Ask a Doctor: Prostate Cancer Myths vs. Facts
Michael Karellas, MD, FACS Director, Division of Urology
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When it comes to prostate cancer, there’s fact and then there’s fiction. Dr. Michael Karellas, Director, Division of Urology at Stamford Health addresses the most common beliefs patients have about prostate health and prostate cancer.
1. I’m 65 and waking up 5 times a night to urinate. That’s normal for my age, so I don’t need to see my doctor.
Dr. Karellas says: False. In most cases, frequent urination usually doesn’t indicate cancer and most men will experience a change in their urinary patterns as they age. This is usually due to noncancerous enlargement of the prostate, also known as benign prostatic hyperplasia (BPH). However, prostate cancer is also very common as men age. That’s why it’s important to evaluate them so we can differentiate between these two types of prostate conditions. If frequent urination is interfering with your life, please tell your doctor. We have treatments available that may help.
2. The PSA test isn’t all that accurate, so I shouldn’t bother unless I’m actually having symptoms.
Dr. Karellas says: False. We recognize the shortcomings of using the prostate specific antigen (PSA) blood test as a screening tool for prostate cancer. The challenge is that without PSA as a starting point, we are unable to diagnose prostate cancer at an early stage. We diagnose most prostate cancers from PSA fluctuations or elevations. However, an elevated PSA does not necessarily mean you have prostate cancer, and also does not necessarily mean you need a biopsy. That’s because non-cancerous prostate conditions can also influence PSA levels. Bottom line? It’s important for us to carefully interpret the PSA value in either scenario. Depending on what we find, we may consider further testing with advanced blood tests such as the 4K score or prostate imaging. If we feel you could benefit from these options, we’ll have that discussion with you first.
3. Sometimes the best treatment for prostate cancer is no treatment at all.
Dr. Karellas says: True. Over the past few decades, our understanding of prostate cancer has evolved, and we recognize there are some prostate cancers now that we can safely watch instead of jumping to treatment. For men with low-risk prostate cancer, active surveillance is a feasible option. This consists of closely monitoring the cancer by blood test as well as periodically repeating the biopsy. As a urologic oncologist, my goal is to minimize the impact of treatment while properly addressing cancer.
4. Changing my diet, exercise routine and overall lifestyle won’t really have an impact on my prostate health.
Dr. Karellas says: False. While staying active and healthy aren’t miracle cures, making a conscientious effort to alter your nutrition and introduce workout routines can help your prostate health. The typical Western/American diet containing a high amount of saturated fats can lead to certain cancers. We also have found that lycopene which is contained in various fruits and vegetables such as tomatoes, watermelon, and red grapes, may be beneficial for prostate diseases. Think Mediterranean cuisine with a colorful plate. In terms of an exercise routine, to incorporate at least 30 minutes of physical activity into your schedule 3-5 times a week.
5. I’m only 45. I’m not old enough to have prostate cancer.
Dr. Karellas says: False, but also true. A man’s chance of developing prostate cancer increases as he ages. Unless you have a significant family history of prostate cancer or certain types of breast cancers, you have a very low chance of developing prostate cancer at a young age. However, we recommend obtaining a baseline PSA blood test in your 40s so we can predict any future PSA changes. If you do have a strong family history of prostate cancer, we’ll recommend early screening and will watch your prostate health closely.
6. My father and brother both have prostate cancer, so I’m more likely to get prostate cancer.
Dr. Karellas says: True. Like many cancers, prostate cancer does have a genetic component. While there’s not much you can do about your genetic makeup, you can work with a cancer genetic counselor to understand your risk and stay informed throughout every aspect of your life.
On the other side of the coin, a man can develop prostate cancer even if he doesn’t have a known family history of the disease. For example, being African American alone is a risk factor.
7. If I get prostate cancer, I’m unlikely to survive, so I shouldn’t bother with further testing or treatment.
Dr. Karellas says: False. Thanks to advanced technology, we’re more able than ever to target specific areas of concern in the prostate. The UroNav MRI Fusion platform uses pinpoint accuracy to sample the prostate for a biopsy. Surgery is also an option for men with prostate cancer. Our team is skilled in robotic prostatectomies, or removal of the prostate, with the daVinci Xi Robotic surgery platform. This approach offers a minimally invasive option which means less time in the hospital and ultimately a faster recovery.
While prostate cancer is very common, the good news is that prostate cancer is serious in only a very small percentage of men. This is due to a combination of factors such as newer techniques for early detection, closely monitoring men who are on active surveillance and providing options for effective prostate cancer treatment.