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Every man's at risk: Expert gives an overview of prostate cancer, 'watchful waiting,' 'active surveillance'

The prostate is a walnut-sized gland located between the bladder and the penis and just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

The prostate is a walnut-sized gland between a male's bladder and penis and just in front of the rectum.

Who is at risk?

“If you‘re a man and you live long enough, you will develop prostate cancer,” says Rakesh Khanna, MD, an assistant professor of urology at Upstate. It‘s the most common cancer in American men, other than skin cancer, “and many men are going to have very small prostate cancers that are asymptomatic.”

Age is the primary risk factor. The average age at diagnosis is 66, according to the American Cancer Society.

Some men whose family history includes early-onset prostate cancer are at greater risk for developing prostate cancer early.

The disease occurs more often in African-American men and less often in Asian-American and Hispanic men than in non-Hispanic whites. No one knows why.

Rakesh Khanna, MD

Rakesh Khanna, MD

 What causes it?

While the exact cause remains a mystery, a variety of genetic abnormalities are known to lead to prostate cancer.

Research today focuses on “trying to identify, at the molecular level, which gene abnormalities are responsible for taking prostate cancer from a confined stage to a metastatic stage, where it spreads outside the prostate,” Khanna says.

How is it diagnosed?

The blood test that measures levels of a protein called prostate-specific antigen can help detect early prostate cancer, but the PSA test does not diagnose the disease.

Prostate cancer is diagnosed through a biopsy of the prostate. A tissue sample is removed and evaluated by a pathologist to determine if cancer is present and how aggressive it is.

Before the PSA screening became available in the 1990s, doctors relied on a physical examination to diagnose prostate cancer. Unfortunately, by the time a nodule could be felt on the prostate, the patient‘s cancer was inevitably advanced and difficult to treat.

The PSA test is not perfect. A man can have prostate cancer and have a normal PSA. He can have an elevated PSA and not have cancer. “But the PSA is the best screening test we have right now,” Khanna says.

“Nowadays, because we are screening, we are trying to find the prostate cancers before they become symptomatic. If they are localized and they‘re smaller when we treat them, a patient will have a better outcome.”

Does prevention help?

It‘s not conclusive, but some data suggests that physical activity and a healthy diet may help prevent prostate cancer from developing. One thing is definite: Physical activity and a healthy diet will not increase your risk.

 What happens after diagnosis?

While not all patients require them, a variety of surgical and radiation therapy options exist, some of which have significant side effects.

Many prostate cancers that are discovered early will cause no symptoms and have no impact on a man‘s lifespan. Based on their patients‘ PSA level, age and treatment preferences, doctors may recommend:

-- “Watchful waiting,” in which no additional testing or treatment is required unless symptoms emerge; or

-- “Active surveillance,” which involves repeated blood tests, physical exams and/or biopsies for signs of cancer progression.

This article appears in the spring 2016 issue of Cancer Care magazineHear a radio/podcast interview with Khanna about prostate cancer, and hear other interviews about the topic by going to healthlinkonair.org and entering “prostate cancer” in the search field. Reach Upstate‘s department of urology by calling 315-464-1500.