Highlights
- Bone pain and weight loss are the most common early symptoms of prostate cancer.
- Screening for prostate cancer is recommended starting at age 50 for those at average risk.
- Shared decision-making is key to finding the best treatment option for each patient.
Prostate cancer is the most common cancer in people born with a prostate, with 1 in 8 diagnosed in their lifetime, according to the American Cancer Society. When caught early, it is highly treatable, so early screening is important.
Christopher Saigal, MD, MPH, professor and vice chair of urology at the David Geffen School of Medicine at UCLA and a member of the UCLA Health Jonsson Comprehensive Cancer Center, researches innovative approaches to help patients make the right treatment decisions when diagnosed with prostate cancer. Here, he discusses what you need to know about the disease, its prevention and the options for treatment.
Q: What is prostate cancer, and what are its initial symptoms?
Dr. Saigal: The most common initial symptoms of prostate cancer are bone pain and weight loss. If left untreated, it can spread to the lymph nodes and bones and cause fatigue, weight loss, bone pain and fractures.
Prostate cancer arises in the prostate gland, located deep in the pelvis above your rectum and below your bladder, and its function is to provide reproductive fluid. As you get older, the prostate gland can grow in size and restrict the flow of urine, which is usually benign, and unrelated to cancer.
Q: What are the major risk factors for prostate cancer?
Dr. Saigal: Age, family history and race are the biggest risk factors.
There are genes we can test for in families that have strong histories of prostate cancer, breast cancer and ovarian cancer, which have genes in common. If your father or brother has had prostate cancer, then you may be at increased risk.
Black men and those of African descent are at higher risk, so we recommend earlier screening for this population.
Q: When should patients get screened for prostate cancer, and how often?
Dr. Saigal: It is recommended that patients get screened for prostate cancer between the ages of 50 and 70, and earlier, from the age of 40, in men with higher risk.
The screening involves a simple blood test, called the prostate-specific antigen test, or PSA test, which your primary care doctor will often do once you are of age. It’s important to get screened every year until you reach 70.
Some men are hesitant to get screened because they are worried about having a rectal examination, which isn’t required for all patients. In men who have an elevated PSA, we use an MRI to get a better image of the prostate.
Q: How is prostate cancer diagnosed?
Dr. Saigal: If the PSA test shows high levels of PSA then we repeat it and do a work-up to make sure it isn’t due to other reasons, such as an infection or recent catheterization. If it is truly elevated, then we perform a biopsy.
At UCLA, we perform a biopsy in the clinic with the help of an MRI to guide a small needle directly to any abnormal areas we find to remove some tissue. It takes about 15 minutes, and we call you back in a week or so with the results.
Q: Once diagnosed, how does prostate cancer progress? What is the rate of survival?
Dr. Saigal: We classify prostate cancers as either low, intermediate, or high risk for spread. This is determined through looking at the baseline PSA levels, how aggressive the cells look on a slide, and the findings from the physical exam.
If these are reassuring, then the prostate cancer is at low risk of spread, and patients can be placed on active surveillance, with a 99% chance of survival over 10 years.
Q: What are the treatment options available at UCLA Health?
Dr. Saigal: Some patients are concerned that treatment for prostate cancer will put their natural functions at risk, including sexual and urinary health. There are many options for treatment, and we’ve gotten better at minimizing side effects.
The key to finding the right treatment for the right patient is through shared decision-making. At UCLA, we use a computer program to help patients select the best treatment for them, based on their personal probabilities, side effects and preferences.
The first option is surgery, which is performed with a surgical robot to minimize incisions and preserve your pelvic functions. Other options aim to protect healthy tissue surrounding the cancer by targeting the treatment, either through external beam therapy, which uses a high dose of radiation to destroy cancer cells, or brachytherapy — where small radioactive seeds inserted into the prostate deliver precise treatment.
There is also cryotherapy, which freezes cancer tissue to kill it, and energy-ablative techniques that use high-energy heat waves to target the cancer tissue. These techniques don’t have the same track record as surgery and radiation, but can offer lower side effects in the right patient.
What steps can patients take to prevent prostate cancer?
Dr. Saigal: There is a medication called finasteride that can reduce the risk of prostate cancer by 30%, but it has been found to cause side effects, including reduced libido.
Otherwise, it is recommended to keep a healthy weight, try to eat whole foods and continue to get screened regularly.
