When a team of doctors diagnosed former President Joe Biden with an aggressive form of prostate cancer last month, it cast the most commonly occurring cancer among men into the national spotlight.

But for as common as it is, there remain questions, even confusion, about all prostate cancer entails, borderline controversy surrounding how it should be diagnosed, and the processes by which it is treated.

Or, in perhaps a surprising amount of cases, the reasons it isn’t.

“I think a real disservice, speaking as an oncologist, when we label prostate cancer is, it’s a little confusing,” said Dr. Christopher Peters, the medical director of Northeast Radiation Oncology Centers in Dunmore, Lackawanna County, and a board of directors member at the Northeast Regional Cancer Institute in Scranton and Wilkes-Barre. “Low-grade, low-risk prostate cancer acts very, very differently than high-risk, high-grade prostate cancer. But, they’re all called prostate cancer. This is a problem, because some people’s prostate cancers are very aggressive; they may cause mortality and morbidity, such as bone metastasis, which may be painful and may cause the patient’s death. There are also other prostate cancers that are low-grade that we may be able to diagnose and watch, for many years, without any treatment. And then, there’s everything in between.”

The trick for men, and their doctors, is discovering where they land on that spectrum.

What is prostate cancer?

By definition, prostate cancer is a growth of cells that starts in the prostate, a walnut-sized gland that is part of the male reproductive system and located just below the bladder.

By the statistics, it can be considered quite a bit more intimidating.

According to the American Cancer Society, nearly 314,000 new cases of prostate cancers are estimated to be diagnosed in 2025. It also estimates prostate cancer-related deaths will top 35,700 this year. Since 2014, the incidence rate for diagnoses has increased by 3% per year. About one in eight American men will be diagnosed with prostate cancer, and ultimately, it will kill one in 44.

That said, those numbers tell more of a story about how common the cancer is than how fatal it can be.

More than 3.3 million men living currently in the United States were, at one point in their lives, diagnosed with a form of prostate cancer, many of which are highly treatable and even curable when detected early.

What are the symptoms?

“As far as symptoms, unfortunately with prostate cancer, there usually are none,” said Dr. Angelo Baccala, deputy physician in chief, innovation and program development, Institute for Surgical Excellence, and chief of the division of urology at Lehigh Valley Health Network, part of Jefferson Health.

That’s why, oncologists and urologists agree, it’s important for men to understand their own personal risk factors.

Those risks vary based on several things, like age, race and ethnicity, and especially family history.

The risk is also statistically higher for men of African ancestry than it is for men of other races.

So for men between the ages of 50 and 69 — and even a few years earlier for those with extreme risk factors — who find themselves in those categories, awareness of potential warning signs for prostate cancers remains important.

While it tends not to show any signs in its early forms and can be relatively slow-growing compared to other forms of cancer, men may notice at least one of the following as early stage prostate cancer progresses:

• Blood in the urine or semen.
• A weak urine flow, or one that stops and starts.
• Pain or burning while urinating.
• The need to urinate more often, and waking up during the night more often to do so.
• Difficulty getting started while trying to urinate.

Advancing stages can come with other symptoms as well, including pain in the back or bones, loss of bladder or bowel control, unintended weight loss, extreme fatigue and erectile dysfunction.

Of course, doctors point out that many of those conditions are symptomatic of maladies not related to prostate cancer, but a general rule is encouraged among those in the age group and with the risk factors who are concerned by changes in how they feel: Call your doctor or another health care professional if there are any symptoms that concern you.

How is it diagnosed?

Just about every process when it comes to diagnosing potential prostate cancer issues starts with a basic prostate exam, one that can be done by a primary care doctor, a urologist or any other physician.

“Basically, what they do is look at the size of the prostate and see if the prostate is big or not,” said Dr. Ahmad Hanif, the division chief of hematology oncology at Geisinger Wyoming Valley Medical Center in Wilkes-Barre. “Even if the prostate is found to be bigger than normal, it doesn’t mean that it is cancer. But it would mean that further workup is needed, especially if you’re having symptoms.”

The main method by which prostate cancers are screened remains the prostate-specific antigen (PSA) blood test.

When detected early, prostate cancer is highly survivable: Upward of 99% live five years or more if the cancer is detected while still localized to the prostate or has not spread beyond nearby structures or lymph nodes, according to the American Cancer Society. Baccala points out that number drops to 37% if the patient’s cancer is advanced or metastatic, stressing the importance of consistent PSA screenings.

“Catching it early is really important, and it’s easy,” he said. “It’s a blood test at an exam. It takes all of three seconds to do, and you’re getting blood drawn by your primary care doctor anyway, so it should be included.”

Baccala said screening should be recommended up to age 70, with some going a few years beyond if there is any concern on recent PSA results.

Understanding the results

If the test reveals higher levels of the antigen in the bloodstream, it is an indicator of a potential cancer presence. However, increased PSA levels are not uncommon in older men, and they also could be a sign of noncancerous diseases or even other factors that could raise the levels.

The question doctors face is whether benefits to consistent screening outweigh potential risks.

“Ordering the test is not a problem. Cost of the test is not a problem. It’s the understanding of the test that is the problem,” Hanif said.

The longer PSA screening recommendations put in place in the early 2010s have been followed, the number of advanced prostate cancer cases that have been diagnosed have decreased. That, Hanif added, is plenty of evidence that screening works.

However, it can be a double-edged sword if patients walk into a PSA screening without the full knowledge of what the results could mean. High results on the test don’t necessarily mean the type of cancer needs to be treated immediately, if ever, given how slowly the cancer can grow. There’s also a chance that a high test result doesn’t result in a positive test for cancer.

“As long as there is a discussion between you and your doctor regarding what a high PSA means and someone can be comfortable living with the fact that they have prostate cancer and a doctor isn’t doing anything about it, then yes, a PSA should be ordered and is a great screening tool,” Hanif said. “It has been shown to reduce the number of advanced cases being detected, so prostate cancer in the early stages can be detected. But, there has to be a discussion.”

What are the treatments?

Research has led to a boon over the last 15 years both in prostate cancer treatments and ways it can be managed.

Peters said that, in addition to testing for PSA, doctors now have multiparametric MRIs that can, noninvasively, more effectively detect aggressive tumors in the prostate that are more likely to need a biopsy. There is also a Prostate Specific Membrane Antigen that can determine if a cancer has spread or returned after treatment.

“We do a lot better in treating prostate cancer in men, on average,” Peters said. “And, that’s the key here. On average, men live longer with prostate cancer.”

There are also potentially curative treatments for more localized, less-advanced prostate cancers that can be handled with surgery or through radiation treatments, like ones Peters specializes in at NROC.

Hanif said that, for less aggressive forms of prostate cancer, living with it can be much more simple: A few visits to the oncologist every year, simply to make sure there aren’t drastic changes that need more immediate attention.

More than anything, the key to beating prostate cancer is detecting it early. And the key to detecting it early is honest, open conversation between men and their doctors about what steps make the most sense for their individual lifestyle.

“If I had a take-home conversation on this, it would be, discuss matters with your doctor,” Peters said. “Ask your doctor, who you trust, ‘What are the pros and cons for me with prostate cancer screening, not on a population-based level, but on an individualized level?’

“Of course, as an oncologist, I recommend some screening, because my goal is to keep people out of my office, right? We want to keep people not having prostate cancer, or having it detected at the earliest possible stage so we can have a shared decision-making conversation as far as, what do we do with this prostate cancer from here?”