10 Myths About Prostate Cancer

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4. Myth: Prostate Cancer Is Always Deadly

While prostate cancer is a serious disease, and it does take lives, most men don’t die of it. Indeed, more than 3.5 million Americans who’ve been diagnosed with prostate cancer are still alive today.

Advancements in treatment have resulted in a better outlook for men diagnosed with prostate cancer. If it’s caught when it’s localized (the cancer is only in the prostate) or regional (spread to nearby structures or lymph nodes), the five-year survival rate is greater than 99 percent.

5. Myth: PSA Tests Are Bad for You

Some prostate cancer experts recommend against regular PSA testing, but not necessarily because of the test itself. PSA screening isn’t perfect, but it doesn’t pose any actual danger to your health. It’s just a simple blood test. The real hazard is anxiety and sometimes faulty decision-making when it comes to interpreting and acting on PSA results. PSA levels usually go above 4 when prostate cancer develops.

 But a PSA level between 4 and 10 results in a prostate cancer diagnosis only about 25 percent of the time.

A high PSA can be caused by bicycling and ejaculation. Some men with a high PSA result on this blood test 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.

6. Myth: If You Have a Low PSA, You Don’t Have Prostate Cancer

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.”

To get the most complete picture of your prostate health, you need to get other diagnostic tests as well. This may mean getting a biopsy. But that standard is changing, says Sartor, pointing to the value of a special type of MRI called multiparametric magnetic resonance imaging.

“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.”

7. Myth: If You Have a High PSA, You Have Prostate Cancer

Your chance of being diagnosed with prostate cancer increases as your PSA level goes up.

 While PSA tests help doctors recommend next steps, such as further testing, they’re not used on their own to diagnose prostate cancer.

If your PSA is between 4 and 10, your chance of having prostate cancer is about 25 percent.

If your PSA is more than 10, the likelihood of having prostate cancer is over 50 percent.

This also means many men with PSA levels over 4 don’t have prostate cancer.

8. Myth: 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.

9. Myth: Prostate Cancer Treatment Always Causes Incontinence

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. 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.”

10. Myth: If the Cancer Comes Back, It Can’t Be Treated Again

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.