Given that about 313,780 men in the United States will be diagnosed with prostate cancer in 2025, it’s likely that you or someone you know will be affected.
Despite this prevalence, myths and confusion abound when it comes to understanding your personal level of risk, what to do when your doctor says you have prostate cancer, and the side effects of treatment.
9 Myths About Prostate Cancer
Get ready to debunk these common myths surrounding Prostate Cancer!
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Myth 1: Prostate Cancer Is a Disease of Older Men
Fact: While it’s true that the majority of men diagnosed with prostate cancer are older, it can (and does) strike younger men. About 40 percent of all cases occur in men younger than 65.
“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.)
The exact age you should start getting regularly screened for prostate cancer is still an area of debate. Start talking to your doctor about PSA (prostate-specific antigen) testing once you’re 50 years old. The exception to this is if the disease runs in your family, in which case it’s a good idea to start PSA screening earlier, at age 40 or 45.
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
Fact: While the five-year survival rate is very high — 97 percent — prostate cancer is still the second leading cause of cancer death in men. The only cancer that kills more men is lung cancer.
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.
The dangers and risks of prostate cancer aren’t distributed evenly among American men, either. African American men are 2.1 times as likely to die of prostate cancer as non-Hispanic white men.
Myth 4: Prostate Cancer Is Always Deadly
Fact: While prostate cancer is a serious disease, and it does take lives, most men don’t die of it. In fact, more than 3.3 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 (cancer only in the prostate) or regional (spread to nearby structures or lymph nodes) the five-year survival rate is greater than 99 percent.
Myth 5: PSA Tests Are Bad for You
Fact: Some prostate cancer experts recommend against regular PSA testing, but not necessarily because of the test itself — which is just a simple blood test. PSA screening isn’t perfect, but it doesn’t pose any actual danger to your health. 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.
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.”
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.”
Myth 7: 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 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.
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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Christopher Wolter, MD, is an assistant professor in urology at Mayo Clinic in Phoenix, Arizona. He has been in practice since 2008, specializing in the areas of urinary incontinence, pelvic organ prolapse, urologic reconstruction, urologic prosthetics, post prostate cancer survivorship, erectile dysfunction, neurourology and neuromodulation, and overall functional considerations of urogenital health.
Dr. Wolter has been heavily involved in urologic education. He spent the last 12 years heavily involved in resident education and leadership for his department, including the last eight years as urology residency program director. He currently serves as the director of urologic education for the preclinical and clinical rotations for the Mayo Clinic Alix School of Medicine Phoenix, Arizona, campus.
Wolter completed his undergraduate and medical education at the University of Illinois. He then completed his urology residency at Tulane University in New Orleans, followed by a fellowship in female pelvic medicine and reconstructive urology at Vanderbilt University in Nashville, Tennessee.
Madeline Vann, MPH, LPC, is a freelance health and medical writer located in Williamsburg, Virginia. She has been writing for over 15 years and can present complicated health topics at any reading level. Her writing has appeared in HealthDay, the Huffington Post, Costco Connection, the New Orleans Times-Picayune, the Huntsville Times, and numerous academic publications.
She received her bachelor's degree from Trinity University, and has a master of public health degree from Tulane University. Her areas of interest include diet, fitness, chronic and infectious diseases, oral health, biotechnology, cancer, positive psychology, caregiving, end-of-life issues, and the intersection between environmental health and individual health.
Outside of writing, Vann is a licensed professional counselor and specializes in treating military and first responders coping with grief, loss, trauma, and addiction/recovery. She is a trauma specialist at the Farley Center, where she provides workshops on trauma, grief, and distress tolerance coping skills. She regularly practices yoga, loves to cook, and can’t decide between a Mediterranean style diet and an Asian-fusion approach.
