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About one in six men are diagnosed with prostate can-cer. Yet if caught early, the cancer is treatable, and most importantly, survivable.

The prostate gland in males is one of the key physiological differences between men and women. Located right below the bladder near the rectum, the walnut-sized gland is responsible for producing seminal fluid to nurture and transport sperm. But in ad-dition to serving an essential role in the male reproductive system, it can also be the location of one of the most widespread forms of cancers affecting men: prostate cancer.

Aside from certain forms of skin cancer, prostate cancer is the most common type of cancer in men—about one in six men are diagnosed with it on average. But thankfully, most prostate cancers grow slowly with about 91% of all cases confined either to the prostate or nearby.

Despite its prevalence, the amount of awareness and research dedicated to prostate cancer is disproportionate to that of other prominent cancers. For example, there has been only one major drug developed for prostate cancer in the past decade, while there have been several therapies discovered for breast cancer and kidney cancer. It seems that patient advocacy has been slow going as well—most men would rather not talk about such a disease.

How do I know if I am at risk of getting prostate cancer? Age is the strong risk factor in developing prostate cancer as it primarily oc-

curs in older men. The average age at the time of diagnosis is 67—two out of three prostate cancers are found in men over the age of 65. It’s very rare before age 40.

By Rashad J. Gober

Prostate CancerGet the Facts

Health Today Prostate CanCer

Get ready!National Prostate Health Month is observed every September to increase public awareness of prostate health and advocate further research.

“Currently, evaluating PSA levels for prostate cancer

screening is the most reli-able way to detect early stage prostate cancer. Early prostate cancer is silent, without symp-toms. In order to intervene in a meaningful and definitive way, we must detect it before it spreads. We look for pros-tate cancer by interpreting PSA levels as a risk factor for prostate cancer, along with other risks factors such as eth-nicity and family history. The successful use of PSA screen-ing for detecting early stage prostate cancer is seen in the 40% decline in prostate can-cer death and the 75% decline

in the incidence of metastatic disease over the last 20 years.”

Lee Jackson, M.D., Urological Oncologist Memorial Hospital

How important is screening?

ExpErt ADvicE

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Family history also plays a role in the risk of developing prostate cancer. For ex-ample, men who have a father or brother with the disease are twice as likely to ac-quire it themselves. The family history risk increases if the relatives were young at the time of diagnosis. Men who have multiple relatives with prostate cancer are almost guaranteed to get it themselves.

Ethnicity is also a factor when it comes to risk of prostate cancer. Pros-tate cancer is more common in African-American men than other ethnicities. African-American men are also more likely to be diagnosed late and are twice as likely to die of prostate cancer.

Health Today Prostate CanCer

Aside from these uncontrollable vari-ables, research suggests certain lifestyle habits may increase your risk of getting prostate cancer. Some studies show that men who eat a “Western” or “Cowboy” diet, which includes large amount of red meat and high-fat dairy products, may have an increased risk. Conversely, prostate cancer seems to be less common among vegetarians.

How can I know if I have it?Unfortunately, there are no observ-

able symptoms of prostate cancer in its early stages, making it difficult to diag-nose early. Symptoms usually arise as the cancer advances, which makes it all the more important to see a doctor if any worrisome signs occur.

Common indications of prostate cancer usually appear when the tumor causes some degree of urinary blockage. These symptoms include difficulty in start-ing and/or stopping the urinary stream. Other less common symptoms of pros-tate cancer include blood in the urine or semen or pain while ejaculating. Men ex-periencing any of these symptoms should see a physician as soon as possible.

Should I get screened? The short answer is yes—if you are of

a certain age or risk level. In addition to seeking medical advice when symptoms arise, men 50 and older, and younger, at-risk men should consider being screened for prostate cancer. The initial steps of prostate cancer screening include the

“ Increasingly, surgeons are performing laparo-

scopic radical prostatecto-mies to completely remove the prostate by using a ro-botic surgical system called the da Vinci robot. With a ro-botic approach, we’ve found the patient has less blood loss and a faster recovery period, as compared to tradi-tional open surgery. Though prostate removal is associ-ated with some temporary side effects, such as leakage, most side effects are tempo-

rary. Major compli-cations are rare.”

Amar Singh, M.D., Urological Oncologist Academic Urolo-gists at Erlanger

Side Effects of Surgery

ExpErt ADvicE

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26 | Available on HealthScopeMag.com Available on HealthScopeMag.com | 27

prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE).

PSA test: High levels of PSA, a sub-stance produced by cells in the prostate gland, can indicate prostate infection, in-flammation, enlargement, or cancer. PSA

Health Today Prostate CanCer

can be measured by analyzing a blood sample taken from your arm. However, since factors other than prostate cancer may affect levels, an increased volume is not a guaranteed diagnosis.

DRE: In this exam, a physician inserts a gloved, lubricated finger into the rec-tum to feel for any bumps or hard ar-eas that may be cancerous. Though the exam can be uncomfortable, it is rela-tively quick and painless.

If these two initial screening tests or certain symptoms suggest that you may have prostate cancer, your physician will conduct a biopsy to make a certain diag-nosis. In this procedure, the doctor inserts a very thin, hollow needle into the wall of the prostate, extracting a small sample of tissue a few times. This sounds painful, but it really only takes around 10 min-utes, is done in office, and most doctors

will inject a local anesthetic alongside the prostate. It’s a small discomfort to pay for testing that may save your life.

How serious is it? That will depend on the results of

your prostate biopsy, which are reported using the Gleason grade and the Glea-son score. These assessment tools tell the patient how aggressive the cancer is by grading tumors on a scale of 1-5, with the two main grades added together. Scores between 6 and 7 are most com-mon, but higher scores suggest that the cancer has spread beyond the prostate.

Drawing from this score, prostate cancer is staged according to how far it has spread within the prostate, whether the cancer has spread to lymph nodes near the prostate, and whether the can-cer has spread to other organs.

GleASon SCoRe SCAle

2-4 (Low – Cancer may grow

slowly enough to not

threaten life)

5-7 (Intermediate – Further

analyses needed before

treatment decisions are made)

8-10 (High – Suggests a more

aggressive cancer threat)

“ The best candidates for surgical management

are men with a clinically important prostate cancer and a life expectancy of 15 years or more. Men with high-risk prostate cancer who are likely to require multimodal therapy should give serious consideration to surgical intervention as a first step in their treat-

ment strategy.”

Lee Jackson, M.D., Urologi-cal Oncologist Memorial Hospital

Best candidates for Surgery

ExpErt ADvicE

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Health Today Pros tate CanCer

Though difficult to catch early, the out-look for those with prostate cancer is gen-erally positive. According to the Ameri-can Cancer Society, 100% of men live at least 5 years after initial diagnosis, 98% live at least 10 years, and 93% live at least 15 years, though many live longer.

Is it painful? Pain is not usually a major effect of

localized prostate cancer, though it does often occur in more advanced stages, par-ticularly when metastasized to the bone. More common side effects of prostate cancer and its treatments include incon-tinence and erectile dysfunction. Inconti-nence is likely to improve over time, but is also treatable with medications and cath-

eters. Erectile dysfunction due to prostate cancer or its treatment is also treatable with medications or surgery.

How is it usually treated?Choosing from among different treat-

ment options for prostate cancer can be complicated because every man is dif-ferent and every case of prostate cancer is different. There is a wide range of dif-ferent treatment options, and each has its pros and cons. Also, physicians must consider which options will prolong life for certain populations (e.g. the el-derly or those with serious health prob-lems). In making a treatment decision, men should consider the probability of eradicating the cancer completely along with possible side effects. Three differ-ent approaches are currently the norm

for treating prostate cancer: active sur-veillance (or watching waiting), curative treatments, and palliative treatments.

Active surveillance: Active surveil-lance, or watchful waiting, is frequent-ly an option for older men (those over 70) who want to avoid or postpone the potential side effects of treatment. For example, it may be recommended to someone with a low Gleason score whose cancer is confined to a small area within the prostate. Active surveillance involves active monitoring, meaning re-peat PSA testing, biopsies, and scans for any signs of spreading.

Curative treatments: Curative treat-ments aim to remove all of the cancer. This approach is common among men with more aggressive cancer as well as those with small, slow-growing cancers

“ The CyberKnife radio- surgery system is ro-

botic technology that tracks the prostate in “real time” and delivers an array of radi-ation beams to the prostate with pinpoint accuracy. This minimally invasive radiation therapy kills the cancer in only five treatments, allow-ing you to continue daily ac-tivities with little down time. Side effects are minimal, and long-term problems are uncommon. Emerging data

suggests an excel-lent cure rate.”

Frank Kimsey, M.D., radiation Oncologist Erlanger Health System

cyberKnife

ExpErt ADvicE

who are healthier and younger (particu-larly those under 60). The most common curative treatments are surgery and ra-diation therapy.

Surgery: Surgery, which involves the removal of part or all of the prostate, is the most common option for men under 70 whose cancer is confined to the pros-tate. Studies show that up to 75% of men who undergo surgery never experience a recurrence. In recent years, technological advancements in surgical techniques for prostate cancer—such as minimally-inva-sive surgery (laparoscopic) and robotically-assisted surgery—have led to smaller inci-sions, and shorter recovery times.

Radiation Therapy: Radiation thera-py kills cancer either through external radiation therapy, in which a machine outside the body sends radiation to the cancer, or internal radiation therapy (brachytherapy), in which tiny radioac-tive seeds are implanted in the cancer. External radiation can also be used to control disease that recurs after a sur-gical treatment. Today, new computer programs are allowing doctors to better plan the radiation doses and approaches for both external radiation therapy and brachytherapy.

Palliative treatments: Palliative treat-ments for prostate cancer aim to treat symptoms and slow cancer growth rather than cure it altogether. They in-clude hormone therapy and chemother-apy, among others. Typically, hormone therapy works to starve cancer cells by using drugs that inhibit testosterone production. For advanced cancers that don’t respond to hormone therapy, che-motherapy, or the use of powerful toxic drugs to kill rapidly growing cells, may be an option.

Aside from active surveillance, many of these treatment options may be more harmful than the cancer it-self, specifically for elderly men. Any treatment decisions should be talked through extensively with doctors and loved ones.

Get Support Today! Despite the lack of media coverage on

prostate cancer, there are many resourc-es out there to help and encourage men dealing with prostate cancer. Here are a few good ones:

Malecare.coM—The largest vol-unteer men’s cancer support group on the web.

acor.org—A collection of can-cer communities offering free support.

MaN to MaN—An American Cancer Society program for prostate cancer patients and their loved ones. Con-tact (423) 778-5119 for more informa-tion.

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The CyberKnife radiosurgery system for prostate cancer treatment