Proactive Steps Against Prostate Cancer This Men’s Health Week With Stephen Freedland, MD

Understanding Prostate Cancer Prevalence and Risk

Prostate cancer is a significant health concern for men, particularly as they age. The prostate, a walnut-sized gland located below the bladder, can develop cancer that is both common and potentially deadly. “Prostate cancer is the most common cancer among men and the second most lethal cancer,” Dr. Freedland noted. He added that among non-smoking men, prostate cancer may even be the leading cause of cancer death. While the disease often grows slowly, it still claims many lives each year, underscoring the need for better prevention and treatment strategies.

Lifestyle, Screening, and the Limits of Medication

When it comes to prevention, Dr. Freedland stressed that the focus should be on reducing the risk of lethal prostate cancer rather than simply preventing diagnosis. “There are drugs that have been studied, but they really didn’t reduce the risk of the aggressive cancers,” he explained, referring to finasteride and dutasteride. These medications are not FDA-approved for prostate cancer prevention, and their impact on mortality is unclear.

Instead, Dr. Freedland advocates for lifestyle modifications and early detection. “Obesity is linked with lethal prostate cancer,” he said, recommending that men maintain a healthy weight, exercise regularly, and avoid smoking. He also highlighted the importance of early detection through prostate-specific antigen (PSA) testing, which can identify cancer at a stage when more treatment options are available.

The Role of Early Detection and Individualized Care

For men diagnosed with prostate cancer, early detection is key to optimizing outcomes. “The best way is to find it early; it gives you more options as to what to do,” Dr. Freedland advised. He recommends that men receive a baseline PSA test in their early 40’s, with more regular testing starting around age 50 to 55. The frequency and duration of screening should be individualized based on patient health and life expectancy.

Treatment options range from active surveillance for low-risk cases to focal therapy, surgery, or radiation for more aggressive disease. “If it’s not so aggressive and we find it early, we can sometimes just watch the tumor and do nothing, which is called active surveillance,” Dr. Freedland explained, emphasizing the importance of minimizing unnecessary treatment side effects.

Men’s Health Week Messages

Dr. Freedland offered advice for both men and clinicians to promote proactive health management and informed care. For men, he emphasized the importance of taking charge of their health. “Men tend to not be the most proactive with their own health, but you need to be proactive and take care of yourself,” he urged. This includes getting regular PSA tests, maintaining a healthy lifestyle, and not being afraid of seeking medical advice.

For clinicians, Dr. Freedland encouraged a reevaluation of PSA testing. “I think PSA has gotten a bad rap, because we didn’t necessarily know how to use it well,” he stated. He believes that with smarter utilization, PSA testing can significantly benefit patients by enabling early detection and intervention.

Key Takeaways

• Prostate cancer is the most common and one of the most lethal cancers among men.
• Lifestyle factors such as obesity and smoking are linked to more aggressive disease.
• Medications like finasteride and dutasteride are not recommended for prevention due to limited impact on lethal cancer.
• Early detection through PSA testing is crucial; clinicians should encourage shared decision making and individualized screening plans.
• Active surveillance and tailored treatment can help minimize side effects and improve quality of life.
• Men should be proactive about their health, including getting regular PSA testing and maintaining a healthy lifestyle.
• PSA testing has high value for prostate cancer prevention when used judiciously.

About Dr. Freedland

Stephen Freedland, MD, is Director of the Center for Integrated Research in Cancer and Lifestyle and Associate Director for Education and Training at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute in Los Angeles. He is also the Warschaw Robertson Law Families Chair in Prostate Cancer and a Professor in the Department of Urology at Cedars-Sinai. He also holds a Staff Physician appointment at the Durham VA Medical Center in Durham, North Carolina. Dr. Freedland has published over 700 articles and served on numerous AUA and ASCO guideline panels for prostate cancer. His research interests include the role of diet, lifestyle, and obesity in cancer, cancer health disparities, and cancer risk stratification.