By Scott Simon, M.D.
It’s not something you’ll hear them talking about at a Chargers game or family cookout, but the risk of prostate cancer is something that all men share. In fact, one in six American men will develop prostate cancer during his lifetime. It is the most commonly diagnosed non-skin cancer in the United States – but while it is very prevalent, it also is very treatable if detected early.
Only men have a prostate, which is a walnut-sized gland located beneath the urinary bladder that is responsible for making a portion of the fluid excreted during ejaculation. Although there are several types of cells found in the prostate, 99 percent of prostate cancers develop from the glandular cells.
Early Detection Can Save Lives
Thanks to current screening methods, prostate cancer is being detected at earlier stages and can be very effectively treated. As a result, the death rate from the disease has decreased in recent years.
As a practicing urologist, I cannot stress enough the importance of routine and early prostate cancer screening. It’s important to be tested sooner rather than later, as there are no apparent symptoms in the early stages. In fact, once symptoms become apparent, it may be too late for treatment. Men who have significant risk factors for the disease, such as a family history of prostate cancer or are of African-American descent, should begin screening at age 40. All others should have their first screening by age 50 at the latest.
One screening test checks the amount of prostate-specific antigen (PSA) in the blood. PSA is a substance produced by the prostate gland; an elevated PSA level may indicate prostate cancer. A PSA test also is useful in determining whether a course of treatment is working or when it may be time to try a different form of treatment.
Another screening method is the digital rectal exam. Because the prostate lies just in front of the rectum, a doctor can feel for any nodules or abnormally hard areas in the prostate.
Either finding indicates a need for further testing. Although a digital rectal exam is not as sensitive as the PSA blood test, it can sometimes find cancer in men with normal PSA levels. Therefore, the use of both detection methods is the most sensitive means we have of screening for prostate cancer.
Diagnosis and Treatment
A core needle biopsy is the gold standard for prostate cancer diagnosis. This simple procedure, typically performed under a local anesthetic, involves inserting a needle into the prostate through the rectum wall and removing tissue samples. The samples are then sent to a pathologist for inspection and diagnosis.
Several treatments exist for prostate cancer; specific treatment plans are based on several factors, which may include the stage and grade of the cancer, the PSA level, and the patient’s age, life expectancy and overall medical health.
Because many men will die with prostate cancer and not from it, the best course of action in some cases is “watchful waiting” to see if the cancerous cells continue to grow. This may be the case in older or ill patients whose life expectancy is less than 10 years or so.
Certain medications, such as Lupron, Zoladex and Casodex, can lower the amount of testosterone in the body. This stops the cancer in its tracks temporarily and can be useful in relieving symptoms if the cancer has spread beyond the prostate. However, this is not a cure; eventually the cancer can learn to grow without testosterone. The medications themselves may cause side effects such as hot flashes, decreased energy and loss of muscle mass.
The two treatments that are intended to cure prostate cancer are surgery and radiation. Surgery is generally the treatment of choice for younger, healthy patients, while older or less healthy patients may be better treated with radiation to kill the cancerous cells. Cryotherapy (freezing the prostate) is a newer approach that may be used instead of radiation. Often, patient and physician will decide on the best course of treatment together.
Scott Simon, M.D., is a urologist at Scripps Memorial Hospital La Jolla. To learn more about staying healthy or for physician referral, please call 1-800-SCRIPPS (1-800-727-4777).