baseline PSA screening starting at age 45 and that non-African Americans get an annual screening between the ages of 55-69. Because of the controversy over unnecessary treatment (invasive treatment for a tumor that might not ultimately spread or be dangerous), the U.S. Preventive Services Task Force does not recommend men over age 70 be screened. Here are some more things your doctor may not have told you about prostate cancer.
"About 40 percent of the prostate cancer diagnosed in the United States looks abnormal under the microscope but won't kill you; the other 60 percent is aggressive or invasive," says Dr. Simons. "Just as we shouldn't be overtreating, we also still want to catch the more aggressive form."
That's where the idea of watchful waiting—or active surveillance—comes in. "A significant percentage of men with a low-risk prostate cancer diagnosis will develop a more aggressive second cancer," says Dr. Simons. With active surveillance, men are advised to simply have their PSA levels rechecked on a regular basis to see if there is any unusual activity, and in some cases may also be given MRIs. "We have gotten better at helping men figure out if they have a form of prostate cancer that may be likely to progress," notes Dr. Wender. "Active surveillance doesn't mean doing nothing—it's being an active participant in your health."
Whether you've been diagnosed with prostate cancer or want to reduce your risk, there are steps to take to improve your health. The first is to watch your weight. "There's clear evidence that having a BMI [body mass index] over 25 by the time you are age 30 increases your risk regardless of your genetics," says Dr. Simons. Determine your BMI here.
Eating more cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts can also help. "There appears to be a protective effect against prostate cancer from these types of vegetables," says Dr. Simons. High-fat dairy—especially milk—on the other hand, may prove problematic.
Smoking not only increases your risk of lung cancer, but it can also speed the growth of prostate cancer, according to a recent study from Johns Hopkins University. If you're struggling to kick the habit, here are 23 tips on how to quit smoking.
It can also pay to get some sunshine. Ultraviolet light is converted to vitamin D in the body, and that nutrient appears to have a protective effect against prostate cancer, says Dr. Simons. "Vitamin D is a hormone that not only keeps your bones strong but also boosts the immune system, so there may be some correlation there," he adds. Researchers are studying whether vitamin D supplements might reduce prostate cancer risk, but it's too early to make definitive recommendations, says Dr. Simons.
Finally, being physically active on a regular basis—walking at least 20 minutes a day, for example, or playing sports that raise your heart rate at least three times a week—may reduce your risk of prostate cancer. "Your prostate is the most sensitive organ in the body when it comes to exercise," says Dr. Simons. "Every form of exercise appears to have a protective effect."
Stay up to date
Being aware of your treatment options, which can range from active surveillance to surgery, is critical if you're diagnosed. "It's important to understand all of the risks and potential side effects involved," says Dr. Wegner. Getting a second opinion can also be very helpful; you're also more likely to hear up-to-date options if you seek care in a large health-care center where clinicians see a higher volume of cases. For more information, check out the Prostate Cancer Foundation's patient and family guide, which provides the most up-to-date information on treatment options and risk assessment. You can also learn some surprising facts about prostate cancer here.