Prostate Cancer: Signs & Symptoms as Discussed by Dr. David Crawley

The uncontrolled (malignant) proliferation of cells in the prostate gland is a symptom of prostate cancer. The prostate is a walnut-sized gland found right below the bladder and in front of the rectum in men. It surrounds the urethra, which is the tube that takes urine out of the bladder. The prostate creates and retains fluid that aids in the production of sperm.

Apart from skin cancer, prostate cancer is the most frequent type of cancer detected in males globally, and it often develops without symptoms. According to the American Cancer Society, 164,690 men will be newly diagnosed with prostate cancer in 2018, 29,430 men will die from the disease, and 1 in every 9 men will be diagnosed with prostate cancer at some point in their lives.

Because prostate cancer is slow-growing cancer, many men die of other ailments before it causes substantial issues. Many prostate cancers, on the other hand, are more aggressive and can spread outside of the prostate gland, which can be fatal. With early detection, the chances of surviving prostate cancer are considerably increased.

September is Prostate Cancer Awareness Month. It is the second leading cause of cancer death in men. Here to further educate us is Dr. David Crawley, urologist with Hartford Health Care. It’s great to have you with us, Dr. Crawley.

Dr. Crawley: Thanks for having me, Jocelyn.

Jocelyn: When we say the second leading cause of death, how many men die from prostate cancer every year?

Dr. Crawley: Well, in Connecticut, it’s about 300 men a year die every year, nationwide, quite a bit more than that. So it’s a big problem.

Jocelyn: Is it, what’s happening here, is it that men don’t realize the symptoms of it? What exactly is going on?

Dr. Crawley: Well,
the challenge with prostate cancer is there aren’t a lot of symptoms,
and especially there aren’t a lot of symptoms early on in the disease
when treatment is effective. And so, because of that, screening is a
real push that urologists and primary care doctors make to try and catch
things early.

Jocelyn: Screening is so important, we all know that. And so what age should men start screening?

Dr. Crawley: Well,
that’s a bit controversial, and it varies on who you talk to, but the
important thing is to start having the conversation with your physician,
and it depends on your risk factors when the appropriate time is. For
most men in the general population, it’s around age 55, that you should
start having screening, and we continue that till about age 70.

Jocelyn: Risk factors, we know there are risk factors out there, especially if you have a family history.

Dr. Crawley: Correct,
family history is a very important risk factor, and if you have family
members, fathers, brothers, that have had prostate cancer, screening
should start as early as 40 in some of those cases.

Jocelyn: We also know that African American men are especially impacted by this. Why is that?

Dr. Crawley: Well,
we don’t know exactly why the incidence of prostate cancer is higher in
African American men, but it is, and it’s also more aggressive in that
population, so we’re trying to be more aggressive with screening in the
African American population to help them with that risk.

Jocelyn: Are you asking those men to come in at the age of 40 as well?

Dr. Crawley: The
guidelines say around age 45 is right for most African American men,
depending on other risk factors, but the important thing is to have the
conversation and have an assessment of your risk factors by your primary
care doctor or urologist.

Jocelyn: The screening itself, talk us through that.

Dr. Crawley: Sure.

Jocelyn: Exactly what it is that they need to be doing?

Dr. Crawley: Sure,
and it is a source of anxiety— Yes it is. For a lot of men, the
annual prostate exam, but it’s cheap, it’s not invasive, it’s not
painful. It’s a quick physical exam in the office with your primary
doctor or urologist, and a simple, inexpensive blood test, and that is
what screening consists of for most men.

Jocelyn: Exactly,
the blood test does tell you a lot about what’s going on with prostate
cancer, and specifically what are you looking at there?

Dr. Crawley: Well,
the blood test we’re talking about is called the PSA test, and an
elevation in the PSA test does not always mean prostate cancer, but it
can raise concerns and prompt us to do more testing that can determine
if cancer’s present.

Jocelyn: And treatment is
basically, some people say, depending on how old they are when they are
diagnosed with prostate cancer, doctors say let it go, it’s
slow-growing, or, then there’s a part of, some men, have to undergo some
type of surgery.

Dr. Crawley: Well, that’s correct. Well, there are various treatment options available, and it depends on what type of cancer’s
present and how much of it, the patient’s age, and their other health
issues. For most men, the options are surveillance, so watching cancer
and intervening if it gets more serious. Surgery to remove the prostate,
which can be done minimally invasively now. Or radiation therapy to
destroy the cancer cells with radiation.