What to Know About a Prostate Cancer Diagnosis

In medical school, we were taught that if all men lived to be 120 years old, every single one would get prostate cancer.

But for those of us who won't live that long, about 1 in 8 men will be diagnosed with prostate cancer at some point in their lives, according to the American Cancer Society.

Last week, we shared why most men tend to be like ostriches when it's time to visit the doctor... and especially when it comes down discussing any problems going on with your penis. Today, we're going to talk more about what to know after a prostate cancer diagnosis...

First, understand your treatment options. Here are some common ones...

• Surgery (which may involve removing the whole prostate gland)
• Radiation (like using high-energy beams to zap tumors that haven't spread or implanting radioactive material next to the tumor)
• Hormone therapy (to reduce levels or activity of testosterone)
• Chemotherapy (typically for advanced-stage cancer)
• Immunotherapy (like drugs to train your immune system to attack cancer cells)
• Cryotherapy (freezing cancer cells)
• Targeted therapy (to target cancer cells specifically, as opposed to chemotherapy, which can damage healthy cells)

For patients diagnosed with early-stage cancer, many opt for a simple treatment: watch and wait.

According to the National Cancer Institute, more men with low-risk prostate cancer are adopting this approach... 26.5% of these folks in 2014 to 59.6% in 2021.

This approach is also called active surveillance. It just means keeping a close eye on your cancer and prostate-specific antigen ("PSA") levels and skipping treatment unless the cancer changes or spreads. And that means avoiding potential side effects of treatment.

Also, a 2015 study using data from Johns Hopkins found that fewer than 1% of men with low-risk prostate cancer on active surveillance died from prostate cancer. A similarly small number progressed to a metastatic phase of cancer, where treatment is more difficult.

Of course, more aggressive cancers can require more aggressive treatments. And with treatment is the chance of side effects...

Many treatments can lead to incontinence and erectile dysfunction... sometimes permanently. You'll need to discuss with your oncologist what the best standard of care is for your type of cancer and how to manage any side effects.

Know your risks, recognize the symptoms, and find a good doctor. You don't want to ignore this problem and hope it goes away. If you're nervous about an in-person visit, see if your doctor will do a phone call or an online video appointment to talk about the problems you're having.

Oh, and on that doctor part... You must take the time to find a good cancer doctor (or oncologist), preferably one with a solid record of catching prostate cancer early. They should work

Call a few local oncologists (cancer doctors) and find out who sends them the most prostate cancer patients. (Yes, just call up and ask for the information.) Use it to find the best doctor out there.

Another way to start your search is to check out large cancer centers (including university-based ones) with doctors who specialize in catching the disease.

These locations also tend to have active cancer research going on. High-risk patients, folks who don't respond to conventional treatments, and folks with recurring or spreading cancer might consider enrolling in clinical trials featuring perhaps a new, cutting-edge therapy.

If you're looking for the best place to go, check out the National Comprehensive Cancer Network ("NCCN"). It's made up of the top cancer centers across the U.S. The NCCN regularly updates its evidence-based treatment recommendations for a variety of cancers, including early- and late-stage prostate cancer. (Don't worry, I'll provide you with the links at the end of the issue.) It's a great place to start if you're feeling overwhelmed.

Finally, I just want to touch base again on routine screening...

Longtime readers also know we like to lean on the U.S. Preventive Services Task Force ("USPSTF"). It's an unbiased, evidence-based group of 16 medical specialists who look at the research data and make recommendations on the usefulness of screenings, counseling services, and preventive drugs.

The group uses a grading system from "A" to "D." A "D" rating means the USPSTF recommends against getting the exam, while an "A" or a "B" grade means the USPSTF recommends the exam.

(If the task force feels there's not enough evidence to either recommend or advise against a service, it could opt to assign the service an "I" for "inconclusive.")

Some of the medical tests I've recommended that everyone get – like screenings for colon cancer or high blood pressure – receive "A" ratings from the panel.

As for prostate cancer screening... currently, the USPSTF says if you're between the ages of 55 and 69, PSA screening should be an individual choice, based on a thorough talk with your doctor.

For men aged 70 and up, the USPSTF recommends against PSA-based testing in men, a popular guideline which maybe Joe Biden's doctor might have been following, as Biden's last PSA test was reportedly back in 2014.

To arrive at that final recommendation, the task force looked at big randomized controlled trials, where it found "no benefit of PSA-based screening for prostate cancer on prostate cancer mortality in men 70 years and older." It also said that "the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, harms from diagnostic biopsy, and harms from treatment."

Now, that final recommendation – and current guidelines – are from 2018. The USPSTF also periodically reviews and revises its grades.

And it just so happens that an update is still in progress for its prostate-cancer-screening guidelines. So we're interested to see if the group will make any changes to its current recommendations. You can also keep tabs on this here, if you prefer.

What We're Reading...

• Here are the 2025 NCCN treatment guidelines for early-stage prostate cancer and advanced-stage prostate cancer.

• Free or low-cost PSA testing.

• Something different: First human bladder transplant performed at UCLA.

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
May 29, 2025