HEALTH: What you should know about prostate cancer

Shiv Khandelwal, MD

According to American Cancer Society (ACS), excluding skin cancer, prostate cancer is the most common cancer and second most lethal cancer found among men in the United States. About one in eight men will be diagnosed with prostate cancer during their lifetime. 

Shiv Khandelwal, MD, an associate professor at UVA School of Medicine and a radiation oncologist at UVA Cancer Care, a department of Novant Health UVA Health System Culpeper Medical Center, says early detection is key to overcoming prostate cancer.Khandelwal starts the much-needed conversation about prostate cancer and how to detect it early for a better outcome.  

Q: How can prostate cancer be identified early?

A: The cells of the prostate gland make a protein called prostate specific antigen, or PSA, which is measured with a simple blood test. Monitoring PSA changes can provide important diagnostic information. Additional testing like digital rectal exam and prostate biopsies are used in conjunction with PSA to diagnose early prostate cancer.

Q: Why is it important for men to be diagnosed early?

A: Cure rates are higher, and treatments are less intensive with fewer side effects and of shorter duration for early relative to advanced prostate cancer. Many less aggressive prostate cancers can be managed with active surveillance without treatment unless progression occurs while on surveillance. 

Q: What are the treatment options for men with prostate cancer?

A: Curative options for prostate cancer patients who need treatment include surgery to remove the prostate, temporary or permanent implantation of the prostate with radiation sources — called brachytherapy — intensity modulated radiation therapy using photons or protons, stereotactic radiation, and testosterone suppression. Combinations of these various approaches are used, as well. 

Each treatment approach has its advantages and disadvantages and not all are appropriate for every patient. The goal of treatment is to maximize benefits and minimize risks and treatment is tailored for each patient’s situation. Many patients have multiple appropriate options in which case educating the patient about those options and patient preferences play a strong role in selecting treatment. 

Q: What is the biggest misconception about prostate cancer?

A: The misconception I hear a lot is that prostate cancer is slow-growing, and you will die with it rather than because of it. While many prostate cancers are slow-growing, which is why many prostate cancer patients can have close surveillance rather than treatment, many men die each year from advanced prostate cancer.

In 2021, ACS estimates there will be about 250,000 new cases and 34,000 deaths from prostate cancer in the United States. While prostate cancer mortality was previously declining, it has stabilized since 2014. Many men who die with rather than from prostate cancer also have negative, preventable quality of life impacts from spread of prostate cancer.

Q: Are patients sometimes uncomfortable talking about prostate cancer or getting tested?

A: Absolutely! Prostate cancer screening receives less attention than other types of cancer, and men can be embarrassed to talk about their prostate health. Prostate cancer itself and its treatments may lead to incontinence or impotence, which are real concerns. My recommendation is to talk to your doctor about your concerns and not to avoid what you fear. These discussions provide important information to allow you to make informed decisions about your health. Keep in mind that research has led to advances to reduce these and other risks involved in treating prostate cancer.  

Q: When should someone get tested? 

A: The only consensus on screening is that men at increased risk for prostate cancer should be screened. While the United States Preventive Services Task Force made headlines a few years ago by recommending against screening, they have since retreated from this recommendation and now consider selective screening appropriate. Other organizations, such as ACS and National Comprehensive Cancer Network, still recommend routine screening. The decision to screen is not straightforward, and I encourage patients to discuss it with their doctor. Personally, I have chosen to be screened even though I am not at increased risk. 

For more information about cancer care services available at Novant Health UVA Health System, visit

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