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鈥淢e encontraron c脿ncer en la pr貌stata,鈥� my father told me. They found cancer in my prostate.

As a who knows very well about the high incidence and decreased survival rates of , I anguished over these words. Even though I study cancer in my day job, I struggled to take in this news. At the time, all I could muster in response was 鈥淲hat did the doctor say?鈥�

鈥淭he urologist wants me to see the radiation oncologist to discuss 鈥榮emillas鈥� [seeds],鈥� he said. 鈥淭hey are recommending treatment.鈥�

However, I understood from my work that not undergoing treatment was also an option. In some cases, that is the better choice. So I took it upon myself to educate my father on his disease and assist him with the life-changing decisions he would have to make. Our journey can give you a preview of what a cancer diagnosis can be like.

Prostate cancer diagnosis

Prostate cancer was not a new topic for my father and me. His battle with his prostate health started 10 years ago with an initial diagnosis of .

The prostate for a number of reasons, including changing hormone levels, infection or inflammation. Two of the most frequent symptoms of BPH are difficulty urinating and a sudden, urgent need to urinate, both of which my father experienced.

Although research suggests that the factors that contribute to BPH similarly contribute to prostate cancer, there is no evidence that an enlarged prostate will necessarily .

Upon my father鈥檚 initial BPH diagnosis, I asked about his , or the amount of prostate-specific antigens in his blood. PSA is a protein that both normal and cancerous prostate cells produce, and elevated amounts are considered red flags for prostate cancer. When combined with a , a PSA test can allow doctors to more accurately predict a person鈥檚 risk of having prostate cancer.

My father said his PSA levels were elevated but that the doctors would begin , or what he called 鈥渨atchful waiting,鈥� and monitor his PSA every six months to see if it rose.

After eight years of monitoring his PSA, doctors found my father鈥檚 PSA level had doubled. He then got a biopsy that indicated he had intermediate-risk prostate cancer.

Cancer risk categorization

After his diagnosis, my father was faced with the decision of how to proceed with treatment. I explained that categorizing how aggressive the cancer is and how far it has spread can help determine the best course of treatment.

Prostate cancer can be . Stages 1 and 2, when the tumor is still confined to the prostate, are considered early-stage or intermediate risk. Stages 3 and 4, when the tumor has spread beyond the borders of the prostate, are considered more advanced and high risk.

Some patients with early-stage or intermediate-risk prostate cancer undergo , including surgery, radiation or radioactive seed implants called brachytherapy. Patients with late-stage prostate cancer typically undergo hormone therapy along with surgery or radiation, or chemotherapy with or without radiation.

Although I was not surprised by my father鈥檚 diagnosis, given his advanced age and his battle with prostate disease over the past decade, I still struggled emotionally. I struggled with our conversations about what 鈥渃uring鈥� his cancer meant and how to explain his treatment options to him. I wanted to ensure he would have the best outcome and could still live his best life.

Our initial inclination was to undergo . That meant we would monitor his PSA every six months instead of immediately starting treatment. That is appropriate for patients with early-stage and less aggressive tumors.

Prostate cancer screening problems

My father was leaning on me to help him decide how to proceed. I felt overwhelming anxiety because I did not want to fail him or my family. Even with all my expertise studying cancer genetics and working with cancer patients, I couldn鈥檛 help second-guessing our decisions, and I sometimes questioned our decision not to immediately treat his cancer.

Some people diagnosed with prostate cancer don鈥檛 immediately start treatment, because many of the tumors found through PSA testing grow so slowly that they are . Detecting these slow-growing tumors is , because the cancer ultimately will not harm the patient during their lifetime. with prostate cancer are overdiagnosed, often leading to overtreatment.

Research suggests that many prostate cancer patients undergo unnecessarily aggressive treatments, which are often associated with significant harms, like urinary and bowel incontinence, sexual impotence and, in some cases, death. Several studies in the U.S. have shown that patients with early-stage prostate cancer have a further. With careful observation, most will never need treatment and can be spared the burdens of unnecessary therapy until there are clear signs of progression.

Overdiagnosis and overtreatment of prostate cancer led the U.S. Preventive Services Task Force to recommend against PSA-based screening in 2012, with caveats for high-risk groups including African American men and those with a family history of prostate cancer. The recommendation was updated in 2018 to make screening a with a clinician.

Those recommendations have resulted in reduced screening and . Given that Black men are to aggressive forms of the disease after initial diagnosis, this may worsen existing health disparities.

Developing tests that better identify patients at risk of dying from prostate cancer can decrease overtreatment. In the meantime, educating patients can help them decide if screening is appropriate for them. For underserved and marginalized communities, can help improve health literacy and enhance awareness and screening.

When I looked through my father鈥檚 stack of medical records, I found a beacon of light that eased my apprehension. His doctor had ordered a that estimates how aggressive a tumor may be by measuring the activity of specific genes in cancer cells. An increase in gene activity linked to cancer would indicate that it is likely to grow fast and spread.

The test predicted that my father鈥檚 risk of dying from the disease in the next five years was less than 5%. Based on these results, we both understood that he had adequate time to make a decision and seek additional guidance.

My father ultimately decided to continue active surveillance and forgo immediate treatment.

Surviving prostate cancer

I still worry about my father鈥檚 diagnosis, because his cancer is at risk for progression. So every six months, I inquire about his PSA levels. His doctors are monitoring his PSA levels as part of his , which is a record of information about his cancer diagnosis, treatment history and potential follow-up tests.

My father鈥檚 decision to undergo active surveillance was controversial among our friends and family. Many were under the impression that prostate cancer required immediate treatment. Several shared successful treatment stories, sometimes followed by stories of adverse treatment-related side effects.

To date, my father believes that active surveillance was the best decision for him and understands that this may not be the same for someone else. Talk to your doctor to see what the best options are for you or your loved ones.

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