A common misconception shared by people and some physicians based on articles in the press, is that prostate cancer is harmless and doesn’t require treatment. But the fact is that in a given year, 28,000 men will die of prostate cancer. And that number would be approximately double if we weren’t doing the amount of prostate screening that we’re doing now.
This is because we’re detecting the cancer before it has the chance to spread to adjacent organs, or even further into the lymph nodes or bones. When a man has advanced prostate cancer it cannot be cured in any sense of the word.
People think prostate cancer is not a problem because it doesn’t present with any outward symptoms and, more importantly, because it grows more slowly than other cancers. In 10 years, most men who are diagnosed with prostate cancer won’t have died from it. But in 15 or 20 years most men with prostate cancer will have died if they have not received definitive treatment, either from the cancer or a related complication.
A lot people aren’t even sure what the prostate does, but it’s very important for enhancing fertility. The gland secretes a number of enzymes into the seminal fluid, liquefying it so the sperm can swim through it and reach the egg. When you think about it, none of us would be here without the prostate gland.
Prostate-specific antigen, or PSA, is the most significant of these enzymes, and that’s what we’re testing when we draw blood during the prostate screening. Elevated PSA levels do not necessarily mean a man has prostate cancer, however. The test, in conjunction with a rectal exam, help assess a patient’s overall risk for prostate cancer. The rectal exam may not be desirable, but for most people it is easily tolerated, and so is the PSA blood test.
These tests can and should be performed by a man’s primary medical provider beginning at age 40, according to the American Urological Association. Family physicians, nurse practitioners and physician assistants are all qualified to do the screening. If a high PSA level is detected, there may not be a need to take any immediate action other than waiting for a period of time and doing another PSA test. If a lump is felt or there is concern about PSA levels, the provider will refer you to a specialist like me for an ultrasound and a biopsy, following which we would discuss the best option for any necessary treatment.
Surgery and radiation are the two most commonly used treatments for a localized prostate cancer. Most people would just get one or the other. Radiation is safer for people who have other health problems that may be complicated by an operation, such as heart disease. Surgery on younger and healthier men is usually the better choice because the long-term control of the cancer is better. Surgery has slightly better outcomes, statistically speaking, but the success rate for each treatment can be expected to be between 80 and 90 percent.
We conduct follow-up visits with patients for the rest of their lives. As long as the PSA levels remain low no further intervention will be required. Research tells us that if a patient can get to 10 years without a recurrence then they’re probably not going to have one at all. This can mean a long, cancer-free life for those patients who are detected in their forties and fifties. Talk to your provider about prostate screening during your next routine physical. If the results are normal, as they are for most men, then you can at least feel reassured that you are healthy.
Craig Rinder, MD, is a board-certified urologist and Director of the Men’s Health program at Brattleboro Memorial Hospital. He can be reached at 802-254-8222.