Prostate cancer is a cancer that starts in the prostate, a walnut-sized gland found right below the bladder in men. If it isn’t treated, prostate cancer follows a natural course, starting as a tiny, microscopic group of abnormal cancer cells that grows into a full-blown tumor. In some men, prostate cancer that isn’t treated can spread (metastasize) and cause death. Women can not get prostate cancer!
- Most men diagnosed with prostate cancer, many of whom receive early and aggressive treatment (at least in the developed world), do not die from this disease.
- At the same time, many men diagnosed with prostate cancer who are not treated also do not die of this disease.
- This means that not all men diagnosed with prostate cancer need treatment.
“Do I or do I not have prostate cancer that needs to be treated?” is thus one of the really hard questions facing every man diagnosed with prostate cancer.
The Global Epidemiology of Prostate Cancer
With an estimated worldwide incidence of 25.3 per 100,000 men (i.e., 1.5 million new cases per year), prostate cancer is the second most common cancer in males, and there are major differences in its incidence from country to country. The global epidemiology of prostate cancer was most recently reviewed by Nelen.
Important clues on risk factors remain to be found, but age, genetic factors, and environmental influences have been extensively studied. The global incidence of prostate cancer appears to have increased over the last two decades, but this is largely a consequence of improvements in procedures for early detection.
The global prostate cancer mortality rate of 8.1 per 100,000 (i.e., just under 500,000 deaths each year) mainly impacts men at older ages; increases in this rate over time and differences between countries are markedly smaller than for incidence.
Prostate Cancer in the USA
Prostate cancer is the most common form of cancer in American men (with the exception of non-malignant skin cancer). More men die from prostate cancer than from any other form of cancer except lung cancer. According to Siegel et al. there are going to be 233,000 new cases of prostate cancer diagnosed in the USA in 2014 and 29,480 men are expected to die of prostate cancer this year. This means that about one in every six men will be diagnosed with prostate cancer during their lifetime and two to three in every 100 men will die of prostate cancer.
To put this in perspective, you should know that about 650,000 male Americans were expected to have a heart attack in 2008 and over 280,000 of them were expected to die as a consequence. A man is therefore about three times more likely to have a heart attack than to be diagnosed with prostate cancer and nine times more like to die of a heart attack than from prostate cancer.
Penson and Chan have provided a very thorough and readable overview of the medical and economic burden that prostate cancer has placed on Americans over the past 30 years, including the changing patterns of diagnosis and management. Their complete article can be found on line.
What’s Your Risk for Prostate Cancer?
There are some things that put or may put you personally at higher risk for prostate cancer. They include:
The older you get, the higher the chance you will be diagnosed with prostate cancer. If you are lucky enough to live to 100, it is a near certainty that you will have at least some cancer in your prostate — but the chance of it killing you will be tiny.
Men with a family history of prostate cancer are at greater risk for prostate cancer than men with no family history. It is worth knowing whether your grandfathers, your uncles, and particularly your father or your brothers have or had prostate cancer.
If you are an African American, you are at greater risk for prostate cancer than if you are white, Hispanic, Asian, or Native American.
What Else Do You Need to Know?
Please click here to learn the 10 most important facts about prostate cancer.
As you learn more, you will come across all sorts of reports and claims, many of which are not proved to be true. For example, there is no association between bicycling and prostate cancer risk and no clearly established linkage between sexual activity and prostate cancer risk (but bicycling can and does raise some men’s PSA levels — see below).
In most men prostate cancer is a slowly developing disease. If it is detected early there is plenty of time for curative treatment (if treatment is needed at all). However, there are some aggressive forms of prostate cancer that can progress very quickly. The key to effective management is early detection, before prostate cancer has a chance to spread.
In its earliest stages, the risk for prostate cancer may be suspected solely on the basis of levels of a protein called prostate specific antigen (PSA), which can be measured using a blood test. However, not all tumors produce enough PSA to become detectable.
Regardless of PSA test results, some prostate cancers can be detected early with a physical examination in which the doctor examines the prostate with a finger inserted into the rectum. This is called a digital rectal exam (DRE).
There is increasingly good evidence that early detection, combined with treatment for appropriately selected patients, is associated with lower risk of death from prostate cancer. However, this does not mean that mass, population-based, annual “screening” of all men over a certain age is similarly associated with a reduction in risk for prostate cancer-specific or overall mortality.