Conditions and Services Belly and Pelvis Men's Health Cancer Care

Answers to common prostate cancer questions

Doctor pointing to medical model of the prostate
Charles Enke, MD, radiation oncologist sits down to discuss prostate cancer. You may listen to the entire interview or, depending on what specific information you would like to learn more about, choose the blue headings below to skip ahead to specific parts of the video that address those areas.

Cancer

I think cancer is a really scary word and sometimes we try to put things in perspective from, yes, this is cancer by definition, but it's not one that we're going to recommend aggressive treatment for. And there are other times that we say, you know, this really is a serious diagnosis that we need to treat aggressively. And it may involve all three different kinds of team members being actively involved.

How common is prostate cancer?

Prostate cancer is common among men in the United States. In fact, it's the most common non-skin cancer diagnosed in men in the United States. But if you look, there over 3 million men who are alive today who have been diagnosed with prostate cancer, most of those who were treated. So it is a cancer that is very treatable.

When is prostate cancer typically diagnosed?

Prostate cancer tends to develop slowly in the vast majority of men who have a diagnosis of prostate cancer. Prostate cancer may be present undiagnosed and asymptomatic in a man for potentially many years before it gets to the point where it can be developed. But if left untreated and if it is a prostate cancer that has more aggressive tendencies, certainly it can spread.

How does prostate cancer spread?

When we think of prostate cancer spreading, I think of it in three ways, it can continue to grow locally within the prostate until it breaks outside of the prostate and may extend into surrounding tissues, and that could include the bladder more commonly into glands called the seminal vesicles, which are physically attached to the prostate but separate from the prostate. It can spread via lymphatic vessels in the lymph nodes. The last way that prostate cancer spreads is via the bloodstream and that tends to occur late in the history of prostate cancer.

At what age is a man most likely to be diagnosed with prostate cancer?

Prostate cancer is definitely a cancer not of young adult males. About the youngest men that may have a diagnosis of prostate cancer are very, very small percentage, maybe in the early 40s. It certainly becomes more common in men as they proceed through their later 40s and more commonly in their 50s, 60s, 70s and 80s and is so it's not something that just tends to decrease once you get to a certain age.

What does “PSA” mean?”

“PSA” stands for prostatic specific antigen. And it's nothing more than a blood test that can be done for diagnosis of prostate cancer. When I say diagnosis, you don't prove that somebody has cancer on the basis of the PSA, but at least it may help identify the man who has a higher PSA number, meaning we think you have a higher risk that you could have prostate cancer and that could lead to additional evaluation - including perhaps a prostate biopsy which is really a more definitive way to do that.

Are PSA screenings recommended?

I think the advice today that is recommended is to discuss the pros and cons of a PSA screening with your primary care provider. But, because of the fact that prostate cancer really can be a fatal cancer diagnosis and it can be highly curable when treated at earlier stages, I still recommend that men strongly consider screening for prostate cancer. The other thing that men try to avoid is still having an examination of the prostate itself. If a doctor feels a lump that is suspicious in the prostate gland, those are rarely prostate cancers that we’re going to ignore. And they usually need to be evaluated, staged and usually those are cancers that require treatment. So although men get squeamish about it, I still encourage them to do it. At a minimum, you want to make certain that you're doing a PSA test and for men who don't have any obvious risk factors (in terms of family history and so on) we recommend that:

  • African-American men should consider starting screenings at age 40.
  • Men with genetic risk such as BRCA 1 or 2 mutations should consider starting screening at age 40 as well.
  • Men in general should consider PSA screening at age 45. 

What is a multidisciplinary approach to care?

I think since we started our multidisciplinary urology clinic where we have the urologist, radiation oncologist and medical oncologist seeing potentially the patient may see all three of those positions at the same office setting. We've seen a fairly significant increase in men come in for maybe second opinions because they essentially can see three doctors, if appropriate, and get an opinion. Plus, we actually present those patients at a tumor board that is really geared for nothing more than patients with urologic cancers. You know the purpose there is not necessarily just to try to convince the patient to have the treatment done at Nebraska Medicine, but it really is an opportunity to give patients peace of mind, give another overview, another set or group of eyes looking at their cancer diagnosis and treatment options. And a lot of times a patient may just feel reassured that their original recommendations are consistent with what another group of physician specialists also feel. And it makes them feel that much more comfortable going forward.

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