Prostate Cancer

What it is

Prostate cancer forms in the tissues of the prostate, a small gland below the bladder in men.

It is the most common cancer among men in the United States and the second leading cause of cancer death among them. Both of those things are true at once, and the reason is worth understanding: the disease is very common, and most of it is not aggressive.

NCI puts the key point this way: prostate cancer usually grows very slowly, and finding and treating it before symptoms occur may not improve men's health or help them live longer.

What to watch for

NCI lists these, and notes they may be caused by prostate cancer or by other conditions:

• Trouble starting the flow of urine
• Needing to urinate often, especially at night
• Trouble emptying the bladder completely
• A weak or interrupted stop-and-go flow

If the cancer has spread, NCI adds pain in the back, hips, or pelvis, shortness of breath, fatigue, a fast heartbeat, dizziness, and pale skin from anemia.

Most men with these urinary changes do not have cancer. An enlarged prostate that is not cancer causes the same symptoms and is very common with age. That is a reason to get it checked, not a reason to panic.

What raises the risk

From NCI's prevention summary:

Things nobody can change: age, above all. NCI says prostate cancer is rare in men younger than 50. A father, brother, or son who had it. Race, with the disease occurring more often in African American men. Hormones.

Things related to what you take: NCI reports that vitamin E alone and high-dose folic acid supplements both increased risk in trials, and that a diet high in dairy foods and calcium may cause a small increase.

NCI also lists things where the evidence is not settled, including selenium, multivitamins, lycopene, and dietary change in general. Two drugs, finasteride and dutasteride, reduced how often prostate cancer occurred in prevention trials.

Is there a test before symptoms start?

There are two tests, and no simple yes.

The tests are the PSA blood test and the digital rectal exam. NCI's summary states that screening has not been shown to reduce deaths from prostate cancer, and lists the harms: finding cancers that may never cause symptoms, complications from biopsies, and false results that lead to anxiety and unnecessary procedures.

The US Preventive Services Task Force reflects that. For men aged 55 to 69 it gives a grade C: the decision to have periodic PSA screening "should be an individual one." For men 70 and older it gives a grade D and recommends against PSA screening.

Grade C does not mean don't. It means the benefit is small enough that what you value matters as much as the statistics do. That makes this a genuine conversation with a clinician rather than a box to tick.