Sorting Through the Prostate Cancer Predicament

September is national prostate cancer awareness month

Dr. Carl Rossi in proton treatment room.

September is national prostate cancer awareness month, a time to sort through what has become one of the most confusing areas for men to navigate in health care.

With controversial screening guidelines, uncertainty about whether to undergo treatment and multiple medical procedures from which to choose, there are more questions than ever about how to approach prostate cancer.

The stakes are high. This year in the United States, more than 238,000 men will get the news that they have prostate cancer and about 30,000 will die of the disease, according to the American Cancer Society.

Carl Rossi, MD, is medical director of the Scripps Proton Therapy Center , which is due to open for patient care this fall. Dr. Rossi has treated more than 9,000 prostate cancer patients in the past 20 years and has taught, researched and written extensively about the disease. He responds to some of patients’ most commonly asked questions about screening and prostate cancer treatment.

Q: Is prostate-specific antigen (PSA) screening worthwhile?

A (Dr. Rossi): “Last year, the U.S. Preventive Services Task Force finalized its recommendation to end routine prostate-specific antigen (PSA) screening for all men. But regular PSA testing has led to earlier and more sensitive detection of the disease. And the cure rate for prostate cancer has increased significantly since widespread use of PSA testing began in the early 1990s. Despite conflicting interpretations on the benefits of PSA screening, these tests should not be abandoned. PSA screenings save lives. Men with a family history of the disease and African-American men should get PSA screenings annually starting at age 40. Men with significant urinary symptoms should also undergo screenings as appropriate. Men without symptoms should talk with their doctor about getting regular PSA screening starting at age 50.”

Q: What’s better the better choice, treatment or surveillance?

A (Dr. Rossi): “We know that overall, a significant percentage of men diagnosed with prostate cancer may never physically suffer from it, and as a result don’t need treatment. We also know that in some cases, some treatments can cause unwanted side effects, and that overtreatment is a problem in this disease. But that doesn’t mean surveillance is the right solution for everyone. Men should know that the predictability of prostate cancer progression becomes much fuzzier on an individual patient level. Patients who choose surveillance over intervention need to know that their cancer can change during their period of “watchful waiting” and that their “cure window” can possibly slam shut without their knowing about it. It’s important for men to meet with their physician to discuss the benefits and risks of each approach, both physiologically and psychologically.”

Q: Which prostate cancer treatment is really best?

A (Dr. Rossi): “There are more treatment choices than ever before for prostate cancer – for example, open surgery, robotic surgery, X-ray radiation, proton beam radiation and others. Patients should take two to three months to explore all of their options, unless they have a high-grade tumor that requires immediate treatment. Men should explore the pros and cons of each treatment, and confer with family and physicians to arrive at an informed decision that is best for the individual patient, based on both medical facts and personal choice. For example, if a patient chooses radiation treatment, will he be worried knowing his prostate gland is still in his body? If so, surgery might be an option. But with surgery comes other possible concerns, like the potential for incontinence. And if a patient chooses watchful waiting, he needs to know that his cancer may change over time and become more problematic to treat at some point.”

Q: What are the key points I need to know about prostate cancer?

A (Dr. Rossi):
1) Talk to your doctor about getting screened regularly
2) If diagnosed, take time to explore all options (interventions and surveillance)
3) Map out pros and cons for each option
4) Consult with physicians and family
5) Decide on individual course of action

Scripps Health is a nationally recognized leader in cancer care, providing comprehensive care at its four hospitals and various outpatient locations. Scripps seeks to provide the best possible treatment and cutting-edge research trials for patients by coordinating medical expertise in the areas of clinical cancer care, community outreach and clinical, translational and basic research.

Learn more about Scripps Health, a nonprofit integrated health system in San Diego, Calif.

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Stephen Carpowich
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