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    Men's Cancers & the Importance of Early Detection

    Deaconess Clinic Urology and Deaconess Clinic ​Oncology 06/20/2014

    There are two cancers that are exclusive to men—prostate and testicular cancers.  Like all cancers, it is best to catch them early for the best chance of a good prognosis.
    Prostate cancer is the most common cancer in men (aside from skin cancer), and more than 230,000 cases are diagnosed each year in the US.  It is the second leading cause of cancer death in American men (behind lung cancer). The prostate gland is part of the male reproductive system, and is located just below the bladder.  Its main role is to produce fluid for semen, which transports sperm during ejaculation.
    Testicular cancer is not as common, but it can be particularly serious because it often occurs in very young men.  Almost half of all cases of testicular cancer are in men between the ages of 20 and 34; however, cancer of the testicles can develop in males of any age, from infants to elderly men.

    How is testicular cancer detected?
    Most testicular cancers can be found at an early stage. The key is for a man to be aware of changes in his own body, and then for him to bring any concerning changes to the attention of his doctor. Typically, a lump on a testicle is the first sign, or the testicle might be swollen or larger than normal.
    Most physicians agree that an examination of a man’s testicles should be part of a general annual exam. Some doctors recommend that all men examine their testicles monthly after puberty (in much the same way that women may do breast self-exams). Ultimately, if a man finds a concerning mass or other change in his testicles, he should visit his doctor as soon as possible.  An ultrasound and blood tests can help determine if testicular cancer is present.
    Prostate Cancer Screening
    Prostate cancer screening is usually part of a man’s annual physical exam beginning around age 50.  Some doctors will start screening earlier, especially if the man has a family history of prostate cancer.  African Americans are a higher risk of prostate cancer, and should also start screening at an earlier age.
    What does the screening include?
    There are two parts to screening. One is a PSA (prostate specific antigen) blood test. It’s a simple needle stick, where a small vial of blood will be taken, and is checked for a chemical made by the prostate gland.  A high—or increasing—PSA level can indicate the presence of cancer.
    The other test is a digital rectal exam (DRE). Your physician inserts a lubricated gloved finger into the rectum to feel for a tumor.  It takes less than a minute to complete. (There are some men who are, shall we say, reluctant to complete that last part of the screening because of embarrassment.  I want to assure all men that your doctor has literally done thousands of these exams, and think nothing of the process.  Also, isn’t it worth a moment of discomfort to possibly live a lot longer?)
    There are government bodies who recommend against PSA screening; however, the American Urologic Association disagrees. As urologists, we have seen a dramatic decrease in metastatic cancer and disability from prostate cancer because of the PSA test. It’s a tool to help us catch it early.
    If you are screened, your cancer is often found earlier. That means the cancer is found before it has spread to other areas of the body (which we call metastasis). It’s better to find any cancer early, when it is more likely to be treatable and even curable.
    So once a man is diagnosed with prostate cancer, the next question is often “how much time do I have left?’
    For early stage prostate cancer, the 5 year survival rate is nearly 100%.  Even for higher risk cancers, the 5 year survival rate is very high. The things that determine how high risk the cancer is include:

    • Gleason score.  The Gleason score is a grading scale that indicates how fast growing, or aggressive, the cancer is.  The higher the grade, the faster the cancer is likely to be growing.
    • PSA levels.  Higher PSA levels are indicative of more advanced cancers.
    • Total amount of cancer in prostate (how extensive it is on biopsy).  Is the cancer in just a small area of the prostate, or is it throughout the gland?
    • Other minor factors

    Prostate cancer is often a very slow growing cancer. In fact, it’s not often that men die of prostate cancer within 10 years of detection (especially if it is detected early). Therefore, some men may choose no treatment at all. Other health issues may take precedence, and there may be little to no benefit to treat low risk prostate cancer. So many low grade early stage cancers can just be watched, to see if they grow significantly or show signs of increased aggression. However, higher grade cancers should be treated. If the cancer is localized (still within the prostate), treatment options include:

    • Surgery
    • Radiation
    • Cryotherapy (freezing the prostate)

    All of these can be good options, but the best option depends on your particular cancer.  A patient should also work with his doctor to get a full understanding of the side effects of each treatment.

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