Tuesday, June 1, 2010

What You Should Know About Prostate Cancer

When Dennis Hopper died of prostate cancer at age 74, my husband asked me "Hey, I thought prostate cancer didn't kill men and it is slow growing".  Well, he is right  about it usually being slow growing, but prostate cancer is still the 2nd leading cause of cancer death in men.  His question made me realize that there are some facts that everyone should know about prostate cancer.

Prostate Cancer is very rare in men under age 40 and the incidence increases with age.  African-American men are at higher risk and Asian and Latin men are less likely that white guys to get it.  We do not know why these ethnic differences occur.  Family history is important and men with an affected brother or father are twice as likely to get prostate cancer.  Although genes are undoubtedly responsible, there are no genetic tests that can predict it.  Some studies show obese men and men who eat large quantities of red meat and dairy products are more at risk.  A vasectomy doesn't seem to matter, nor does exercise or prior prostatitis.

Prostate cancer grows slowly and the PSA (prostate specific antigen) test or a digital rectal exam can screen for an enlarged prostate.  The PSA test can be false positive for many reasons and the only way to diagnose suspected prostate cancer is by a biopsy.  The most important marker for a cancer in the prostate is the "Gleason" score.  This grade (1-10) tells us how advanced or aggressive the cancer is.  The pathologist can see if the cells are suspicious for atypical changes or are high-grade.  The extent of the tumor determines the stage.

Once a cancer has been diagnosed, graded and staged, the confusing choices of treatment come into play.
Because most prostate cancer occurs in older men and it is slow growing, many men choose "watchful waiting".  By following PSA tests and ultrasounds we can determine if the cancer is growing.  For many men nothing more needs to be done because the cancer causes them no problems.  For younger men or men with high Gleason scores, treatment is usually surgical removal of the prostate or radiation of the prostate gland.  Radiotherapy can also occur with seed implantation of radioactive material.
Hormone therapy or cryoablation is also used less often.

The Prostate Cancer Foundation and the Mayo Clinic have  more good info if you wish to delve further.

RIP, Dennis Hopper.  I think I'll take a stroll down memory lane and rent "Easy Rider" again.  I haven't seen it for 40 years!.


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Prostate cancer is very dangerous thanks for sharing.

Michael Kirsch, M.D. said...

I have hostility against the PSA strategy, which I have explained in this post: http://bit.ly/OVzkj

In my view, the PSA test has caused much more harm than good. I suggest that men become fully informed about this test - and where it can lead - before going forward.

kennylin said...

Totally agree with Dr. Kirsch. There are some good, unbiased resources on the problems of prostate cancer screening at the website of the CDC (http://www.cdc.gov/cancer/prostate/informed_decision_making.htm)

I've also written about how guidelines questioning the efficacy of the PSA test (esp. in men older than 75) have often been misconstrued: http://www.pulsemagazine.org/Archive_Index.cfm?content_id=125

KM said...

Thanks for writing this, I will pass this info. along to a few men I know.

Another thing a friend of my boyfriend's had a physical after turning 40 and because of a family history of brain cancer was tested for prostrate cancer and was found to have prostrate cancer. When he had a consult and was asking the surgeon questions of side effects from surgery, and treatment and what the percentage rates were didn't like what he was told so he sought a 2ed opinion with another physician who ended up being the one who trained the first doctor. This second doctor told him about better possibilities of how everything would work afterward for an outcome in his case, so he went with him. After his surgery and radiation, but no chemo. he is able to do everything he could do before and is healthy, happy and doing great.

Toni Brayer, MD said...

Dr Kirsch and kennylin: I agree with you about the PSA test, but have you ever tried talking a male patient out of getting the test? It is a complicated issue and many men (as well as women) would prefer a false positive screening test rather than no test and an undiagnosed cancer.

Michael Kirsch, M.D. said...

@Toni, no I haven't discussed PSA with pts, as it is outside of my sphere of gastroenterology. If I were a primary MD, I certainly would have a discussion with these men, so they could understand the potential cascade they will face if a 'positive' result occurs. I believe that many men, if fully informed, would forego the tests. The PSA is often casually ordered by physicians, or requested by patients, who don't understand that they are facing much greater risk of harm than medical benefit. The facts are still that most prostate cancer is clinically silent and that treatment is expensive and morbid. Are some folks saved by treatment? Sure, but how many are harmed in order to save one. In my view, too many. Let's see what Dr. Lin has to say.

Cary McNeal said...

I wonder how many cases go undetected because men avoid that godawful exam?

Toni Brayer, MD said...

Dr. Kirsch: I have had the discussion many times. I try to do a good job of discussing the literature, the pros and CONS and I have failed to convince even one man that they should not have a PSA. They cannot see the rationale of forgoing a test that might pick up an early cancer. They could care less about false positive. Academic discussions often fail in the reality of office practice.

Cary McNeal: Men are sometimes embarrassed about the digital rectal exam, but I've never had anyone refuse it. It is used to check the prostate as well as screen the rectal colon for abnormalities. As a woman, I have small fingers...a plus!!! (P.S. the rectal exam is a cinch compared to a pelvic exam. Think about that ugly speculum and the awful position!!!!)

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buy caverta online said...

Prostate cancer is form of cancer that develop in the prostate.It occurs when cell in the prostate gland grow out of control. This are some factors due to this cancer start to grow:
This are some common symptoms of prostate cancer:
Blood in the urine
Blood in semen
Bone pain

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