Wednesday, March 21, 2018

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The Big 8 of Prostate

Written by  Rick Piester

September is Prostate Cancer Awareness Month, a time set aside each year to focus on the disease that is the second largest cancer killer of men in the United States. The good news, however, is that if prostate cancer is caught early, the five-year survival rate is almost 100 percent.

To help observe the special month, we talked with some local experts about prostate cancer, its detection, and its treatment. Here's what they say to help you keep ahead of the game, and possibly avoid prostate cancer.

Am I at higher risk to develop prostate cancer based on my race?

The only racial group known to have a higher prostate cancer risk are African Americans. Prostate cancer is more prevalent and more aggressive in African Americans. African Americans have both a higher rate of getting prostate cancer (1.6 times) and dying from it (2.4 times) compared to Caucasian men. For this reason, African American men are encouraged to undergo screening beginning at age 40.

If I have a family history of prostate cancer, should I get checked more often?

Men with a family history of prostate cancer should start annual screening earlier (age 40 instead of 50), but not more frequently. A family history of prostate cancer generally doubles the risk of being diagnosed with cancer. The more relatives and the closer they are to you genetically, the higher the risk. 

If the rectal exam is normal and the PSA is low and stable, annual screening is reasonable. However, if the PSA begins to rise in a patient with a strong family history, the patient may opt for more frequent PSA testing or proceed with a biopsy. Individual evaluation is essential in these circumstances.

   Paul Roberto, MD
   Chesterfield Urology
   Midlothian | 804.639.7777

Are there self-tests I can perform to check for prostate cancer? (Similar to self-breast exams women can perform for breast cancer.)

Unfortunately the prostate gland location prevents effective self-examination. Urinary symptoms such as weak stream, voiding frequently during the day or night, and urine stream hesitancy may be signs of an enlarged prostate. Prostate enlargement can be the result of benign or cancerous change. A change in a man’s urinary pattern is an indication to have a prostate exam. A PSA blood test can also be useful regarding the diagnosis of prostate cancer.

At what age should I start getting a prostate exam?

Virginia Urology recommends evaluation of the prostate in men without urinary symptoms starting at age 50. Men with urinary symptoms or men with risk factors for prostate cancer should undergo evaluation at age 40. Risk factors include African American ancestry, a family history of prostate cancer, and a change in urinary symptoms.

   James Ratliff, MD
   Virginia Urology
   Richmond | 804.330.9105

As I age, does the recommendation for a prostate exam change?

Prostate cancer screening recommendations have changed recently. The United States Preventive Services Task Force recommends against prostate cancer screening. However, prostate cancer is the most commonly diagnosed cancer among men in this country, making it difficult to unilaterally accept this recommendation.

The American Urological Association takes a more nuanced approach, which I favor. Per AUA guidelines:

  • Men 40 years or younger should not undergo prostate cancer screening.
  • For men between the ages of 40 and 55, decisions regarding prostate cancer screening should be individualized based on family history and ethnicity of the patient. 
  • For men ages 55 to 69 years, AUA recommends that the decision to undertake a PSA screening involve weighing the benefits of preventing prostate cancer mortality (1 man for every 1,000 men screened over a decade) against the known potential harms associated with screening and treatment. 
  • PSA screening in men age 70+ years or any man with less than a 10 to 15 year life expectancy should not be done.

What are the treatment options for prostate cancer?

Patients with very early stage, localized prostate cancer or those whose life expectancy is less than 10 years can undergo surveillance only. Radical prostatectomy is appropriate for patients who have cancer localized to the prostate who may have a higher risk of recurrence. Patients with localized prostate cancer could also receive external beam radiation therapy. Radical prostatectomy and external beam radiation therapy for the treatment of localized prostate cancer are equally effective. For low risk localized prostate cancer, patients could undergo radiation seed implant in the prostate.

For patients with advanced prostate cancer there are a variety of treatment options. Prostate cancer grows under the influence of testosterone, so testosterone suppression is the most effective initial treatment of advanced prostate cancer. There are other treatments such as chemotherapy, radiation emitting small particles such as Ra-223, immunotherapy such as Sipuleucel-T, and finally newer hormonal therapies which are pills.

   Kumar Abhishek, MD
   Bon Secours Cancer Institute Medical Oncology at Memorial Regional
   Mechanicsville | 804-764-7220

What are symptoms of prostate cancer?

Prostate cancer does not cause any symptoms at early stages. That’s why early screening and detection is so important. In later stages it can cause urinary frequency, weak stream, and inability to urinate.

   Eugene Park, MD
   Urology Specialists of Virginia
   Richmond | 804.323.0226

Can prostate cancer be prevented?

Unfortunately, according to the American Cancer Society, prostate cancer cannot be prevented because these risk factors (age, race, and family history) cannot be controlled. But there are some things you can do that might lower your risk of prostate cancer. Keep healthy servings of fruits and vegetables in your diet, stay physically active, and maintain a healthy weight can help lower your risk of prostate cancer. Schedule a visit with your local provider to make sure you are on the right track.