Prostate cancer is periodically in the news, often when a celebrity or public figure announces they are undergoing treatment. But experts say that for older men, prostate cancer should be something they regularly discuss with their health care providers, and the key for most men is to understand the need for regular prostate cancer screenings.

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. It’s also the second-leading cause of cancer death (after lung cancer). About one in eight men will get prostate cancer in their lifetime.

However, in many cases, men can recognize and manage this disease through testing and early detection, according to Ash Tewari, MBBS, MCh, FRCS (Hon.), DSc (Hon.), Professor and Chair, Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai.

“The one thing men should know is that they should understand the risk and get tested,” says Dr. Tewari,  a leading expert on prostate health and an advocate for expanding efforts to get men tested for prostate cancer. “That’s one thing that makes all the difference.”

In this Q&A, Dr. Tewari, who is also Director of the Center of Excellence for Prostate Cancer at The Tisch Cancer Institute at Mount Sinai, explains when men should be tested for prostate cancer, how to assess your risk, and how regular testing is critical to identifying cancer earlier when treatment is significantly more successful, especially for those who may be at higher risk.

What are the warning signs of prostate cancer?

Prostate cancer is a silent killer. No symptoms will show up before the cancer has grown and has become incurable. The message here is: Don’t expect cancer to declare itself. You should go out and look for it. You should understand the risk. If you find it early enough, it’s very curable. But if you wait for the signs and symptoms to come and the cancer declares itself, the battle is usually a difficult battle. It’s a silent killer, don’t wait for the symptoms.

What are the symptoms?

Symptoms can happen when the cancer is quite advanced. People may have difficulty in passing urine, they may have some pain, they may have some blood in their urine. That usually is a sign that the cancer is growing into the areas surrounding the prostate. But similar symptoms can happen even if there is no cancer. For example, an enlarged prostate—a condition called benign prostatic hyperplasia, or BPH—can produce these symptoms. It can be confusing. My message remains the same: Look for prostate cancer, and get screened, especially if you have a high risk, and that’s what saves lives.

When should men get tested for prostate cancer?

Men normally should start having a conversation with their primary care doctor or a urologist when they are about 45 to 50 years of age. When we talk about the testing, it’s not just about the test, it’s also what are the implications of the test—what we call shared decision making.

On average, any man 50 to 69 years old should be having a discussion with their doctors about prostate-specific antigen (PSA) screening, and older men should also discuss prostate cancer with their doctor. But we can have this conversation earlier. For example, if someone has a family history of prostate cancer, is BRCA positive, or is African American, we could consider that group to have a high risk of prostate cancer. That discussion can start at about age 40. It is all about the individual’s risk for prostate cancer. Prostate cancer can be checked, and that’s the beauty of it.

About 288,000 men were diagnosed with prostate cancer last year. About 34,700 men died due to prostate cancer last year, and the majority of these deaths were avoidable if we had found the cancer early. PSA screening is a simple blood test. I think of PSA as standing for “Please Stay Alert.” There are other ways of testing, including a digital rectal exam, ultrasound and MRI scans, and other tests of your blood and urine. But the discussion starts with the PSA, and people should talk about what this PSA can do for them.

How can you minimize the risk of prostate cancer?

Those at high risk can do a lot to prevent this cancer and live healthier lives. It’s not rocket science. It starts with diet and nutrition—cutting down on carbs and processed food, balancing your diet, having more lean protein, avoiding red meat, cutting down on smoking and alcohol. And exercising a lot. I mean about 30 minutes a day, three to four times a week. Combining all of these is one of the biggest preventive factors in prostate cancer risk. Obviously, testing early makes all the difference.

How treatable is prostate cancer?

If we find prostate cancer early, we can cure it 98 to 99 percent of the time. But think about it: Despite this high cure rate, we still lost 34,700 men last year. Why did that happen? Because we are finding the cancer a little late. In five percent of patients, when we find cancer, they already have a cancer that has advanced to their bones, to the lymph nodes, to other parts of the body. We call it metastatic cancer.

Finding cancer when it is confined within the prostate makes all the difference. At that time, it’s very curable, and the cure can come in many different forms. We have nerve sparing procedures in which we can remove the prostate using minimally invasive, robotic surgery, and the patient is cured of the cancer in a majority of times. We have new kinds of radiation therapies that can do the same job in a select group of patients. In many cases, prostate cancer doesn’t even need active treatment. Patients can be closely monitored in what we call “active surveillance.” We have many forms of the treatment. An expert can tell exactly what is suitable for each person, based on the type of cancer, how far it has progressed, and personal choices. Hope is there, but we need to fight it early.

What role does family history play in prostate cancer risk?

When I ask people about their cancer, they often say, “I never talked to anyone in the family about medical issues.” That’s not a good answer. Basically, if people have many members in the family who had prostate cancer, or if there is breast cancer, uterine cancer, or pancreatic cancer in the family, that tells us they are from a family with high risk of prostate cancer. For example, the BRCA2 gene that can increase the risk of breast cancer in women is known to be correlated with a higher risk of prostate cancer. Knowing there are members in your family going through the same journey should make you a little more cautious, and that can save your life.

Eye examinations reveal a lot about a person’s general health. With multiple sclerosis, what is found deep inside an eye may yield an initial diagnosis of the chronic disease, and yearly checkups can help to measure disease progression.

With the acquisition of an Optical Coherence Tomography (OCT) machine, vital for neuro-ophthalmologists, the Corinne Goldsmith Dickinson Center for Multiple Sclerosis has expanded its capacity to provide comprehensive care. A generous gift from the Muzio Family Foundation enabled the Center to purchase the OCT machine.

Sylvia Klineova, MD, MS

In this Q&A, Sylvia Klineova, MD, MS, who specializes in multiple sclerosis (MS) eye health, explains why routine exams are essential for MS patients, how an OCT works, and the benefits of offering it at the Center. She is also an Associate Professor of Neurology at the Icahn School of Medicine at Mount Sinai.

“OCT tests are a new part of how we’re assessing our patients and should be incorporated in MS comprehensive care,” she says.

Why are regular eye exams important for multiple sclerosis care?

You can think of eyes as sort of a surrogate for changes in the brain of someone with multiple sclerosis. The “retinal nerve fiber layer” (RNFL) are the nerves in the back of the eye that are the beginning of the pathway for vision into the brain. Loss of thickness in the RNFL has been correlated to the degree of brain atrophy in MS patients, particularly in those with prior optic neuritis, a condition in which the optic nerve, which connects the eye to the brain, becomes swollen or inflamed. An MRI, however, cannot precisely measure the thickness of retinal nerve fiber layer, or accurately determine the effects of lesions in optic nerves. Optic neuritis is one of the most common initial attacks of MS, so a precise diagnosis is important. Even in patients without optic neuritis, we can see the impact of MS on retinal nerve fiber layer thickness.

Why do multiple sclerosis neurologists use an OCT?

The OCT, first introduced in 1991, was predominantly used by ophthalmologists for care in glaucoma, a very common reason for people developing optic neuropathy, or damage to optic nerves. Since the optic nerves are often affected in people who have MS, researchers who focused on eyes concluded that an OCT is more sensitive than an MRI in uncovering optic nerve lesions. The technology can help attain an earlier diagnosis of MS or confirm diagnoses in patients where the use of MRI doesn’t reveal an optic nerve lesion.

An OCT also is used to help to distinguish optic neuritis in MS versus other demyelinating diseases like neuromyelitis optica (NMO). After an MS optic neuritis attack, doctors use OCT to monitor how much optic nerves are damaged. Looking at changes in thickness of the neural layer can help to predict the degree of vision recovery in six months or a year after the attack. In imaging of a patient’s eyes over time, doctors look for any sign of changes of a neural layer in optic nerves and macula, the area with the highest number of cells that form optic nerves.

How does OCT work?

An OCT machine looks a little bit like a big computer. You put your chin on a chin rest and look straight ahead without shifting your eyes. A scanning light, moving across your line of vision, reaches deep inside tissues of the retina, and comes back with pictures of different cell layers. The test lasts about 15 minutes, is painless and non-invasive, and the results are quickly available to the physician.

The OCT will be part of the newest multiple sclerosis diagnostic criteria (the McDonald Criteria), which have been widely discussed at international conferences and will be published in 2025. The older criteria did not specifically single out optic nerves as one of the locations where doctors would look for lesions.

Why did Mount Sinai’s Center get an OCT?

The OCT program began in December 2023 when the Center added an OCT to its onsite equipment. Our Center staff take the images. The only thing needed from a patient is to sit and not move their eyes. With the OCT installed at the Center, patients do not need to go to another facility for a test that is recommended as a part of their comprehensive care. The exams usually are scheduled by providers as part of patients’ regular clinical visits.

Are OCT tests necessary?

Annual OCT exams are recommended for many MS patients. How the nerve layer around the optic nerve and retina looks can tell neurologists something about how MS is affecting the whole nervous system.

OCTs are particularly useful for tracking progression in patients who had optic neuritis. Whether and how much these patients lose vision depends on the extent of damage to the optic nerve as well as the macula, the place of sharpest vision. Evaluating the loss of thickness in optic nerves and macula can help to predict the degree of vision recovery.

For patients without prior optic neuritis, doctors can see how MS affects thickness of the neural layer. They are looking for stability of the thickness over time. And since neuroprotective or remyelinating drugs have not yet been developed, if a significant drop in retinal thickness occurs, then advancing to a more effective MS therapy can be discussed.

By Kenneth Bandler, a multiple sclerosis patient, advocate, and member of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Advisory Board