Prostate Cancer: Second Most Common Cancer in Men

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Although 1 in 5 men in this country will develop prostate cancer — the second most common cancer in men — in his lifetime (roughly 198,000 new cases are reported in this country each year), most are only vaguely aware of the disease.

Count Rev. Thomas Walker, a Baptist minister from Rocky Mount, North Carolina, among that number of uninformed. When he got a prostate cancer diagnosis six years ago, he was stunned. He didn’t know much about the disease; he only knew his "symptoms were inconvenient. I thought it might be some type of infection," he says. "I didn’t relate it to prostate problems. I never suspected I had a cancer."

Prostate cancer starts in the walnut–sized prostate gland, located just below the bladder and in front of the rectum. It is usually found in men 50 years or older, and a man’s risk of developing the disease is higher if there is a family history of the disease.

The prostate–specific antigen (PSA) test, which determines how much PSA is circulating in a man’s bloodstream, has been the gold standard for checking a man’s prostate for cancer since its development in the 1980s. Normal prostate glands make some PSA, but enlarged glands make more. An elevated PSA level doesn’t automatically indicate cancer, but a level higher than 4 usually leads doctors to perform a prostate biopsy.

But there is much controversy surrounding prostate cancer and the PSA test these days.

There are now different ways to look at serum PSA: total PSA, free PSA, age–adjusted PSA, ethnically adjusted PSA, PSA velocity and PSA density. Total PSA’s cut–off point of 4 is more sensitive than the free PSA cut–off point of less than 25 percent, making the free PSA reading more specific for a diagnosis of cancer and often making unnecessary the need for biopsy in about 20 percent of patients who would otherwise undergo this procedure based upon total PSA alone. But not all doctors perform the more specific PSA tests, relying instead on total PSA alone.

Another wrinkle: The American Cancer Society recommends PSA tests and digital rectal exams beginning at age 50. But since PSA testing has become widespread, the number of men who have surgery or radiation therapy for prostate cancer has increased significantly. But many prostate cancers grow slowly, and some medical experts believe men may have unnecessarily aggressive treatment of tumors that might never have given them trouble.

In fact, several medical organizations have gone on record opposing mass screenings. The debate comes from the Prostate, Lung, Colorectal and Ovarian (PLCO) trial, a current National Cancer Institute study of roughly 154,000 adults. In the study, men either receive an annual PSA test and digital rectal exam or they get normal care from their regular doctors. Men whose baseline PSA level is below 1 can, it is believed by medical experts, forego the annual PSA and wait five years. Men with PSA levels between 1.1 and 2 can safely have the test every other year. Only men who have a PSA level between 2 and 4 should be tested on a yearly basis.

But for Black men, who are more likely to be diagnosed and die from prostate cancer, this debate could mean the difference between life and death. That prostate cancer hits African–American men particularly hard is well documented. Three national cancer surveys have found Black men have a 34 percent greater chance of being diagnosed with the disease and a 123 percent greater change of dying from it than white men. According to the American Cancer Society, it is twice as common among African–American men as white men. The reasons why these discrepancies exist are not so clear.

What is clear is that waiting until age 50 to begin yearly PSA testing is probably too late for African–American men. "[The fact that black men are dying at higher rates] has a great deal to do with late detection and a lack of aggressive treatment," says William Baker, M.D., assistant professor of urology at the University of California, Davis. "There is something we eat, how we are educated, how we act when faced with life–threatening problems and our ability to access quality medical care that sets us apart from whites and other ethnic groups."

"Many African–American men harbor a keen mistrust of the medical profession because of historical bias and mistreatment," Dr. Baker says. In addition, many men wrongly believe prostate cancer can be caused by an injury to the genitals or masturbation. Some fear loss of their manhood; others think the disease equals an instant death sentence.

According to Dr. Baker, education, prevention and early detection are essential for black men.

Terry Mason, M.D., a prostate cancer specialist, agrees: Every African–American man should have a PSA test and digital rectal exam yearly after age 40, Dr. Mason says. Those with a first–degree family history of the disease should begin testing at age 35.

Yearly exams, plus these lifestyle changes, can help prevent prostate cancer:

  • eat a high–fiber, low–fat diet
  • exercise at least 20 minutes a day, three times a week
  • stop smoking
  • reduce alcohol consumption

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