The prostate is a gland in the male reproductive system that is about the size of a walnut and normally weighs around 30 grams. It is located below the bladder and surrounds the urethra, which carries both urine and semen. The prostate’s main function is to produce seminal fluid, which nourishes and transports sperm cells from the testicles. It also produces prostate-specific antigen (PSA), a protein that helps semen become more watery.
A non-cancerous enlargement of the prostate that can be caused by aging, testosterone, and genetics. BPH can cause the prostate to double or triple in size, which can put pressure on the bladder and make it difficult to urinate. Symptoms include:
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. However, the cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease. Prostate cancer can be diagnosed by a blood test called prostate-specific antigen (PSA) and a digital rectal examination (DRE). Prostate Cancer can be a deadly killer if not diagnosed early and it is the second leading cancer killer of men next to lung cancer.
Prostate Cancer is also known as a “Silent Disease,” meaning there are very few symptoms related to the early stages. The information presented here is to help men who do not have prostate symptoms decide if they want to be tested. If you have prostate symptoms now, such as urgency to urinate, pain when you pass urine, blood in your urine, or trouble passing urine, see your doctor. These are often symptoms of other non-cancer prostate problems, but they can also be caused by prostate cancer, so you should speak with a doctor about them as soon as possible.
Prostate cancer starts when normal prostate cells mutate and begin to grow out of control. These small changes in DNA cause the cells to grow faster and live longer than normal, and they can accumulate and monopolize resources from normal cells, damaging surrounding tissue. As the abnormal cells multiply, they can form a lump called a tumor.
If you’re a Veteran we consider you to be at high risk for prostate cancer due to factors like being exposed to hazardous materials and radiation sources. In addition, if you are African American or have a family history of the disease, screening discussions typically begin earlier than the standard recommendations. We at VPCa find no harm in having a discussion with your doctor at the age of 40 and asking for a simple PSA blood test.
Veteran Men: Discussions about screening should start around age 40, as this group has a higher risk of developing prostate cancer and tends to be diagnosed at more advanced stages.
African American Men: Discussions about screening might start around age 40-45, as this group has a higher risk of developing prostate cancer and tends to be diagnosed at more advanced stages.
Family History: If you have a family history of prostate cancer, especially if a close relative (father, uncle, brother, grandfather) was diagnosed at a younger age, screening discussions might also commence around age 40 to 45 or even earlier, depending on the specifics of your family history.
For those at very high risk due to multiple family members affected by prostate cancer at a young age, discussions might even start as early as age 40.
However, the decision to screen should be made after a thorough discussion with your healthcare provider, weighing the potential benefits and risks of screening based on your individual risk factors, age, overall health, and personal preferences. Regular discussions and evaluations will help determine the best approach for your situation.
PSA screening has yielded a dramatic transformation in how prostate cancer patients present — meaning, the status of their disease when they first get the diagnosis. More men begin care with early-stage and potentially curable diseases.
The PSA test is a blood test that measures a protein released in the blood by prostate cells. The higher a man’s total PSA level, the more likely he is to have prostate cancer. A few things to keep in mind about this test:
Both normal and cancerous prostate cells secrete the protein.
Elevated PSA levels are usually caused by noncancerous conditions, such as benign prostatic hyperplasia or prostatitis.
Some men who have prostate cancer do not have elevated PSA.
While there is no perfect screening test for prostate cancer, a PSA test is the most common screening.
Unfortunately, there usually aren’t any early warning signs for prostate cancer. The growing tumor does not push against anything to cause pain, so for many years the disease may be silent. That’s why screening for prostate cancer is such an important topic for all men and their families.
In rare cases, prostate cancer can cause symptoms. Contact your doctor for an evaluation if you experience any of the following:
What about difficulty in having an erection? Again, this is most likely not caused by cancer but by other factors such as diabetes, smoking, cardiovascular disease, or just plain getting older.
That said: Symptoms are symptoms, and no matter what’s most likely to be causing them, you should get them checked out by a doctor.
By the Numbers: Diagnosis and Survival
Prostate cancer is the most commonly diagnosed type of cancer in the US (excluding skin cancer), and the second leading cause of cancer in men worldwide. 1 in 8 US men will be diagnosed with prostate cancer at some point in their lives. Because of factors we are not certain of Veterans will be diagnosed at a rate of 1 in 5 men. VPCa believes the cause is exposure to hazardous materials, exposure to radiation sources, and potentially combat stress related conditions. Prostate cancer incidence increases with age: the older you are, the greater your chance of developing it.
Although only about 1 in 456 men under age 50 will be diagnosed, the rate shoots up to 1 in 54 for ages 50 to 59, 1 in 19 for ages 60 to 69, and 1 in 11 for men 70 and older. Nearly 60% of all prostate cancers are diagnosed in men over the age of 65. These figures are all related to the general USA population and does not account for the reduction in age and percentage of aggressive prostate cancer found in veterans.
Prostate cancer is diagnosed with a biopsy. The most common reason for a man to undergo a prostate biopsy is due to an elevated prostate-specific antigen level (PSA), determined by a blood test and an abnormal lesion seen in a MRI image. In the last decade, changes in PSA screening recommendations have affected the rates of prostate cancer diagnosis. In addition, the introduction of Prostate Cancer Biomarker (PCM) tests has added to the accuracy of diagnosis and offers recommendations as to optimum treatment choices.
Each year nearly one million prostate biopsies are performed. There are two physical pathways to access the prostate for tissue samples:
1. via the rectum (TRANSRECTAL)
2. via the perineum, the area between the anus and the scrotum (TRANSPERINEAL).
The following video is a description of the device used to optimise a transperineal biopsy. PrecisionPoint® Transperineal Access System
The Traditional Method of Prostate Biopsy (TRANSRECTAL)
For over 30 years the transrectal path has been the standard method to biopsy the prostate.Because this technique obtains prostate tissue samples through the rectal wall it is possible to introduce fecal material and bacteria into the prostate.
Due to increased rates of antibiotic-resistant bacteria the risk of infection after the prostate biopsy has risen dramatically. Over the past 10 years the risk of infection has approached 6% and the risk of hospitalization due to sepsis has reached 3%.
An additional drawback of this approach is the relative difficulty in accessing certain zones of the prostate where cancer is sometimes found.
By passing the biopsy needle through the perineum instead of the rectum, the risks associated with the transrectal approach are avoided.
Using the TRANSPERINEAL method in a freehanded, constant ultrasound-supervised technique allows the surgeon to maintain accurate sampling of all zones of the prostate while at the same time avoiding the coliform bacteria responsible for infections.
The TRANSPERINEAL method offers the distinct advantages of minimizing, or even eliminating, the risk of infection while maximizing the cancer detection rate.
The Better, Safer Method of Prostate Biopsy (TRANSPERINEAL using The PrecisionPoint®)
If you or a loved one has recently been diagnosed with prostate cancer, your mind might be racing, trying to figure out what happened. What went wrong? What could we have done differently so that this wouldn’t happen? The answer is simple, but unsatisfying: doctors and researchers don’t know exactly—yet.
We know that there are three main, established risk factors: one’s racial background, family history, and age. (Learn more about risk factors for prostate cancer.) Additional factors, like smoking, obesity, and possibly consuming very high amounts of calcium, seem to factor into more aggressive cases of prostate cancer as well—although some of these factors are associated with many other health problems, too. Someone who has systemic health issues may fare more poorly with any illness.
It has become apparent in a number of studies that veterans are developing this disease at a significantly higher rate of incidence. While we do NOT know the exact cause of this increase in incidence we hypothesise it is exposure to a number of hazardous conditions and materials including radiation exposure, and many chemical components including Agent Orange, BPA, cadmium, PFAS that significantly elevate prostate cancer risk. Further research is warranted to strengthen these associations, as the current evidence remains limited. These findings underscore the unique risks faced by veterans due to their military service, highlighting the importance of considering the reclassification of veterans as a high-risk group for early prostate screening. We at VPCa highly recommend a veteran begin their annual screening at the age of 40 unless direct relatives have also had prostate cancer then we recommend a baseline at age 35.
One of the biggest apparent underlying factors is one we have little control over: our genes.
At the moment of our conception, DNA from our mother and our father combine to create a unique genetic fingerprint which contains all the information needed to grow those few cells into an entire human being. But sometimes that genetic code contains quirks which seem to be involved in certain types of illness later in life. In particular, mutations in the BRCA1 and BRCA2 genes are among those known to be linked to certain cancers that run in families. Genetic screening is available for families who seem to share these cancers. But inherited genetic mutations are only believed to cause 5% to 10% of cases of prostate cancer.
The other type of genetic mutations are acquired mutations. These are changes to your genetic material that happen at any time after your conception. Your cells are constantly dying off and being replaced by new cells, and each time a cell divides to create a new cell, there is a chance that something could go wrong as the genes are copied over. We don’t yet know all the things that can affect this process, but we know that body chemistry and hormones, exposure to chemical toxins, poor diet, lack of exercise, and radiation (from the sun or other sources) are among the factors implicated in acquired gene mutations.
So the short answer is both simple and complicated, and it’s the same advice your doctors will give you for almost any question about your health: to avoid prostate cancer, eat healthy foods, stay in shape, and get enough rest. You should also maintain a thoughtfully designed screening regimen for prostate cancer as you age.
The Total PSA test measures the blood levels of Prostate-SpecificAntigen (PSA), a protein made by both normal and cancerous tissue in the prostate. Some tests measure PSA in urine, not blood.An elevated PSA can be caused by prostate cancer but also by age, prostate size, prostatitis (inflammation), or BPH. It is not specific to prostate cancer.
“PSA density” is your total PSA divided by your prostate volume(measured by MRI or transrectal ultrasound.) “PSA velocity” is thespeed with which your PSA rises between tests over time; “PSA doubling time” calculates the rate of PSA doubling.
No. Prostate Cancer is a tissue-based diagnosis, and an elevatedPSA has other potential causes (1, above). PSA is one factor your doctor will consider before recommending a biopsy. If cancer is diagnosed, your biopsy tissue is graded on the likelihood of the cancer to grow and spread quickly (Gleason Grade Group).
Yes. High-grade (aggressive or Gleason Grade Group 5) disease can sometimes be found with very low levels of PSA; this is considered high-risk disease.
Periodic PSA testing (i.e. every 6 months) along with a yearlyDigital Rectal Exam (DRE) and a prostate biopsy every 2-5 years(after the first biopsy within 6-12 months of the diagnosis) is part of the monitoring protocol recommended by the AmericanSociety of Clinical Oncology (ASCO). If test results such as a risingPSA suggest the cancer is progressing, treatment will likely be recommended.
PSA “persisting” after treatment may be stressful for patients, but is not necessarily cause for concern. After surgery your PSA should drop to undetectable levels within 6-8 weeks; “PSA persistence”means that within the first 3 months after surgery, your PSA is detectable. After radiation, your PSA can drop more slowly and should remain low indefinitely. While your PSA after radiation therapy may not reach its lowest point for up to 2 years, your physician may follow your PSA to look for upward trends.
PSA is an important tool to monitor success of treatment. When your PSA falls to undetectable after a radical prostatectomy, but later increases twice in a row; or if your PSA falls to near zero after radiation therapy, but later rises by at least 2ng/mL, cancer may have returned (“biochemical recurrence”). Cancer that returns after surgery will be treated differently than cancer that comes back after radiation therapy.
PSA is checked periodically during Active Surveillance (5). If there is PSA persistence/recurrence after surgery or after radiation therapy (6,7), treatments may be based upon PSA Doubling Time.With hormonal therapy, a rising PSA means resistance to therapy(CRPC), and new treatments will be added (9).
Prostate cancer is fueled by testosterone, so hormonal therapy is used to lower testosterone and reduce your PSA. Most prostate cancer eventually becomes resistant to hormonal therapy and PSA starts rising (CRPC). If conventional imaging shows no evidence of spread, the cancer is non-metastatic (nmCRPC). Hormonal therapy is continued. If your PSA Doubling Time is 10 months or less, you may be treated with an anti-androgen such as enzalutamide, apalutamide or darolutamide,to delay or prevent metastases. But if there is evidence of spread, your cancer is metastatic (mCRPC).
Don’t be afraid to ask questions about tests and treatments.Topics may include salvage therapy, hormonal therapy, anti-androgens, genetic testing, immunotherapy, PARP Inhibition, and chemotherapy. Ask about bone health and cardiovascular issues.Ask questions that help you make judgments based upon your personalvalues.
Download the attached set of questions and take them with you to the doctor. There are two sides to the handout, one for the patient and one for the physician.
Veteran’s Prostate Cancer Awareness (VPCa) is a registered non-profit organization dedicated to saving lives by promoting awareness, early detection, and providing solutions among Veterans, active-duty military, and all men.
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