September is Prostate Cancer Awareness Month, and for men living in the U.S., one in eight will be diagnosed with the disease at some point, including more than 200,000 this year. If you are an African American man, the likelihood is one in five, and if you have a family history of prostate cancer, the odds are even higher at one in three.
As one of the nearly 3 million men in the U.S. who counts himself as a prostate cancer survivor, as well as a clinical exercise physiologist, I write to promote greater awareness of this disease and to share a few aspects of my personal experience.
Prevention
Importantly, the primary lifestyle factors — dietary and physical activity habits — are effective for both prevention and preventing recurrence of prostate cancer. These, of course, fall squarely in our domain as physical activity experts and fitness and medical professionals, and it’s important that we educate the public about them. You may find this recent study, published in Medicine and Science in Sports and Exercise®, of interest.
In my case, my healthy lifestyle did not prevent prostate cancer; however, it helped make for a reasonably short recovery, and my periodic prostate specific antigen (PSA) checks (more on this in a minute) have remained undetectable.
Misconceptions and key questions
Before I go into the details of my personal experience, it may be important to address a few key questions about prostate cancer.
Is prostate cancer an “old man’s disease”? Although age is a risk factor, only six cases in ten are diagnosed in men over 65 years old; approximately 10% of diagnoses are made in men younger than 55. Thus, thinking of prostate cancer as an “old man’s disease” is not entirely accurate. More of our patients, fitness clients or colleagues may be affected by this disease than we would imagine.
Who should be screened and when? The screening recommendations have changed over time. Interestingly, the ~50% decline in the death rate from prostate cancer between 1993 to 2013 was likely due to earlier detection (as well as improvements in treatments). Age, race (African American), and family history are the key factors that influence the decision about who to screen and when to start screening. The American Cancer Society provides guidance on making informed decisions. It might seem like an awkward conversation to have with patients, clients, family or friends, but spreading the word about prostate cancer screening can be a lifesaving act.
What tests are used for screening? In the U.S., screening is most commonly via a blood test for prostate specific antigen (PSA) and a digital rectal exam done in a physician’s office. Like all medical tests, the accuracy of the tests are not perfect, as possibilities of false positives or negatives may occur. Recently, additional options (blood, urine, or imaging [MRI] tests) have emerged which may aid individuals in making decisions. If findings from these tests are positive, the next step is considering a prostate biopsy. If cancer is found on a biopsy sample, the next decision is about treatment.
The treatment decision will be based on each individual’s characteristics, with particular emphasis being placed on age, comorbidities, stage/grade of cancer, and the possible side effects of the treatment options. The three primary options are active surveillance, radiation therapy (with or without hormone therapy), or radical prostatectomy (complete removal of the prostate).
My personal experience
In my case, as a white man with no family history of the disease, I started having prostate cancer screening (PSA and digital rectal exam) at age 55 at my annual medical exam. After many years of normal results, I had a notable jump in my PSA level and my doctor recommended a biopsy. That’s when I got the call with the news “You have prostate cancer.”
I immediately started investigating the different treatment options and sought a second opinion from a urologist specializing in prostate cancer and also sought the opinion of a radiation oncologist. Additionally, I sought information from various medical research centers. I was able to enroll in a clinical trial investigating the role of a positron emission tomography (PET) scan, using a radiopharmaceutical agent that recognizes prostate-specific membrane antigen in guiding surgery. As importantly, I talked with many other men who had previously been diagnosed to learn about their treatment decisions. I came away from all this information gathering with an understanding that each case is unique. Fortunately, having a range of treatment options, each with supportive data, allows men good options. My advice, if you receive the news “you have prostate cancer,” is to gather all the information you can so you can make the best choice for you.
I encourage you to do a web search for Prostate Cancer Awareness Month to access resources available from numerous organizations to learn more about prostate cancer. Please support prostate cancer awareness by promoting this in both your workplace and community.
Dr. Lenny Kaminsky directed the Clinical Exercise Physiology Program and Laboratory and the Adult Physical Fitness Program at Ball State University (BSU) for over 25 years and is currently he is the Director Emeritus of BSU’s Fisher Institute of Health and Well-Being. He is one of the primary collaborators of the Ball State Longitudinal Lifestyle Study (BALLST) and one of the co-founders of the Fitness Registry for the Importance of Exercise National Database (FRIEND) Registry for Cardiorespiratory Fitness. He has served as editor of multiple American College of Sports Medicine (ACSM) publications and regularly contributes to scientific writing groups including the American Heart Association’s Scientific Statement supporting Cardiorespiratory Fitness as a Vital Sign and the American Association of Cardiovascular and Pulmonary Rehabilitation’s (AACVPR) Statement on Progression of Exercise Training. He is the Editor-in-Chief of AACVPR’s Journal of Cardiopulmonary Rehabilitation and Prevention and the Commentary Editor of the ACSM Bulletin.
