What to know about prostate cancer prevention and treatment

After skin cancer, prostate cancer is the most common cancer type and the number two cause of cancer death among men in the United States. Because it's so common, scientists have been working hard in recent years to improve screening methods, treatments, and outcomes for people with prostate cancer.

“Prostate cancer research is an exciting field because we’re seeing so many advancements,” says Shaw Zhou, MD, a urologist in St. Petersburg, Florida. Many new and emerging therapies are driving major progress in treatment.

The prostate is a male reproductive organ that makes semen and sits below the bladder. With all the latest developments, it can be difficult to know which treatments may actually benefit someone with prostate cancer. Here’s how to make sense of the key issues.

What to know about supplements and prostate cancer

There’s no known way to prevent prostate cancer, but you may have read about foods or supplements that can help lower your risk.

“You see prostate supplements and fad diets in the media all the time,” says Dr. Zhou. “Be sure to discuss these with your healthcare provider (HCP) before trying them.”

A dose of skepticism is warranted. There’s not always enough evidence to determine whether a supplement claiming to help with prostate health is safe and effective. Even if something seemed to work in a study, it may not be right for you.

For example, taking supplements containing the mineral selenium was once thought to be potentially beneficial. But a large 2009 study in JAMA—and its follow-up in 2014—suggested selenium was linked to more aggressive prostate cancer that grows and spreads faster in men who were already diagnosed. Now, many HCPs recommend people with the disease avoid selenium supplements.

Be especially wary of multivitamins that claim to have cancer-fighting abilities. There is no strong evidence that multivitamins increase or decrease your risk of prostate cancer.

Always check with your HCP before adding dietary supplements or vitamins to your daily regimen.

What to know about the PSA test

The prostate-specific antigen (PSA) blood test is used for prostate cancer screening. If your PSA level is high, your HCP may recommend additional testing to check for prostate cancer.

There are pros and cons to the PSA test; it’s not always reliable. Your level of PSA could go up if you have an enlarged prostate or an infection. What’s more, PSA levels don’t always rise when someone actually has cancer.

As a result, the United States Preventive Services Task Force (USPSTF) recommends that men between the ages of 55 and 69 should make an informed, personal decision with their HCP about whether to get the PSA test. Weighing the benefits and drawbacks this way is called shared decision-making.

The USPSTF advises against screening for prostate cancer if you’re over 70. People at a higher risk of prostate cancer, including Black people and those with a family history of the disease, should speak with an HCP about screening at an earlier age.

What to know about prostate cancer screening

A PSA test alone is not entirely reliable for diagnosing prostate cancer.

“With the PSA, it’s not like a pregnancy test where you get a positive or a negative result, and then you have an answer,” says Zhou. “Instead, you have to consider a whole spectrum of risk factors to decide whether you’ll do more testing.” These factors include age, race, weight, and medical history.

That’s why many HCPs are now putting together a more complete picture using precision medicine, rather than looking at the PSA alone, Zhou explains. Precision medicine takes into account a person’s genes, their lifestyle, and their medical history to better tailor treatment decisions to them. Precision medicine tests include:

• 4Kscore: This test system measures four proteins in a patient’s blood to evaluate their likelihood of aggressive prostate cancer that grows and spreads more quickly. It also considers factors like age, medical history, and the results of a digital rectal exam (when an HCP inserts a gloved, lubricated finger into the rectum to check the prostate).
• Prostate Health Index (phi): This is a combination of three blood tests that provides information on the likelihood of finding cancer that would require treatment.
• Gene testing: Testing certain genes, including breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), is recommended for people who have a family history of cancer and may be at higher risk for prostate cancer, according to National Comprehensive Cancer Network guidelines.
• ExoDx Prostate IntelliScore (EPI): This is a test that looks at levels of three substances in urine to find out the risk for aggressive prostate cancer in people 50 years and older who have a certain amount of PSA in their blood.

Your HCP may recommend you get these tests if your PSA level is uncertain or you’re trying to decide whether to receive cancer treatment.

What to know about prostate cancer treatment

To confirm that you have cancer and determine how advanced it is, you’ll likely need a biopsy. A biopsy involves using a needle to remove a sample of prostate tissue, which is then sent to a lab for testing under a microscope.

If your biopsy reveals that you have cancer, you may opt for surgery to remove your prostate. “Currently, many prostate removals are done with minimally invasive robotic surgery,” says Zhou. “The newest generation of robots has improved tremendously. They’re easier to move and operate on the very small level that surgeons need to work.”

Most people have a number of treatment options available in addition to surgery. “Again, precision medicine is making treatment very specific to the individual,” says Zhou. “For example, immunotherapy involves using your own immune system—your own white blood cells—to treat the cancer.” Other treatment approaches include the following.

• Active surveillance: Prostate cancer is often slow-growing and many people live with it for years or decades without needing treatment. Active surveillance involves making routine visits to your HCP for blood tests and, possibly, for additional biopsies to monitor the cancer.
• Radiation therapy: High-energy X-rays are directed at your prostate or small pieces of radioactive substances are placed inside the prostate to kill cancer cells.
• Cryotherapy: This procedure uses very cold temperatures to freeze and kill prostate cancer cells. It's sometimes used if prostate cancer comes back after radiation.
• Hormone therapy: For most prostate cancer cells to grow, male sex hormones called androgens need to attach to part of the prostate cancer cell called an androgen receptor. Anti-androgen drugs (also called androgen deprivation therapy) connect to these receptors, preventing androgen hormones from causing tumors to grow.
• Chemotherapy (chemo): This approach uses drugs that attack cancer throughout the body. It's sometimes used if cancer has spread beyond the prostate gland and hormone therapy isn't enough to treat it.
• Targeted therapy: Unlike chemo, which affects the whole body, newer forms of treatment target cancer cells while leaving healthy cells alone.
• Adjuvant therapy: For people with high-risk prostate cancer, additional treatment called adjuvant therapy can be used after the first treatment has been received. This may improve response to treatment.

To help develop a treatment plan that makes the most sense for you, talk with your HCP to discuss all your options, ask about risks and benefits, and get any questions about insurance coverage answered.