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Prostate Cancer: Causes, Signs, and Treatment
Lisa Reisman • Aug 28, 2019
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Prostate Cancer: Age & Treatment
Prostate cancer in older men has become one of the most common malignancies in our day and age. According to the US National Library of Medicine, the probability of developing prostate cancer increases from 0.005% in men younger than 39 years to 2.2% in men between 40 and 59 years and 13.7% in men between 60 and 79 years. The increase diagnoses in prostate cancer can be a result of increased life expectancy as well as our advances in prostate screening tests via blood work. Age has become a key-determining factor in how to treat prostate cancer; however, age can also be the reason why doctors don’t treat it at all.
Understanding Prostate Cancer
Prostate cancer, like most cancers, starts when cells begin to grow out of control. With prostate cancer, the cells in the prostate gland start to grow uncontrollably. Prostate glands are only found in men and help make the fluid that is found in semen—it is located below the rectum and behind the bladder. Most forms of prostate cancer grow slowly; in fact, many times elderly die from other natural causes other than prostate cancer even if they have had prostate cancer.
Detecting prostate cancer with screenings are recommended for men approaching their 50s and older or sooner if it runs in your family. The cancer can be detected in one of two ways: a digital rectal exam (DRE) or prostate-specific antigen (PSA) test. A DRE or PSA is the best way for a medical professional to detect for signs of prostate cancer in order to catch them at their earliest stage. If either screening comes back with some concern, your doctor might want to conduct an ultrasound of the prostate or collect tissue for examination.
According to an article on Mayo Clinic’s website, when a biopsy confirms the presence of prostate cancer, the next step is to figure out the aggressiveness of the cancer. A pathologist can then see how many of your healthy cells differ from the cancer cells and proceed to determine the “grade” of the cancer. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).
Treatment: Good or Bad?
When most people get diagnosed with cancer, it’s a natural assumption to want to treat it immediately to prevent its spreading. Prostate cancer has research surrounding it, suggesting that its treatment may not apply to older men with prostate tumors. As stated before, some men live with prostate cancer for many years and experience no symptoms at all. Alexandra Sifferlin, in an article on Time’s website, suggests that the cancer is typically so slow-growing that many of these men will die from other causes, which means the benefits of treatment do not always outweigh the risks. Treatment surrounding prostate cancer can usually involve things like radioactive seed implants, which can lead to erectile dysfunction as well as urinary incontinence. With most aggressive cancer treatments, it can take several months to see improvements. However for prostate cancer, the survival advantage is low in cases where the prostate tumors aren’t deadly.
A study done in 2013, published in the Annals of Internal Medicine led by researchers at the University of California Los Angeles (UCLA) Department of Urology, looked at the 14-year survival of 3,000 men diagnosed with prostate cancer between the years 1994 and 1995. The patients observed in this study proved that while having intermediate cases of prostate cancer who also had at least three other health problems like diabetes, hypertension, congestive heart failure and arthritis, were significantly more likely to die from a cause unrelated to their cancer. Lead study author Dr. Timothy Daskivich points out that the importance of the study being “older men with multiple underlying health problems should carefully consider whether they should treat these tumors aggressively, because that treatment comes with a price.”
Blood-based prostate specific antigen (PSA) test and imaging to search for hidden growths are two common predictive screening methods for prostate cancer, but they can often mischaracterize the severity of the tumor and lead to unwanted surgeries. Watching and waiting is a better strategy for elderly men who have been diagnosed with prostate cancer because operating on an older patient with preexisting health complications can leave these men worse off in the long run.
If you or a loved one has been recently diagnosed with prostate cancer, consult a physician to explore your options before beginning treatments— it’ll be worth the conversation to avoid unnecessary surgeries and could leave you healthier overall.
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