Kleven: What men need to know about prostate cancer

Dr. Michael Kleven, DO

Submitted photo

Men should take the opportunity to discuss the potential benefits and harms of screening directly with their doctor and incorporate their own values and personal preferences in the final decision.”

Prostate cancer is the second-most common cancer among men and the second-leading cause of cancer death among American men. While this is an important subject to talk about year-round, Prostate Cancer Awareness Month in September is an ideal opportunity to bring the discussion front and center.

According to the American Cancer Society, nearly 300,000 new cases of prostate cancer will be diagnosed in 2024. And in Arizona, in 2021, the most recent year of full reporting, there were 3,393 prostate cancer cases reported. During their lifetime, about 1 in 8 men will be diagnosed with prostate cancer.

Prostate cancer occurs when cells in the prostate, a small organ in males located below the bladder and in front of the rectum, begin to grow out of control. It has a wide range of possible symptoms, though most men don’t experience early symptoms or warning signs at all.

When symptoms do present, they can include:

• Pain or burning during urination

• Painful ejaculation

• Blood in the urine or semen

• Frequent urination (especially at night)

• Difficulty emptying the bladder completely

• Pain in the back, hips or pelvis that does not go away

• Difficulty starting urination or weak or interrupted flow of urine

While it is important to keep in mind that many of the above may be caused by conditions other than prostate cancer, you should see your doctor right away if you experience any of these symptoms. But again, prostate cancer often doesn’t present with symptoms, especially in the early stages. And that’s where screening enters the discussion.

The goal of screening is to find cancer early before it causes symptoms or has spread and is more difficult to treat and more deadly. There is no single, standard test for prostate cancer screening, although two of the most common are:

• Prostate-specific antigen (PSA) test — a blood test that measures the level of PSA in the blood. PSA, a substance made by the prostate, can be present at higher levels in men with prostate cancer. High levels of PSA can also indicate another prostate condition that is not cancer. PSA levels can also be impacted by certain medications or medical procedures.

• Digital rectal examination (DRE) — a health care professional puts a gloved, lubricated finger into a man’s rectum to feel for any prostate abnormalities.

According to current recommendations by the U.S. Preventive Task Force, for men ages 55 to 69, the decision to undergo periodic PSA screening should be an individual one in which men discuss with their clinician the potential benefits and harms of screening including their values and preferences in decision making. The USPSTF does not recommend it for men 70 years and older. Additionally, the USPSTF does not recommend DRE screening, citing a lack of evidence of its benefits.

Men should take the opportunity to discuss the potential benefits and harms of screening directly with their doctor and incorporate their own values and personal preferences in the final decision.

Screening may offer a small potential reduction in the risk of death from prostate cancer in some men. However, many men may experience harm from screening, including overdiagnosis and overtreatment, as well as significant treatment complications including erectile dysfunction and incontinence.

As with most matters affecting your health, talk to your doctor about your options, risk factors, and your concerns. This can help you make the most informed decisions.

Editor’s note: Dr. Michael Kleven, DO is a primary care physician with Optum Arizona. Reader reactions, pro or con, are welcomed at AzOpinions@iniusa.org.