Did you know that prostate cancer is the most common non-skin cancer among men? Roughly 1 out of 8 men will develop prostate cancer in his lifetime. However, never fear. Most cases of prostate cancer are slow-growing. Therefore, when prostate cancer is found in its early stages, treatment success rates average well over 90%. But there’s a catch.

Early stage prostate cancer has virtually no symptoms. This means that by the time warning signs appear, the disease may have advanced to the point at which more aggressive treatments are needed to manage it, but recurrence rates are high. This means treatment may start out working, but the cancer comes back because it has already spread. 

Early detection is essential

This raises the question, how do you find prostate cancer before symptoms appear? The answer is an annual PSA blood test. PSA stands for Prostate Specific Antigen, a tiny surface protein on both normal and cancerous prostate cells. Since cells “shed” the protein into the blood, the PSA test is a way to monitor levels. The higher the level, the more likely that something is disturbing the prostate gland. However, it’s important to know that the test is not specific for only prostate cancer. Other noncancerous conditions can also cause the PSA level to increase, so more investigation is needed.

Additional tests

It wasn’t that long ago that a higher-than-normal PSA was considered a red flag, and men were routinely sent for a needle biopsy. Since then, new “markers” specific for prostate cancer have been discovered in blood and urine. So if a PSA test is suspiciously high, the next step is to wait a few weeks and do a repeat PSA blood draw (to rule out lab error) and also to measure a couple of PSA variants called free PSA and PSA density. Taking these additional tumor markers into account narrows the possibility that it is or is not cancer.

If the blood markers still point to cancer, a special type of imaging called multiparametric MRI (mpMRI) can then be used to rule prostate cancer in or out. So far, there’s been nothing more invasive than a needle prick into a vein.

However, if the mpMRI reveals a suspicious area, the doctor will order a needle biopsy to sample prostate tissues. A biopsy is the only way to definitely diagnose cancer, but thankfully it is less invasive if it is done under live MRI so the doctor can see where to target a minimum number of needles. This is the latest, most advanced diagnostic test for prostate cancer. It is called an in-bore MRI-guided targeted biopsy, and it gives the most accurate results with the fewest needles. Remember: when prostate cancer is found early and accurately, treatment has the best chance of success—and there are the most treatment options, including some minimally invasive treatments that destroy the cancer while preserving healthy prostate tissue. These treatments have the lowest risk of side effects.

What symptoms might mean prostate cancer?

What if a man is already having any of the following symptoms?

• Weak or slow urine, trouble urinating or needing to urinate often, especially at night
• Blood in urine
• Blood in semen
• Erectile difficulties
• Numb sensation in legs or feet, or discomfort in one’s pelvic area
• Pain in the back, hips, or chest (prostate cancer spread can cause bone pain or organ pain)
• Loss of bladder or bowel control if a prostate cancer tumor spreads and presses on the spinal cord

The first thing is, don’t panic. Other conditions, especially noncancerous prostate growth called BPH (benign prostatic hyperplasia) can cause similar symptoms. But don’t wait! See a doctor as soon as possible. It’s essential to diagnose the real cause and receive necessary treatment right away. Better still, at midlife start monitoring for early stage prostate cancer by having an annual PSA blood test.

PSA controversy

But wait—aren’t doctors advising individual patients to find out if it’s right for them? For nearly 15 years, there has been debate over the merits of the PSA test. Why? The cause tracks back to its lack of specificity for prostate cancer. Before the PSA variants and mpMRI, many men whose PSA was higher than normal were sent for a biopsy. This led to too many men being biopsied who could have avoided it; too many men whose biopsy was positive for low-risk cancer receiving aggressive whole-gland treatment; too many men living with urinary or sexual side effects after aggressive treatment. Thus, doctors have been recommended to talk with each patient about the potential for these harms, and make a PSA decision accordingly.

Thankfully, there is now a kinder, gentler and more accurate route avoids these harms yet still detects prostate cancer early. This new route relies on an annual PSA test to monitor for prostate activity, without the need to rush to biopsy. The sources for this revolution in men’s health are the more specific tumor markers and mpMRI. Don’t wait for prostate cancer to get your attention by having symptoms.

Remember these steps: a) have an annual PSA blood test; b) if the result is high, repeat the test and analyze the extra PSA variants; c) if the results are still suspicious, have an mpMRI; and d) if the scan results show something suspicious, have a live MRI-guided targeted biopsy. A growing number of hospitals and medical centers in your region now offer real-time mpMRI-guided prostate cancer detection and diagnosis. However, if there is no convenient location near you, talk to your doctor about modifications in these steps that are still highly specific for prostate cancer.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.