Understanding the Risks and Preventative Options
by TERESA SCHIFFER
No one wants to hear “cancer” when they go to the doctor, but when it comes to prostate cancer, there can be a silver lining. Even though it makes up about ten percent of new cancer diagnoses each year, it only accounts for about five percent of deaths. That means that not only are people living longer with it, but treatment for it is highly effective. Even with that being said, there are still some important things to know about prostate cancer.
The first thing to know is that most cases of prostate cancer are diagnosed asymptomatically. By the time you are showing symptoms, the disease has progressed quite a bit. Fortunately, modern diagnostic techniques are less invasive than in the past. A simple blood test can be used to determine whether or not cancer is present in the prostate.
According to Dr. Ahmed Al-Hazzouri, a medical oncologist at Florida Cancer Specialists, one of the main symptoms of prostate cancer is urinary obstruction. The prostate sits at the bottom of the bladder, and all urine passes through the prostate before being expelled from the body.
“An enlarged prostate, or cancer in the prostate, will cause the urine to be slower to move through,” says Dr. Al-Hazzouri. The urine stream may be weaker, a man may need to urinate more frequently, he may urinate just small amounts, or he may see blood in the urine. A sense of fullness in the pubic area may also occur, or pain that could possibly radiate to the rectum.”
“Prostate cancer is a very serious disease,” says Dr. Nitesh Paryani, a board-certified radiation oncologist at Watson Clinic. “It is the second most common cancer in men, after skin cancer.” Over 30,000 men die each year from prostate cancer. The American Cancer Society estimates that there will be over 174,000 prostate cancer cases diagnosed this year alone. That is one in nine men. Prostate cancer is the second leading cause of cancer death in men, behind lung cancer. One in 35 men diagnosed with prostate cancer will die of the disease.
The mortality rate has actually gone up from 27,000 in 2017. The United States Preventative Task Force is a task force put together by the government to explore preventative services, such as cancer screenings. They recently made the controversial decision to recommend decreasing the frequency of prostate cancer screenings. The American Cancer Society, the American Urological Association, and the American Society for Radiation Oncology have all been vehemently opposed to that recommendation.
The reason for the recommendation from the United States Preventative Task Force was because of over-diagnosis. Many men were being diagnosed with prostate cancer who would likely never develop any symptoms or problems from the disease. This includes men in their 80s and 90s being diagnosed and potentially treated for very low-grade cancers. Unfortunately, the result is that there are younger men with very high-grade cancers not undergoing screening.
Doctors and professionals still recommend screening for men with risk factors such as a family history or being African-American. African-Americans tend to have a higher rate of prostate cancer and an earlier onset.
“For the high-risk patients, we recommend screening at age 40,” says Dr. Paryani. “Those are the ones that have a first-degree relative with prostate cancer at a relatively early age.” Men at “intermediate risk” are those who are African-American or have a first-degree relative diagnosed at an older age, 65 or above. Those with intermediate risk are recommended to begin screening at age 45. For those at average risk, the recommendation is age 50.
The screening process is a simple blood test called a “PSA.” PSA stands for “prostate-specific antigens.” Elevated PSA is an indicator of prostate cancer. The frequency of screening depends on the results of the first test, but it tends to be annual. The digital rectal exam has been deemphasized over the years, as the blood test has become the standard test.
As for preventative measures, the recommendations are the same for many other diseases. Leading a healthy life is the best way to minimize risk. Obesity is a major trigger for many cancers. Although prostate cancer hasn’t been specifically linked to smoking, cancer in general has been, so it’s a good idea to avoid that. “Prostate cancer is a testosterone hormone-driven cancer,” says Dr. Al-Hazzouri, so testosterone supplements can make prostate cancer grow.
Men need to have an open line of communication with their doctor. They need to discuss their risk factors and the need for screening. Many men are reluctant to visit their doctors, but it’s important to realize that when prostate cancer is caught early, the recovery rate is upwards of 90 percent. When it’s caught at a later stage that number drops to about 65 percent. As they say, an ounce of prevention is worth a pound of cure, so Dr. Paryani recommends having these discussions early and often.
When caught early, there are multiple options available for treatment. Surgical removal of the prostate is one option. Radiation is another option. There is external radiation and internal radiation. Internal radiation is when radioactive seeds are implanted in the prostate. Catching prostate cancer early gives men time to explore their options and make the best decision for their situation.
Testing and treatment for prostate cancer has come a long way over the years. Dr. Paryani is a third-generation radiation doctor, and in his grandfather’s day men would come in with blood in their urine and that was the first indication of a problem. By that point, it was way too late. Survival rates were below 50 percent. Since PSA was developed in the 1980s, survival rates have skyrocketed and treatment side effects have become minimal. There is now no good reason to avoid this important screening.