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Prostate Cancer

Prostate Cancer Explained

Summary & Participants

The most common cancer in men is also the most complicated to treat. Listen to experts describe the latest in screening, diagnosis and treatment.

Medically Reviewed On: July 06, 2008

Webcast Transcript

ROBERT DREICER, MD: Prostate cancer is, in the United States, a very common cancer. Other than skin cancer, it's the most common cancer in men. This year, it's estimated about 230,000 cases of prostate cancer will be diagnosed.

ANNOUNCER: Prostate cancer is also the second-leading cause of cancer death among men in the US. About 30,000 men die of the disease each year. The most significant risk factor is age.

PHILIP KANTOFF, MD: Probably more than any other cancer, prostate cancer is related to age. You rarely see prostate cancer in men under the age of 40. Maybe 10 percent of men who develop prostate cancer will do so in the range of 40 to 50 and the incidence of prostate cancer rapidly increases as a function of age after that.

ANNOUNCER: Other risk factors include diet and family history. Some combination of genetics and environmental factors lead to a high prevalence among African Americans.

WILLIAM OH, MD: Within the United States, the men at highest risk are African Americans. And, again, we're not certain to what extent this is contributed to by environmental factors or true genetic factors, but the bottom line is that we know, epidemiologically, that African-Americans have the highest rate of prostate cancer in the world and, therefore, we target our screening more aggressively towards African Americans.

ANNOUNCER: Screening used to be limited to a fairly primitive method called a digital rectal exam.

WILLIAM OH, MD: A digital rectal examination or DRE is when a urologist or an oncologist or a primary physician inserts a gloved finger into the rectum to feel where the prostate is. And this is the traditional way in which prostate cancers were detected before the advent of PSA screening. So if there's an abnormal prostate on examination, that's similar to finding a lump on the breast.

ANNOUNCER: PSA, short for prostate specific antigen, is a protein produced by prostate cells. Levels tend to rise with non-cancerous changes to the prostate that are normal with aging, a condition called benign prostatic hyperplasia, or BPH. However, a high or rising level can also indicate cancer. Doctors used to consider a PSA of 4 units a critical mark.

WILLIAM OH, MD: In general, this traditional cutoff for an elevated PSA was 4 or higher. However, we've become much more sophisticated over the last decade in understanding what the context is for a high PSA. So, for example, a level of 4 in a 50-year-old man would be considered abnormal, even though it's considered normal for the total range, and that's because men who are younger tend to have smaller prostates and therefore have a lower PSA at their baseline. Whereas, if you were 70 years old or 75 years old and had a history of having trouble urinating, BPH symptoms, a PSA of 4 could be perfectly within normal range.

ANNOUNCER: The PSA count is not a direct indicator of cancer, so it can not be the basis of diagnosis.

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