Prostate cancer is the second most common cancer among men in the United States, after skin cancer, and the number of cases has been rising yearly. About one man in eight will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society.
Prostate cancer comes in many different forms, which is why Mount Sinai offers a wide variety of treatment options while conducting research to find new and innovative treatments and expanding care to those communities most at risk.
“The most important thing people can do is find this cancer early, when it is easier to cure. That starts with understanding your own risk, and talking with your doctor before there are any symptoms,” says Ash Tewari, MBBS, MCh, FRCS (Hon.), Professor and Chair, Milton and Carroll Petrie Department of Urology and Director of the Center of Excellence for Prostate Cancer at The Tisch Cancer Institute at Mount Sinai.
One key message remains unchanged: Prostate cancer screening is critical to detecting this cancer early, before you have any symptoms, when you have more treatment options.
In this Q&A, Dr. Tewari, who is also Surgeon-in-Chief of the Tisch Cancer Hospital at The Mount Sinai Hospital, explains when men should be tested for prostate cancer and what options are available to those who may be diagnosed with prostate cancer.
What should patients and consumers know about the rise of prostate cancer?
Ash Tewari, MBBS, MCh, FRCS (Hon.)
It is likely that this perceived rise of prostate cancer is not a true rise in prostate cancer incidence but rather there has been increased awareness about testing and screening. This is a good thing because we can prioritize delivering care to those who need it and make sure they are managed appropriately.
Who should be tested for prostate cancer, and when?
The decision of when to initiate screening should be an individual one that is based on shared decision making between physician and patient. There are several factors to consider including race, family history of cancer (not only prostate but also breast, ovarian, and pancreatic cancer), and age. According to the U.S. Preventative Services Task Force, all men over the age of 55 should have this conversation with their physician about the decision to begin screening with Prostate-Specific Antigen (PSA) testing. Patients who are at higher risk, such as those with family history, should start this conversation earlier, and some as early as age 40.
Who is most at risk for prostate cancer?
Those who are most at risk of prostate cancer include:
- Black men
- Men with a family history of prostate cancer and other cancers
- Men over 55 years old
- Men who have done genetic testing and were found to have mutations, such as BRCA2, that are known to be correlated with a higher risk of prostate cancer
How is prostate cancer diagnosed?
Prostate cancer is diagnosed when a PSA test rises above a certain threshold, and a biopsy becomes indicated. A biopsy can be done even if PSA is not above threshold—for example if a patient has other factors that might put him at risk or has a concerning magnetic resonance imaging (MRI) test. This biopsy can be performed transperineally or transrectally. Sometimes, this biopsy is guided by imaging tests such as an MRI and micro-ultrasound imaging to increase the sensitivity of the biopsy.
How do doctors use the PSA test?
The PSA test is a blood test that can be used for screening. It also is used as a marker to track treatment response and for surveillance to detect recurrences after treatment. A single PSA test is often insufficient to draw meaningful conclusions. A single elevated PSA during screening is followed up with another PSA test to corroborate that the rise was not due to other factors, such as the result of inflammation or infection in the prostate.
What treatments are available for prostate cancer?
If you are diagnosed with prostate cancer, what follows next would be a discussion with your doctor about next steps. The conversation depends largely on the type of prostate cancer diagnosed. There are a number of different types and grades of prostate cancer, and treatment must be appropriate for the individual patient. Some patients are diagnosed with a disease that is confined to the prostate. Options for these patients range from active surveillance for low-risk disease to radical treatments such as radiation or surgery for intermediate-risk and high-risk disease. There are also emerging experimental therapies, called focal therapies, that are being investigated for their appropriateness and safety for certain patients. For advanced and metastatic disease, sometimes hormones and other treatments that target the entire body, such as chemotherapy may be used. This is also a very active field of research. There is a tremendous effort to improve the outcomes and quality of life for patients.
What is active surveillance, and why is that important?
Active surveillance is an approach that is used for patients who have low-risk and very low-risk cancer confined to the prostate. Because these cancers are usually slow growing and do not involve complications or pain, we prefer not to implement radical treatments if they are not necessary, and so active surveillance can be a good option for them. This protocol often involves periodic imaging and biopsies to monitor the disease and intervene only if necessary.
Can I reduce my risk for prostate cancer?
There is no evidence that one lifestyle choice will either cause or prevent prostate cancer. Studies show that patients who eat more vegetables and less red meat, and patients who exercise regularly, are at lower risk for prostate cancer. Overall, leading a healthy lifestyle has many wide-reaching benefits.
What steps is Mount Sinai taking to bring prostate cancer screening to the community?
In 2022, we launched the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit, a state-of-the-art mobile facility equipped with advanced PSA tests and trained staff that visits predominantly Black neighborhoods across New York City. We are very excited about this initiative. We want to reach patients who cannot easily access a urologist, and we want to make it easier to screen for prostate cancer and treat them if necessary to save their lives. So far, we have screened more than 3,000 patients and of those, we have found several hundred with elevated PSAs that required further follow up. We detected cancer in 30 patients and conducted surgery to remove the cancer in half of these patients. In addition, we are following up with these patients to make sure they have the most appropriate testing and treatment.