Prostate cancer is one of the most common cancers affecting men. About one in eight men will be diagnosed with prostate cancer during his lifetime.
For Harry Hawthorne, MD, a primary care physician with FMOL Health | St. Francis, helping men understand their risk starts with a conversation. That talk is particularly important when it comes to prostate cancer as it can develop without noticeable symptoms in its early stages. Waiting until something feels wrong can mean missing an opportunity to find cancer sooner.
“The reason we call them screening exams is because we are looking for a problem that is there that is not giving you any problems yet,” Dr. Hawthorne says. “You can say, ‘I’m not having any problems,’ and that’s good. But we still want to look.”
Finding Prostate Cancer Earlier
Many prostate cancers grow slowly, and early detection can give patients and their care teams more options for determining the appropriate next steps.
That is why Dr. Hawthorne encourages men to talk with their primary care provider about their individual risk and when screening may be appropriate.
Screening recommendations can vary based on age, overall health, family history and other risk factors. The American Cancer Society recommends that men at average risk begin discussing screening with their healthcare provider at age 50. That conversation may begin earlier for men at higher risk, including men of African ancestry and those with a close family history of prostate cancer.
Dr. Hawthorne often begins those conversations with his patients at age 40, particularly as he considers their personal and family history. He emphasizes that the right timing is something each patient should discuss with his provider.
“If you catch it early, you have some work to do — don’t get me wrong — but you can get your work done, get past this and get back to living and enjoying your life,” Dr. Hawthorne says.
Screening May Be Simpler Than You Think
For some men, one particular fear can keep them from making an appointment: the physical exam they associate with prostate cancer screening.
Dr. Hawthorne has seen that concern become a significant barrier to care. He has met patients who avoided seeing a physician for years because they expected prostate cancer screening to automatically involve a rectal exam.
But for many patients, screening can begin with a prostate-specific antigen, or PSA, blood test. That simple clarification can change the entire conversation.
“I’ve had patients in the past couple of months who have not seen a doctor in 10-plus years because they knew they were due for prostate cancer screening and did not want to come in,” Dr. Hawthorne says. “It’s a blood test now. I don’t want anybody to feel like they can’t get screened because they think they have to go through that exam.”
For someone already having routine lab work completed during a primary care visit, discussing whether a PSA test is appropriate can be an easy addition to the conversation.
What Is a PSA Test?
PSA is a protein produced by cells in the prostate. A PSA test measures the amount of that protein in the blood. Higher levels can be associated with prostate cancer, although an elevated result does not automatically mean cancer is present. An enlarged prostate, inflammation or an infection can also raise PSA levels.
The number itself is only part of the picture. A physician may also consider previous results, changes over time and other risk factors.
Depending on the result, a provider may recommend repeating the test after a period of time, treating a possible infection or pursuing additional evaluation. If a PSA remains elevated or continues to rise, imaging such as an MRI or a referral to a urologist may be appropriate.
Following PSA levels over time also gives a physician valuable context, another reason regular primary care visits matter.
Start the Conversation With Your Doctor
Prostate cancer may eventually cause symptoms such as difficulty urinating, blood in the urine, unexplained weight loss or back pain. Some urinary symptoms can also be caused by common noncancerous conditions, including an enlarged prostate. Because early prostate cancer may cause no symptoms at all, feeling well does not necessarily answer the question of whether screening is appropriate.
A primary care provider can help you understand your personal risk, including your age, overall health and family history, and talk through the potential benefits and risks of PSA screening.
For Dr. Hawthorne, preventive care is ultimately about helping his patients protect the lives they want to lead for years to come.
“I want to tell every patient when you get into your golden years, if you want to go travel, go travel,” Dr. Hawthorne says. “If you want to stay on the lake and fish all day, go stay on the lake and fish all day. I want you to have that ability to live and enjoy your life. But we’ve got to do that work now before we get there.”
