This cancer often has no warning signs — a pioneering new treatment freezes it away

Consider this a PSA about PSA.

Prostate cancer is the most common cancer in US men, excluding skin cancer, and the second-leading cause of male cancer deaths, after lung cancer.

One in 6 men will be diagnosed with prostate cancer, and about 3% of men will die from it.

Early-stage prostate cancer often has no warning signs because the tumor is small and hasn’t spread — a PSA test can help detect potential problems before symptoms develop.

September is Prostate Cancer Awareness Month. Here’s what you should know about updates to screening guidelines, advances in treatment and the one diet that may help prevent it.

What are the risk factors for prostate cancer?

Prostate cancer is the uncontrolled growth of abnormal cells in the prostate, a walnut-shaped gland found below the bladder and in front of the rectum.

This unchecked cell growth becomes a big problem when these cells spread throughout the body.

We don’t really know what causes prostate cancer. We know that there is a genetic predisposition.

You’re at a greater risk if your first-degree relatives (father, brother or son) have it.

African-American men face a significantly higher risk than other racial and ethnic groups, but the exact reasons for this disparity remain a mystery.

The likelihood of developing prostate cancer also increases with age.

What are the symptoms?

When prostate cancer is curable, there are no symptoms. That’s why screening is so important for this disease.

As the cancer advances, the prostate grows and presses on the bladder and urethra, blocking the flow of urine. Men will have trouble peeing if this happens.

And when prostate cancer spreads, it typically goes to the bones, which can lead to pain and numbness in the legs and even some neurological problems.

It can also spread to other organs, which is when the disease potentially becomes fatal.

How is prostate cancer diagnosed?

We generally recommend men start routine screening for prostate-specific antigen at age 50.

African-American men and those with a family history of prostate cancer or other risk factors should start around age 45.

It’s a simple blood test that can be done as part of your annual physical. If your primary care physician is concerned about your PSA level, they will refer you to a urologist to determine if other testing, such as an MRI or a prostate biopsy, is needed.

The average age of diagnosis is mid-60s.

The US Preventive Services Task Force recommends against routine prostate cancer screening for men aged 70 and older because the potential benefits do not outweigh the harms.

This guidance was made over a decade ago and reaffirmed in 2018. 

The problem is that PSA is “prostate specific,” not “prostate cancer specific.” Other noncancerous factors, like benign enlargement or inflammation of the prostate, can cause elevated PSA levels. 

Many men were getting negative biopsies — they had issues that weren’t potentially lethal. Others were found to have disease that was very low risk. Overdiagnosis and overtreatment were downsides of PSA screening.

We saw a lot more men getting diagnosed with prostate cancer in the 1990s when PSA screening became widespread. Now we’re seeing more aggressive cancer in older men.

Men over 70 should talk with their doctor to see if screening is right for them.

At NYU Langone, we recommend screening men who have a 10-year life expectancy independent of chronological age. 

Are there ways to prevent prostate cancer?

Five-alpha reductase inhibitors are a class of drugs used to treat an enlarged but noncancerous prostate.

Several years ago, researchers suggested that these drugs might play a role in preventing the development of prostate cancer.

But there was concern that the meds increased the risk of developing higher-risk cancers. While that notion has been debunked, those medications never came to market to prevent prostate cancer.

Since there’s no magic bullet, men should focus on exercising and eating healthfully.

There’s some evidence, though it’s not definitive, that the best diet for prostate cancer prevention is a vegan diet. If that doesn’t sound appetizing, focus on reducing your intake of red meat and processed sugar.

How is prostate cancer treated?

Prostate cancer treatment depends on the location of the cancer within the prostate, its aggressiveness and evidence of metastasis.

If the cancer is low risk, we’ll monitor it very closely. The problem is that in at least half of the patients, we’re simply delaying prostate cancer treatment.

If prostate cancer has spread throughout a large portion of the prostate, we can surgically remove the entire prostate in a radical prostatectomy or use radiation therapy to destroy the cancerous cells.

Unfortunately, the consequences of radical prostatectomy can include urinary incontinence and sexual dysfunction. 

Radiation generally leads to a lower risk of urinary incontinence compared to radical prostatectomy.

But radiation can potentially cause side effects such as rectal and bladder issues, an increased risk of bladder and colon cancer, delayed inflammation and hemorrhagic cystitis and proctitis.

In some cases, the prostate cancer is just too aggressive to follow and not aggressive enough to remove the whole prostate or perform radiation.

Here at NYU Langone, we’ve pioneered the treatment of focal therapy. We find out where, specifically, the aggressive cancer is on the gland and destroy that area by freezing it.

It’s a two-hour procedure done in an outpatient setting. We’ve treated 600 men so far.

We’ve published very encouraging quality of life assessments, treatment complications and cancer outcomes validating focal therapy using cryotherapy, and we’re getting ready to publish our seven-year data.

It’s truly quite remarkable. There’s no incontinence like with surgery. There are no rectal issues and no need for the hormonal treatment that goes along with radiation. There’s also dramatically less impact on sexual function.

The risk of recurrence is really going to depend upon the aggressiveness of the cancer at the start of treatment.

We carefully discuss these pros and cons in great detail with the patient to determine the right plan.

Looking ahead

Over the last two decades, we’ve made tremendous progress in how we screen PSA, how we detect cancer with MRI-guided biopsy and how we treat the disease, such as with focal therapy.

But we have a long way to go. We need a better screening test. We would like to determine which cancers require treatment and which can be safely monitored with surveillance.

And we need better ways to treat metastatic disease — too many people are dying from prostate cancer despite these advances. 

Here at NYU Langone and other major health centers around the country and the world, we’re committed to making prostate cancer a curable disease for all men.

Dr. Herbert Lepor is the Martin Spatz Chair and chief of the Department of Urology and a professor of urology, biochemistry and molecular pharmacology at NYU Langone Health. He specializes in prostate cancer treatment and research at the Smilow Comprehensive Prostate Cancer Center.