After skin cancer, prostate cancer is the most common cancer diagnosed among men in the United States, and about one in eight men will be diagnosed with the disease during their lifetime.
“Many patients are understandably distressed to learn that they have prostate cancer,” says urologist Christopher Anderson, MD, assistant professor of urology at Columbia University Vagelos College of Physicians and Surgeons and a specialist in the treatment of prostate cancer. “Much of my job is to help men understand their cancer and what kind of risk it may pose to them.”
Though prostate cancer is one of the most treatable types of cancers with high survival rates, treatments may lead to short- or long-term urinary, bowel, and sexual side effects.
But Anderson adds that newer approaches to treatment in the past 10 to 20 years have meant that many men don’t need aggressive treatment and advances in treatment techniques may reduce side effects.
We talked with Anderson to get the facts about prostate cancer and how it’s treated today.
For many, the initial treatment for prostate cancer is no treatment.
For many men, Anderson says, prostate cancer is not life-threatening and does not require aggressive treatment.
“For many men with newly diagnosed prostate cancer, we start with careful observation, what’s known as active surveillance,” he says. “That is now the standard of care for many men, because we’ve learned that most low-grade prostate cancers are not life-threatening.”
Historically, men diagnosed with a low-risk prostate cancer were often treated with surgery or radiation. But today, according to a recent study, about 60% of men in the United States with low-risk prostate cancers are now being managed by active surveillance. At Columbia, active surveillance is nearly always discussed as an option for patients with favorable risk factors.
Active surveillance plans are personalized for each patient, though typically involve repeated PSA tests, imaging, and biopsies at regular intervals, Anderson says.
Certain men have a higher risk.
Like most cancers, the risk of prostate cancer goes up with age. “Most men who are diagnosed with prostate cancer are between the ages of 50 and 70,” Anderson says, “which is when we screen for prostate cancer.”
Certain men have a higher than average risk of developing prostate cancer, including men with a brother or father who was diagnosed with prostate cancer and those who harbor certain hereditary cancer genes, such as BRCA. Men of African descent also have a higher chance of developing prostate cancer.
These men, Anderson says, should discuss the option of earlier screening with their physicians.
PSA tests are still important detection tools.
Physicians screen for prostate cancer using a blood test called prostate specific antigen (PSA). This screening test allows doctors to detect men’s cancers when they are smaller and more likely to be curable. PSA tests are not perfect but are still an important tool in detecting prostate cancer early, says Anderson.
Though the tests have been criticized in the past, Anderson says that doctors today are smarter about interpreting the results. “Today, we no longer biopsy everyone with an abnormal PSA. Instead, we often use additional tests to identify which men are at low risk of having a significant prostate cancer and can avoid invasive testing,” he says.
In addition, for men who require a prostate biopsy, the use of pre-biopsy prostate MRI allows for biopsies to be targeted very precisely to suspicious areas inside the prostate, thereby improving biopsy accuracy.
As a result of early detection from screening, most men have no signs and symptoms at all when their prostate cancer is diagnosed.
When treatment is needed, a team approach is best.
According to a recent study, about half of men on active surveillance will receive treatment within five years. For men who have more aggressive cancers, some may require curative treatment.
When an aggressive cancer is confined to the prostate, several treatment options may be considered, including surgery and radiation. “Each of these approaches has various risks and benefits, which is why we have a long, extensive conversation with patients to understand each man’s treatment goals and which of these different options makes the most sense for him,” Anderson says.
At Columbia, doctors take a team-based approach to prostate cancer care. Patients often have a team of specialists—surgeons, medical oncologists, pathologists, radiologists, and radiation oncologists—that work together to identify treatment options best suited for each patient given the cancer’s characteristics and the patient’s treatment goals.
For patients with more aggressive cancers or cancers that have spread, new medications, including next-generation hormonal therapies, are available and have improved outcomes compared to older medications.
New surgical and radiation techniques may minimize side effects.
For patients who elect to have surgery, robotic techniques provide excellent results and try to minimize side effects. At Columbia, surgeons use the DaVinci robotic platform to perform a minimally invasive prostatectomy that helps patients recover after surgery. For patients who have radiation, new machines help minimize side effects to surrounding tissues by creating more precise radiation fields to the prostate.
But urinary and sexual side effects may still occur even with the latest treatments.
“Though advances in surgical and radiation techniques work towards minimizing treatment side effects, men who have treatment for prostate cancer are at risk for changes to sexual, urinary, and bowel function,” Anderson says. “While we work hard to help patients avoid side effects by utilizing less-aggressive treatments when appropriate, our survivorship team of specialists in urinary function and sexual health is able to expertly diagnose and manage treatment side effects.”