June is Men’s Health Month – a time dedicated to raising awareness about the health challenges men face and encouraging early detection and treatment of preventable conditions.

One critical topic is prostate cancer, which remains one of the most common cancers among men. While it often develops slowly, prostate cancer can be serious if not caught early. This month presents an important opportunity to talk about risk factors, symptoms and the importance of routine screenings – empowering men to take charge of their health through education and proactive care.

What is the prostate, and why does it matter?

The prostate is a walnut-sized gland just below the bladder that wraps around the urethra. It plays a crucial role in male fertility by producing seminal fluid.

As men age, the prostate naturally enlarges, which may or may not indicate cancer. Distinguishing between benign prostatic hyperplasia (BPH) and prostate cancer is an important task for urologists.

Who is at risk?

Several factors increase your risk of developing prostate cancer:

* Age: Most cases occur in men over 50. Risk increases significantly with each passing decade.

* Ethnicity: African American men are more than one and a half times more likely to get prostate cancer and over two times more likely to die of it than Caucasian men.

* Family history of prostate, breast or ovarian cancer: If your father or brother had prostate cancer, your risk doubles. Inherited mutations, such as BRCA1 or BRCA2, can also elevate your risk.

* Lifestyle: Diets high in red meat and low in vegetables may contribute to increased risk.

Silent but serious: Recognizing the signs

In the early stages, prostate cancer usually does not cause symptoms. That is why screening matters.

Later, signs may include:

* Frequent urination, especially at night.

* Difficulty starting or stopping urination.

* Weak urine stream.

* Blood in urine or semen.

* Pelvic discomfort or bone pain (in advanced cases).

However, these symptoms can also be caused by noncancerous conditions like BPH or prostatitis.

Should you get screened?

The decision to screen for prostate cancer is complex and needs to be decided in conjunction with your risk factors.

* Men aged 50 to 69 with average risk should discuss screening with their family or primary care physician.

* High-risk men (family history, African American ethnicity) may start as early as 40 to 45.

* Screening decisions for men over 70 should be individualized based on health status and life expectancy.

Screening options

The two most common screening tools are:

PSA (prostate-specific antigen) blood test

* The PSA test measures the amount of PSA in the blood, which is produced by the prostate gland.

* Elevated PSA levels can indicate prostate cancer, but they can also be caused by other conditions affecting the prostate, such as prostatitis or an enlarged prostate.

* The test is often used as a first step in screening for prostate cancer and, if the results are concerning, further testing like a biopsy may be recommended.

Digital rectal exam (DRE)

* A DRE involves a healthcare provider inserting a gloved finger into the rectum to examine the prostate.

* The DRE can be used to feel for lumps, abnormalities, or changes in the size or shape of the prostate.

* An abnormal DRE finding can indicate prostate cancer or other prostate problems.

What if the results are abnormal?

If initial tests suggest cancer, your physician will proceed with a prostate biopsy. This helps determine the Gleason score, which is a grading system ranging from 6 to 10, where lower scores indicate less aggressive cancer, and higher scores indicate more aggressive cancer.

Low-risk cancers may not need immediate treatment and may call for active surveillance. Others, especially those that are high-grade or have spread outside the prostate, may require prompt intervention.

Regarding treatment options, it’s not one-size-fits-all. Treatment varies depending on the stage and aggressiveness of the disease, your age, overall health and personal preferences.

Common approaches include:

* Active surveillance: Regular monitoring with PSA, MRI and biopsies.

* Surgery (radical prostatectomy): Removal of the prostate; effective for localized cancer.

* Radiation therapy: External beam or brachytherapy (internal radiation).

* Hormone therapy: Reduces levels of male hormones (testosterone) that fuel cancer growth.

* Chemotherapy or immunotherapy: Used when cancer is resistant to hormone therapy or has metastasized.

Each treatment has potential side effects, like urinary incontinence or erectile dysfunction. So, it is important that you are included in the decision-making process.

What is the prognosis?

If detected early, the prognosis for prostate cancer is excellent. The five-year survival rate for localized prostate cancer is nearly 100%. Even when cancer has spread, newer treatments are improving outcomes significantly.

The bottom line

* Don’t ignore urinary symptoms – get them checked out.

* If you’re over 50 (or 40 with risk factors), discuss PSA testing with your family or primary care physician.

* Not all prostate cancers need to be treated aggressively.

* Informed decisions and regular checkups can save lives.

Prostate cancer doesn’t have to be feared. With awareness, timely screening and individualized care, it’s a highly manageable condition. If you have concerns, talk to your urologist – we’re here to help you navigate every step.

Achal Modi, MD, urologist is on the medical staff of Baylor Scott & White Medical Center – Waxahachie.