Discuss the risk factors, common presentation and physical exam findings of prostate cancer. Discuss the most recent American Cancer Society guidelines for prostate cancer screening.
Prostate cancer is one of the most common forms of cancer among men, with a lifetime risk of about 1 in 8. It is a disease in which cancer cells develop in the prostate gland, which is responsible for producing seminal fluid. The risk of prostate cancer increases with age, with most cases being diagnosed in men over 65 years old.
Risk factors for prostate cancer include age, family history of the disease, and race. African American men are at higher risk of developing prostate cancer than men of other races, and they are also more likely to be diagnosed at an advanced stage of the disease. Other risk factors include a high-fat diet, obesity, and a sedentary lifestyle.
The most common presentation of prostate cancer is the absence of symptoms. In many cases, prostate cancer is discovered during routine screening tests, such as a prostate-specific antigen (PSA) blood test or a digital rectal exam (DRE). However, as the cancer progresses, some men may experience symptoms such as difficulty urinating, frequent urination, blood in the urine or semen, or pain in the back, hips, or pelvis.
During a physical exam, a healthcare provider may perform a DRE to feel the size, shape, and texture of the prostate gland. They may also order a PSA blood test to measure the level of PSA in the bloodstream. A high PSA level may indicate the presence of prostate cancer or other conditions, such as an enlarged prostate or inflammation of the prostate gland.
In recent years, there has been some controversy surrounding the use of PSA testing for prostate cancer screening. In response to this, the American Cancer Society (ACS) released updated guidelines for prostate cancer screening in 2020. These guidelines recommend that men discuss the potential benefits and harms of prostate cancer screening with their healthcare provider starting at age 50 (or earlier for men at higher risk), and make an informed decision based on their personal values and preferences.
For men at average risk of prostate cancer, the ACS recommends that screening with a PSA blood test occur every two years for those who choose to be screened. However, for men at higher risk, such as African American men or men with a family history of prostate cancer, the ACS recommends that screening begin at age 45. For men with a strong family history of prostate cancer, screening may begin even earlier, at age 40.
In conclusion, prostate cancer is a common cancer in men, with age, family history, and race being significant risk factors. Physical exams and PSA testing can help detect prostate cancer, but the benefits and risks of screening should be discussed with a healthcare provider. The most recent ACS guidelines recommend that men make an informed decision about prostate cancer screening based on their individual preferences and risk factors.