Myth 1: Prostate Cancer Is a Disease of Older Men
“It’s not uncommon at all for men in their fifties and some in their forties to have prostate cancer,” says Oliver Sartor, MD, a professor of medicine and urology at the Tulane University School of Medicine in New Orleans. (It’s rare in men younger than 40, however.)
Myth 2: My Dad Had Prostate Cancer, So I Will, Too
Fact: “If a man has one relative with prostate cancer, say a father or brother, his chances of getting it are two times higher than those of someone who doesn’t have this history,” says John Wei, MD, a urology professor at the University of Michigan in Ann Arbor. Two family members with prostate cancer hike the risk fivefold.
But not everyone with a family history of prostate cancer will get it themselves. If prostate cancer runs in your family, talk with your doctor about when to start regular PSA tests; your healthcare provider might be more aggressive about recommending follow-up testing.
Myth 3: Prostate Cancer Isn’t Deadly
Most prostate cancers are what doctors call “indolent,” which means that they grow slowly and can often be actively monitored over the course of many years without other treatment. But sometimes prostate cancer is aggressive, and grows quickly.
“While most men don’t have a prostate cancer that’s fast and deadly,” acknowledges Dr. Sartor, it does exist. And you won’t know which type you have until it’s thoroughly checked out.
In other words, assuming prostate cancer isn’t serious — and not having further testing because of this misconception — could be a risky way of approaching the illness.
Myth 4: Prostate Cancer Is Always Deadly
Myth 5: PSA Tests Are Bad for You
Causes of a high PSA can include bicycling and ejaculation. As a result, some men with high PSA are given invasive biopsies that aren’t needed. Or, if they do have cancer, they may be treated aggressively for slow-growing tumors that might never have caused any issues.
Which is not to say that PSA tests aren’t valuable or that they can’t save lives; in the years since they’ve been widely used, says Dr. Wei, prostate cancer diagnoses have gone up — but “the death rate is going down.” This is at least in part because PSA tests lead to more investigation, which can find cancer early, when it’s more receptive to treatment. Talk with your doctor about whether — and how often — you should be screened for prostate cancer.
Myth 6: If You Have a Low PSA, You Don’t Have Prostate Cancer
Fact: PSA levels can be useful in diagnosing prostate cancer, but they’re really only one piece of the puzzle. The PSA test is far from perfect, Sartor says. He draws a parallel between low PSA readings and negative mammograms in women. “If you have a negative mammogram, it’s not 100 percent in terms of excluding cancer. The probability is less. Likewise, just because your PSA is relatively low, you can’t interpret that to mean that there is no cancer present.”
“While the biopsy is still the gold standard when it comes to the diagnosis of cancer, this MRI can add localization and help streamline the efficiency of the biopsy,” he explains. “It can tell you where to put the needle and also, in some patients, tell you that a biopsy is not required because the probability of cancer is very low.”
Myth 7: If You Have a High PSA, You Have Prostate Cancer
This also means many men with PSA levels over 4 don’t have prostate cancer.
Myth 8: Prostate Cancer Treatment Always Causes Impotence
Sartor says the risk of impotence depends on many factors, including the skill of the surgeon who is operating on you. But as surgical techniques are improving, people are recovering faster and having fewer side effects. This offers hope to those wanting to maintain an active sex life during their treatment.
According to Sartor, one year after surgery, approximately 25 percent of patients will say their sexual function is fine, 25 percent will have mild dysfunction, 25 percent will have moderate dysfunction, and 25 percent will say they have severe dysfunction.
Age can also be a complicating factor, adds Wei: “As men get into their sixties and seventies, a lot of them already have some compromise of sexual function.” Prostate cancer treatment certainly won’t correct this problem, but it also isn’t likely to make it significantly worse for most men.
Myth 9: Prostate Cancer Treatment Always Causes Incontinence
Fact: Next to sexual function, men worry most about urinary incontinence as a result of prostate cancer treatment. “The majority of people do not have significant urinary problems,” Sartor says.
If you do have bladder problems, you’re more likely to face minor leakage than major accidents — and in most men, the situation is temporary or treatable.
To help ensure the best outcome after surgery, Sartor recommends looking for a surgeon who has performed the procedure many times — surgeons who are on their 900th procedure, for example, not their 41st. “Experience does matter,” he says. “It’s important to consider.”
Myth 10: If the Cancer Comes Back, It Can’t Be Treated Again
Fact: Recurrence of prostate cancer can be wrenching. But just because a cancer comes back doesn’t mean you can’t reach remission again. You’ll likely have to try another approach to treatment, though.
“Your first cancer cure is always the best,” says Sartor. “But you do have a possibility for cure if it comes back — particularly if you’ve had an initial radical prostatectomy [removal of the prostate gland], in which case if you catch [the recurrence] early, you can radiate and get a pretty good cure rate.”
Sartor adds that this is one of the reasons why he often recommends surgery before radiation — so that people get a second chance at a cure if the cancer comes back.
The Takeaway
- There are many myths about your personal risk of getting prostate cancer, what different test results mean, and the side effects of treatment.
- While prostate cancer does take lives, most people don’t die of it.
- High or low PSA levels don’t mean you do or don’t have cancer for certain.
- A year after treatment, many men return to their precancer level of sexual function.
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