Column: Dr Adam Feldman On Prostate Cancer
[Column written by Dr Adam Feldman]
Prostate cancer is the number one cancer affecting men in Bermuda, accounting for around one-third of all male cancer diagnoses on the island. Approximately 50 new cases are diagnosed locally each year and, as Bermuda’s population continues to age, awareness of prostate health and the importance of screening has become increasingly important.
Globally, prostate cancer affects 1 in 8 men, with approximately 1.5 million new cases diagnosed every year. In the United States alone, there are approximately 333,000 new cases and 36,000 deaths annually.
Who is most at risk?
Men at greater risk include Black and African American men, men with a family history of prostate cancer, and those with a family history of other genetically related cancers such as breast, ovarian, endometrial, pancreatic and gastric cancers. Men with known inherited genetic risks or mutations, including BRCA gene changes, are also at increased risk.
What symptoms should people be looking out for?
Prostate cancer is most commonly detected when it does not cause symptoms, which is why screening is so important. Urinary symptoms, such as frequent or urgent urination and difficulty with flow are more often due to benign enlargement of the prostate. However, if these symptoms develop over months rather than years, they should be assessed. Blood in the urine or ejaculate and erectile dysfunction can also occur but are more commonly linked to non-cancerous conditions and ageing. Advanced disease may present with persistent pain in the back, hips, pelvis or thighs, unexplained weight loss or general fatigue.
Aside from an annual physical and prostate check, what should patients monitor?
Men should be screened using a blood test called prostate specific antigen, or PSA, alongside a digital rectal exam. The Bermuda Cancer and Health Centre recommends screening from age 40 for black men or men with a family history of prostate cancer and from the age of 50 for all other men who are at average risk of prostate cancer. Routine screening is not usually recommended for those over the age of 75 unless there are symptoms, elevated risk or concerning prior results.
Prostate health is often difficult to talk about. What advice is there for patients?
Prostate cancer is the most common non-skin cancer in men. Many men experience similar urinary symptoms and concerns, so discussion is more common than people expect. There is no need for embarrassment and early conversation and blood testing can be an important step.
What are treatment options and outcomes?
Management can range from active surveillance in low-risk cases to surgery or radiation in intermediate and high-risk cases. Hormonal therapy can also be used alongside radiation. When prostate cancer is localised, cure rates are generally high and even recurrences can most often be treated effectively. In advanced disease that has spread, treatment is not usually curative but can control the condition for many years.
What are recent advances?
Minimally invasive robotic surgery has improved recovery and reduced complications. Advances in radiation allow more precise targeting with fewer side effects. New systemic therapies have improved outcomes in advanced disease, helping men live longer. Imaging has also improved significantly with prostate MRI and prostate specific membrane antigen [PSMA] PET scans, both improving detection and staging.
All of this is to say that early detection remains key and that awareness and routine screening continue to play a central role in improving outcomes for men in Bermuda as well as around the world.
- Dr Adam Feldman, Chief of Mass General Brigham Urologic Oncology
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