By Dr Ananya Mandal, MD
Some of the common questions that men ask regarding prostate cancer include:
1. Can prostate cancer be inherited?
Genetics are thought to play a role in a small number of prostate cancers. Men who have a first-degree relative such as a father or brother who have been affected by prostate cancer are twice as likely to develop this cancer. In hereditary forms of prostate cancer, disease course usually begins at an earlier age (before age 65) than in non-hereditary forms.
2. Is screening for prostate cancer important?
Yes, the American Cancer Society (ACS) advises that men should have the opportunity to discuss the possibility of being screened for prostate cancer with their healthcare adviser and be provided with information about the potential risks and benefits of screening.
The ACS advises that such a discussion should take place at age 50 for those at an average risk of prostate cancer, at age 45 among those at high risk (those with a first-degree relative affected by the condition before the age of 65), and at age 40 in those at very high risk (those with more than one first-degree relative affected before the age of 65).
Screening involves routine blood tests for prostate-specific antigen (PSA) and digital rectal examination (DRE) to check for abnormalities in the prostate.
3. After detection, what are the chances of spread and growth of the cancer?
Prostate cancer is a slow growing cancer and it may take years before the cancer spreads to other organs and bones. A system called the Gleason grading system can be used to help determine the prognosis of a patient with prostate cancer.
4. What is the Gleason score?
Prostate cancers are categorized according to the Gleason grading system which assigns a cancer grade on a scale of 1 and 5, based on the number of cells from the prostate tissue biopsy that look like normal prostate tissue. A tumor categorized as Gleason grade 1 or 2 has a relatively normal architecture and a tumor differentiation that is considered close to healthy prostate tissue.
Most prostate cancers feature a grade 3 cellular pattern characterized by large, widely spaced and abnormally shaped cells. A grade 5 pattern is very irregular and features large sheets or clusters of abnormal cells.
5. What is active surveillance? Should it be considered?
Since prostate cancer is mostly slow growing, treatment is sometimes delayed (especially in those who are elderly or suffer from other ailments) and, instead, the cancer is regularly monitored to check its progression. Monitoring involves assessing PSA levels and performing DREs and transrectal ultrasounds at regular intervals (usually around 3 to 6 monthly) to see if the cancer is growing or changing.
6. Can prostate cancer be prevented?
The exact cause of this cancer is not known and is therefore not yet preventable. Many of the risk factors such as advancing age and family history for the condition are non-modifiable factors. However, some of the lifestyle factors such as body weight, physical activity, diet, and smoking and drinking habits can be altered to decrease the risk for developing this cancer.
Reviewed by Sally Robertson, BSc