Non-invasive screening tests for preventive healthcare

Prostate cancer detection summarized – #MOVEMBER 2021

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Prostate cancer is a very devious cancer because it often does not cause any symptoms until it has already  advanced to a more severe stage. In addition, the usual symptoms of prostate cancer can also be caused by a variety of other quite common conditions besides prostate cancer, which makes early detection even more challenging. When it comes to prostate cancer, it is important to be aware of your individual risk, monitor your health, and get screened regularly.    

 

What is the prostate?

The prostate gland is a part of the male reproductive system, located just below the bladder. It’s generally about the size of a walnut and has a significant role in the production of semen. 

As  a man ages, the prostate will usually increase in size and sometimes affect the urine flow. This benign overgrowth of the prostate is often otherwise harmless and does not affect the chances of developing prostate cancer. But its symptoms can be very similar to the symptoms of prostate cancer. 

 

What is prostate cancer?

Prostate cancer is a cancer that develops in the prostate. It is the most common cancer in men in several parts of the world, with around 1,4 million new cases diagnosed and over 300,000 deaths in 2020. Prostate cancer incidence is highest in Northern and Western Europe, Australia and New Zealand, and Northern America. 

There are different types of prostate cancer – slow growing cancers confined in the prostate gland that often do not require treatment, and aggressive, metastatic forms that can spread to other organs and even bones through the bloodstream. 

 

Who is at risk of prostate cancer?

The most significant risk factor for prostate cancer is age – it mainly affects men aged 50 and over. However, this does not mean that you cannot develop prostate cancer if you are under the age of 50. Actually, the incidence of prostate cancer in men under the age of 40 has increased during the last few decades. This is a worrying development, as 40-50 year old men are globally almost as large of a population group as the current 50-74 year old risk group. 

Studies have shown that people who have a family history of prostate cancer are more likely to develop it themselves as well. The chances of being diagnosed with prostate cancer increase even further if a close relative was diagnosed with it when they were under the age of 60. This increased risk stems from hereditary, genetic changes. 

Black men are also more likely to get prostate cancer. The reason for this statistic remains relatively unknown, but studies have shown that black men are more likely to develop aggressive forms of prostate cancer and that they are almost twice as likely to die from prostate cancer than men of other ethnic backgrounds. 

 

What are the common symptoms of prostate cancer?

Like mentioned before, prostate cancer often does not cause any symptoms until it is already advanced. If symptoms do occur, the most common ones are changes in urination. More frequent urination, difficulties to start urinating, straining while peeing, weak urinary flow, and blood in the urine or seamen are all signs that should be taken seriously, especially if you belong to a risk group. 

The more serious and noticeable symptoms tend to occur when the cancer is already advanced. Then the most common symptoms can include pain in the lower back, pelvis or hips. Anemia, tiredness and decreased energy-levels are also common signs of advanced prostate cancer. 

 

How is prostate cancer detected*?

The path to a prostate cancer diagnosis usually starts from either a routine doctor’s appointment or when a man seeks an explanation to symptoms related to difficulties urinating. However, it is important to note that the path to a diagnosis may differ between countries and individual cases. 

When a doctor has a reason to suspect prostate cancer, the examination usually starts with a Digital Rectal Examination, or a DRE. During a DRE the doctor will use their finger to feel for abnormalities like lumps or hardness in the prostate. In addition, a blood sample is also collected and the amount of Prostate Specific Antigen (PSA) in the blood is checked.

A heightened PSA-value in the blood can be  a sign of developing prostate cancer, but the PSA-value alone is not a reliable enough indicator to base a diagnosis on. The blood’s PSA-value is dependent on several factors like age or race, which is why a PSA-test must be followed with further examinations. The PSA-test is currently not recommended to be used for population level screenings, and the decision to get screened for prostate cancer rests largely on individual men. 

 

How is prostate cancer diagnosed?

If the DRE result or the high level of PSA in the blood give more reasons to suspect prostate cancer, the next step is usually a biopsy. To determine the correct site to take the biopsy, the doctor may need to perform an ultrasound or an MRI. During the biopsy, a small tissue sample is collected from the prostate using a needle. Then a pathologist studies the sample under a microscope in the laboratory and gives their professional opinion. 

If the pathologist determines the biopsy to be a non-aggressive, low-risk form of prostate cancer that is not likely to spread elsewhere, further tests are not needed and active surveillance of the prostate and the patient’s  PSA-level is often enough. However, if the cancer turns out to be an aggressive or a metastatic variant, the doctors must find out how widely the cancer has spread to determine the next steps and to choose the right individual treatment approach. 

 

Help raise awareness

Prostate cancer is the most common cancer in men in several countries around the world, but for many, it is a difficult subject to discuss. Men are not aware whether they belong to a risk group or not, don’t know their family history with prostate cancer, and do not get screened as often as they should. 

Urologists and healthcare professionals are advocating for national prostate cancer screening programmes to be established in countries with a long  life-expectancy and high rate of prostate cancer. Several studies have concluded that even though the screening of prostate cancer has its downsides (unnecessary treatments and false positive diagnoses), screening does reduce the prostate cancer mortality rate. 

New, innovative and accurate screening tests for prostate cancer can hopefully in the future become a routine part of health screening practices. 

Raising awareness and making sure men are aware of their individual risk factors and signs to watch out for, so that they know if they should get screened, is as important as national screening programmes and new screening tests. If prostate cancer is detected at an early stage, the chances of survival are higher, the patients are spared from extremely aggressive treatments, and their everyday lives will not be greatly impacted by the cancer diagnosis. 

 

*The testing order and  path to a diagnosis  may vary between countries. These diagnostic paths are based on mostly Finnish, UK and US practices. 

 

Sources and more information on prostate cancer in English and in Finnish:

https://www.nhs.uk/conditions/prostate-cancer/symptoms/

https://prostatecanceruk.org/

https://www.kaikkisyovasta.fi/tietoa-syovasta/syopataudit/eturauhassyopa/#eturauhassyovan-toteaminen-ja-tutkimukset

https://www.suomalaineneturauhassyopa.fi/eturauhanen/

https://www.cdc.gov/cancer/prostate/basic_info/screening.htm