Montefiore in the News
September is National Prostate Cancer Awareness Month
- September 22, 2021
By Dr. Kara Watts, Associate Profes-sor, Department of Urology Montefiore Health System and Albert Einstein Col-lege of Medicine
Prostate cancer is one of the most common cancers for men, only after skin cancer. In fact, one in nine men will be diagnosed with prostate cancer in their lifetime. For Black men, this cancer is especially deadly. In the Bronx, we have seen a 23% greater mortali-ty risk of prostate cancer among Black men compared to their white counterparts.
But there’s good news. Early screening can catch 95% of prostate cancers, and when caught early, the five-year survival rate for prostate cancer is 99%.
Prostate cancer has few or no symptoms in its ear-ly stages. Because of the prostate gland’s location, a growing tumor will have nothing push on, so often when the cancer is most curable, people don’t feel any pain. Warning signs can be vague and easily ignored, such as difficulty urinating, sexual dysfunc-tion, blood in the urine or semen, pressure in the rectum, or stiffness in the lower back, pelvis, hips, or thighs, which is why screening is so important.
The number one risk fac-tor for prostate cancer is age. Risk of prostate can-cer rises rapidly after age 50, so men should begin prostate screenings around then. Black men are 76% more likely than white men to develop prostate cancer and often develop more aggressive forms of the disease, so we recom-mend regular screening for Black men to begin at age 45. We are currently researching the genetics of our patients with prostate cancer to identify why this disparity exists. One thing we know for sure is that family history is another significant risk factor.
If you have a relative who has had prostate can-cer, you are twice as like-ly to develop it. Two or more relatives with the disease multiplies your risk by four. A family history of other cancers such as breast, ovarian, colon, or pancreatic cancer can also increase your risk of devel-oping prostate cancer. We have ongoing studies fo-cused on familial risks, as well as the correlation be-tween weight and pros-tate cancer risk to deter-mine how we can curb prostate cancer rates in our region and enhance current screening efforts in high risk areas of our community.
Two initial tests can find abnormalities in the prostate. The PSA test is a blood test that measures the level of prostate specif-ic antigen; when there’s a problem with the prostate gland, more of this protein in produced. It doesn’t al-ways indicate cancer; it may be a sign of inflam-mation, a urinary tract infection, or an enlarged prostate.
The second test is the digital rectal exam, which allows the doctor to feel the prostate and determine if it’s enlarged or irregu-larly shaped. The digital rectal exam is a little more uncomfortable but it isn’t painful. It is also quick – lasting less than a minute.
If one or both tests show there may be a concern, the next step may be an MRI or additional tests. MRI images can help show prostate enlargement or abnormalities. Based on these images, a urologist may recommend a prostate biopsy. This minimally in-vasive procedure removes tissue from different areas of the prostate that are then examined in a pathology lab.
Earlier this year, we reviewed the records of 410 men—49% identified as non-Hispanic Black, 30.5% identified as Hispan-ic and 20.5% identified as non-Hispanic white—who underwent a fusion-guid-ed biopsy at Montefiore, which is when an MRI im-age is “fused” with the ul-trasound image. We found that biopsies guided by this technique, which our De-partment of Urology offers at its main office location, detected more prostate can-cers among non-Hispanic Black men compared with non-Hispanic white men and Hispanic men, who had similar likelihoods of prostate cancer detection. Our findings suggest that, especially for non-Hispan-ic Black men, suspicious prostate lesions detected using MRI/ultrasound im-aging may have higher likelihood of finding pros-tate cancer that should be biopsied. In addition, this type of biopsy may help to avoid detection of some low-grade prostate can-cers that do not need to be treated.
Even when problems are diagnosed, prostate cancer does not always require im-mediate treatment. There are non-aggressive forms of the disease that can be managed with regular checkups. In fact, about 30% of men with prostate cancer have tumors that are so slow-growing that regular monitoring is enough.
For those men who are recommended treatment, we offer a multi-disciplinary ap-proach with a full range of treatment options. Overall, prevention is always the very best treatment option.
To mark National Prostate Cancer Awareness Month, we are offering a no-cost PSA test to men on Saturday, September 25, from 10 to 2 pm at 899 Elton Ave, Bronx, NY 10451. Appointments are limited, so we encourage people to register by calling 646-921-3007 as soon as possible. We hope to see you at our screening event and encourage all men over age 40 to learn more about their risk of prostate cancer and screening options today.