Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. 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 difficulty urinating, urinary retention, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease such as fatigue, nausea, weakness, back pain, swollen lymph nodes, discomfort in the perineum, hip pain, or weight loss. Blood may be present in the urine. Most prostatic cancers are detected in asymptomatic men who have an elevated PSA (Prostate Specific Antigen) level or a nodular or enlarged prostate at the time of examination.
Prostate cancer screening is utilized to detect the tumor while it is localized in the prostate and is most easily and successfully treated. Biopsy of the prostate is essential for establishing the diagnosis and is indicated when an abnormality is detected by palpation or elevated PSA.
Recent data suggests that prostate cancer screening may lead to overtreatment in men who do not actually need any cancer treatment. The study reviewed information from 123,934 men with newly diagnosed prostate cancer. Researchers found that 14 percent had PSA values below 4 ng/mL, 73.5 percent were between 4.1 and 20 ng/mL and 12.5 percent had levels above 20 ng/mL. Men with screen-detected prostate cancer and PSA values less than 4 ng/mL were 1.49 and 1.39 times more likely to receive radical prostatectomy and radiation therapy, respectively, and were less likely to have high-grade disease than men who had non-screen-detected prostate cancer. This means that many men with low-risk prostate cancer are receiving aggressive cancer treatment even though active surveillance may be a safer and acceptable alternative for some men with PSA levels below 10 ng/mL.1
1 Shao YH, Albertsen PC, Roberts CB, et al. Risk profiles and treatment patterns among men diagnosed as having prostate cancer and a prostate-specific antigen level below 4.0 ng/ml. Arch Intern Med. 2010;170(14);1256-61.