by Dr. C.H. Weaver M.D. Updated 1/2022
Can Prostate Cancer be Prevented?
Cancer is largely a preventable illness based on lifestyle choices. Several large studies have been conducted to examine the relationship between dietary factors and the development of prostate cancer. The results of some studies have suggested that increased intake of lycopene, selenium, and vitamin E can reduce the risk of developing prostate cancer. In addition, there is an association between lifetime testosterone levels and prostate cancer, which has led researchers to examine whether finasteride, a hormone inhibitor, can reduce the risk of prostate cancer. In one study that involved over 18,000 men, finasteride was shown to reduce the risk of prostate cancer by 25%.1,2,3 Finasteride has not been approved by the U.S. Food and Drug Administration for prevention of prostate cancer. Men at high risk of prostate cancer may wish to talk with their physician about the risks and benefits of using finasteride for this purpose.
Who is at The Greatest Risk for Developing Prostate Cancer?
There are several risk factors associated with the development of prostate cancer, including age, family history, high-fat diets, and being of African-American descent. Age is the most important risk factor in the development of prostate cancer. Prostate cancer is very rare in men under the age of 40 and is most commonly diagnosed in men over the age of 70.
Men who have a family history of prostate cancer are at a greater risk. Prostate cancer, can be caused by changes (mutations) in specific genes which are inherited; these are called germline mutations. Germline prostate cancer causing mutations are found in 12-17% of men with metastatic prostate cancer and 7% of men with early-stage disease.
How Can You Tell if You Have Prostate Cancer?
Unfortunately, you often cannot tell if you have prostate cancer. In most men, prostate cancer does not cause any symptoms until it is advanced and incurable. Furthermore, these symptoms (such as difficulty urinating) are often caused by benign enlargement of the prostate rather than prostate cancer. The best way to detect prostate cancer early is through regular screening with the PSA blood test and a prostate examination by a physician.
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What are the Options for Treatment of Early Stage Prostate Cancer and how do Patients Choose?
There are several options for the treatment of prostate cancer and thus far, all have been shown to produce similar results. The standard treatment options for prostate cancer that has not spread to distant sites include: surgery to remove the prostate, external beam radiation therapy, radiation with seed implants, and/or watchful waiting (observation). No single approach is best for everyone. Many factors such as age, general health, size and location of the cancer, PSA level, Gleason score, and individual preferences of the patient determine which treatment option is best for any given individual. It is always prudent to seek a second opinion and carefully consider all options before choosing treatment.
How is More Advanced Prostate Cancer Treated?
Cancer that has spread beyond the prostate gland, but has not spread to distant sites, is often treated with a combination of surgery or radiation, chemotherapy, hormonal therapy and newer precision medicines. Once cancer has spread to distant sites, chemotherapy and hormonal therapy, a treatment designed to markedly lower the level of testosterone in the blood, are the mainstay of treatment. Currently, chemotherapy is also used when hormonal therapy is no longer working and is also being evaluated for use in earlier stage disease. While neither chemotherapy nor hormonal therapy can cure advanced prostate cancer, both can keep the disease at bay, protect quality of life, and extend survival.
- Hamilton RJ, Kahwati LC, Kinsinger LS. Knowledge and use of finasteride for the prevention of prostate cancer. Cancer Epidemiology, Biomarkers & Prevention. [early online publication]. August 10, 2010.
- Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. New England Journal of Medicine. 2003;349:213-222.
- Redman MW, Tangen CM, Goodman PJ, et al. Finasteride does not increase the risk of high-grade prostate prostate cancer: A bias-adjusted modeling approach. Cancer Prevention Research [online publication]. May 18, 2008. 10.1158/1940-6207.CAPR-08-0092
- Pritchard C, Mateo J, Walsh M, et al. Inherited DNA-repair gene mutations in men with metastatic prostate cancer. The New England Journal of Medicine. Abstract. July 6, 2016DOI: 10.1056/NEJMoa1603144