G. Joel DeCastro, MD, MPH
Over 200,000 prostate cancer diagnoses occur each year, making it the second most common cause of cancer-related deaths in men. Often considered a taboo topic, many men struggle to discuss symptoms and warning signs out of fear or shame. Misinformation, like outdated beliefs about screening tests, treatment options, and its effect on sexual health also continue to cloud understanding about this disease.
One in eight men will be diagnosed with prostate cancer in their lifetime, making it essential to know the facts. The Herbert Irving Comprehensive Cancer Center (HICCC) spoke with G. Joel DeCastro, MD, MPH, assistant professor of urology at Columbia University Irving Medical Center (CUIMC) to debunk some of the most common myths surrounding this disease, providing clarity needed for patients to make the best decisions for their health.
Prostate cancer is not something I need to worry about until I'm older.
While the American Cancer Society recommends prostate cancer screenings beginning at 55, age is not the only risk factor to consider. Family history, race, and physical health can also play a role in your risk for prostate cancer. For African American men and those with family members who have been diagnosed with prostate cancer, screening is recommended as early as age 40.
I don't have any symptoms, so I don't need to get screened.
Most men with early-stage prostate cancer usually do not have symptoms, since it is often slow-growing and only in the prostate. Because of this, screening is key to catching prostate cancer before it becomes more advanced and spreads to other areas of the body. Patients with a more advanced disease may have symptoms. If you have any of the symptoms below, you should speak to your doctor.
- A slowed urinary stream
- Difficulty starting or holding back urine
- Blood in the urine
- Recent onset of hip and back pain
Screening tests are too invasive, and I don't want to feel uncomfortable.
One of the most commonly used screening methods is the prostate-specific antigen test, or PSA blood test. This is a simple blood test that measures the amount of PSA, a protein found in prostate gland cells, in the blood. PSA screening can help diagnose prostate cancer in its early stages, before it has spread to other parts of the body. Early detection through PSA testing can lead to less aggressive treatments and better outcomes, giving you more options and peace of mind. Avoiding the test could lead to missing these early signals when treatment is most effective.
I did a prostate-specific antigen (PSA) test and my levels were high. I definitely have prostate cancer.
A high PSA level does not necessarily mean that you have prostate cancer. PSA is produced by normal prostate cells, and an elevated value can be the result of an enlarged gland or even inflammation. If your PSA is elevated, your doctor may consider additional blood tests or a prostate MRI to determine the cause and monitor any additional changes.
If I'm diagnosed with prostate cancer, surgery is my only treatment option.
Even if you are diagnosed with prostate cancer, you may not immediately need treatment. For example, if you are diagnosed with low-grade prostate cancer, your doctor may recommend active surveillance, or a 'watch and wait' approach. Radiation therapy is one treatment option that is usually equally effective to surgery. If surgery is deemed appropriate, the procedure is called radical prostatectomy. It is a common procedure performed by urologists at the HICCC. It is most often performed using the Da Vinci robot, which provides an improved view of the surgical field and greater precision and control of instruments. This leads to less blood loss, less time in the hospital, and a faster recovery.
In addition to radical prostatectomy and radiation, additional minimally invasive treatment options are offered at the HICCC for patients with localized prostate cancer. These include focal therapy, which uses either high-intensity focused ultrasound or focal cryoablation to destroy the tumor and reduce side effects like incontinence and erectile dysfunction. The HICCC also offers the opportunity to participate in innovative prostate cancer clinical trials, along with complementary patient support services like yoga therapy, acupuncture, support groups and more.
Prostate cancer causes incontinence and will have a negative effect on my sex life.
Prostate cancer itself does not cause erectile dysfunction or incontinence but treatments like surgery, radiation therapy, and hormone therapy can cause some of these issues. However, multiple factors including prior medical issues and existing sexual and physical health play a role in the degree of the resulting negative side effects. It is also important to speak with your doctor early in the treatment process to learn about available medications or rehabilitation programs that will assist in your postoperative recovery and in regaining your quality of life.
HICCC surgeons are careful to consider all treatment options and are experts in minimally invasive approaches, working to help patients maintain sexual function and minimize other side effects. Support services are also available during and after treatment including a men's health specialist and a dedicated genitourinary nutritionist.
Getting a vasectomy will increase my risk of prostate cancer.
Epidemiologists have discovered no evidence that vasectomies increase the risk of prostate cancer. A 2017 study set out to specifically combat this myth by analyzing over 50 studies occurring over the course of 24 years that focused on the potential connection between vasectomies and prostate cancer. The researchers found no association between vasectomy and clinically significant prostate cancer.
Prostate cancer is less dangerous than other types of cancer.
It is true that most prostate cancers are slow growing, with a greater than 90% five-year survival rate. However, some prostate cancers are more aggressive and can spread beyond the prostate, which is why it remains the second leading cause of cancer death in men. It is therefore important not to dismiss the potential danger of prostate cancer.
