By Dr. Gino Carpinito, Chairman, Department of Urology, Tufts Medical Center
The Prostate Cancer Education Council recommends that men age 40 and older begin screening for prostate cancer. Men at high risk like African-American men or men with a family history of prostate cancer should begin screening at age 35.
Since the late 1980’s when prostate screening with the PSA began, the 5 year survival rate for men with prostate cancer has risen dramatically from 75% to over 99%.
The prostate gland is a part of the male reproductive system. The prostate is about the size of a walnut and is located below the bladder and in front of the rectum. The prostate surrounds the urethra, the canal that the urine passes through as it moves from the bladder during urination. The main function of the prostate is to produce the liquid part of semen necessary for ejaculation and sperm function.
Prostate cancer is an uncontrolled growth of abnormal cells in the prostate gland. Most prostate cancers usually grow slowly, however some cancers can grow rapidly and spread outside the prostate gland. Prostate cancer usually has no signs or symptoms, especially in its earliest stages. However, once the cancer has grown, it may cause discomfort and a variety of other symptoms.
Below are a few of the many reasons why it is so important to be screened for prostate cancer:
• 1 in 6 American men will get prostate cancer in their lifetime.
• Over 30,000 men will needlessly die of prostate cancer this year alone.
• A man is 33% more likely to get prostate cancer than a woman is to get breast cancer.
• Chances of survival improve substantially with early diagnosis and treatment.
• If diagnosed and treated early, survival rates are nearly 100%.
• The best protection against lethal advanced prostate cancer is early detection.
HOW IS PROSTATE CANCER DETECTED?
A digital rectal exam (DRE) performed together with the prostate specific antigen (PSA) blood test is the most effective way to detect prostate cancer at an early and likely curable state. PSA is produced by both normal and cancerous prostate cells and is measured in a blood sample. The higher the PSA level, the greater the chance a man has prostate cancer. Elevated PSA tests are usually followed by an ultrasound and a biopsy to determine whether cancer is present and, if so, its level of development. Both DRE and PSA tests are preformed during prostate cancer screening.
WHAT ARE THE TREATMENT OPTIONS?
Treatment options depend on the stage of the disease, patient’s age, physician’s recommendation and personal decision. Some prostate cancers may never affect a patient’s health and are better left untreated to avoid potential complications of treatment. Such cancers are managed by a conservative approached known as “Watchful waiting”, when the patient is closely observed by his physician, but no active treatment is undertaken.
The first course of action for treating the disease includes, but is not limited to:
• Surgery (Radical Prostatectomy)
• Radiation Therapy
• Hormone Therapy (Advanced cancer)
• Chemotherapy (Advanced cancer)
INFORMED DECISION MAKING
Testing for prostate cancer is a personal decision that should be made by each man in consultation with his physician. The advantages of screening were discussed above. Some disadvantages of early detection should be also considered, such as false-positive results. These are infrequent, but cause unnecessary anxiety and have to be ruled out by additional tests such as prostate biopsies. Large research studies are ongoing to study benefits and shortcomings of early prostate cancer detection and treatment.
For an appointment with the Tufts Urology Clinic please call 617/636-6317.
Article funded through the Asian Health Initiative of Tufts Medical Center