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Prostate Cancer: Questions and Answers

Nelson Mandela. Joe Torre. Frank Zappa. They're very different men with one thing in common: prostate cancer. Prostate cancer is the second-most common cancer in men after skin cancer, according to the American Cancer Society. One in six men will develop prostate cancer during their lifetime, but it can be cured, if it's detected early.

Talking about cancer can be intimidating, but treating it as a taboo can lead to a lot of myths - and a lot of unnecessary anxiety. Here are some of the most common questions about prostate cancer, answered by University of Michigan specialists.

1.   I've heard that all men get prostate cancer eventually, but no one ever dies of it. Right?

Wrong. Prostate cancer is the second-leading cause of cancer death among men, and nearly 30,000 Americans die from the disease yearly. However, prostate cancer is highly treatable, particularly if it's caught early. Doctors now have methods of predicting which types of prostate cancer will be more aggressive than others, allowing them to plan treatment accordingly. And the numbers show just how successful treatment can be: Although one in six men develops prostate cancer, only one in 34 dies from it. The key is early detection.

2.   How do you detect it early?

Your doctor can evaluate your risk by performing a rectal exam and a prostate-specific antigen blood test, which is commonly called a PSA test. You should consider asking your doctor for an annual prostate cancer screening if you are:

• A man 50 or older;
• A man who is 40 or older with a family history of prostate cancer; or
• A man who is 40 or older and African American.

Be sure to talk to your doctor about whether screening is right for you and what the results of your exam mean.

3.   Why should I be more concerned if I am African American?

African-American men have a higher risk of getting prostate cancer and are more than twice as likely to die from it, according to the National Cancer Institute. Researchers are still working to understand why this is. In the meantime, it's important to ask your doctor about regular screenings. 4. But if I have prostate cancer, wouldn't I have symptoms? What are the signs? Prostate cancer doesn't cause symptoms until it's very advanced. These symptoms can include frequent urination or having a weak urinary stream. However, these problems can also be caused by a condition called "benign prostate enlargement" that's not life-threatening. If you experience these symptoms, see your doctor.

5.   Doesn't prostate enlargement lead to prostate cancer?

No, prostate enlargement is a natural process that occurs in all men. Prostate cancer mimics this condition only in its most advanced stages. In most cases, urinary problems are caused by prostate enlargement, which is treatable with medication or a minor procedure.

6.   Isn't prostate cancer an elderly man's disease?

o. The average age of diagnosis for men undergoing prostate surgery at the U-M Comprehensive Cancer Center is 58. Nationally, the average age of diagnosis has dropped during the past two decades from age 77 to 65. Remember, the earlier the cancer is caught, the less likely it is to be fatal or cause impairment.

7.   Is it true that you'll get prostate cancer if you don't have sex enough or if you have it too often?

There is no scientific evidence linking sexual activity to the development of prostate cancer. It's completely unrelated.

8.   If I have prostate cancer, what's the best treatment?

Several treatment options are available to people with prostate cancer, but each one should be evaluated by you and your doctor based on the stage of the disease, your medical history and your personal desires. In elderly men with relatively slow-growing cancer, it may be best to simply monitor the disease's progression and forego aggressive treatment, a course of action often called "watchful waiting" or "active surveillance." For patients who are expected to live at least 10 more years, curative therapy is appropriate. This includes surgery, radiation or cryotherapy.

The best treatment for each patient is an individual decision. Talk to your doctor about the pros and cons of each option available to you and decide for yourself. It's not about what treatment is "best," but what's best for you.

9.   If I choose surgery, could it cause my cancer to spread?

No, surgery will not cause your cancer to spread. Many years ago, before good diagnostic testing was available, people with cancer would undergo surgery without knowing the full extent of the disease. Because the cancer was not diagnosed until it was in its very late stages, people would die soon after the surgery, causing people to incorrectly assume the surgery had spurred the cancer's growth. Cancer spreads naturally with time; that's why it's so important to catch it and treat it early.

10.   Will I be disabled after treatment?

The vast majority of patients recover within a month after the completion of treatment. There's a low risk of incontinence with today's therapies and a moderate risk of impotence.

11.   Will I be impotent?

Prostate cancer treatments affect your ability to achieve an erection. If your cancer is caught in its early stages and you are able to maintain good erections before treatment, there is a good chance you will continue to be able to perform adequately. However, if you do experience erectile dysfunction after treatment, it is one of the easiest things to fix. Several medications are available.

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This site is part of the U-M Health System. The information presented is not a tool for self diagnosis or a substitute for professional care. © 2008 U-M Comprehensive Cancer Center