|Mark Drews, M.D.
Whittier Street Health Center
While approximately 186,000 American men are diagnosed with prostate cancer annually, nearly 90 percent of prostate cancers are detected before they spread beyond the gland. Widespread screening has helped the disease become highly curable, and after five years men who have undergone treatment remain cancer-free in many cases.
Prostate cancer is the second most common cause of death from cancer in men of all ages, the most common cause of death from cancer in men over 75 years old, and is rarely found in men younger than 40. Because prostate cancer is often a very slow-growing disease, it can sometimes take 10 years or more for small tumors to spread beyond the gland and pose a serious threat to health.
Age, race and family history can affect the risk of developing prostate cancer and those at a higher risk for being diagnosed with the disease include African American men and men with a family history of prostate cancer. According to the American Cancer Society, American Urological Association and National Comprehensive Cancer Network, men should receive regular screening tests for prostate cancer beginning at age 50. However, African American men or those who have a family history of the disease should begin screening tests at age 45.
“It is extremely important for men to be aware of their personal risk for all diseases, including prostate cancer,” said Dr. Mark Drews, an internist at Whittier Street Health Center. “This information is readily accessible at local community health centers or from your primary care physician who you should visit regularly for preventive care, not just when you are feeling ill.”
A number of screening tests for prostate cancer are available, including a digital rectal exam and a prostate-specific antigen (PSA) test. Thanks to PSA testing, many prostate cancers are now found before they start to cause symptoms. A PSA test measures how much PSA, a protein essential to human reproduction, is in a man’s blood. A measure of PSA will help determine whether a man has cancer of the prostate. Since the prostate regularly produces PSA, a small amount of the protein is normal. In general, expected readings range from one to four. However, because cancer cells produce extra PSA, a higher PSA reading can be dangerous.
The PSA test is essentially painless. The doctor draws a blood sample from which the level of PSA is easily measured. The results are available within a few days. If the PSA level is below 4, most doctors agree that testing is not necessary for another year. On the subsequent test, it is important to remember that it is entirely normal for a reading to increase by a few tenths of a point every year. In general, only a drastic increase in PSA (from one half point to one point, depending on age) is considered a reason to worry.
Men who have been diagnosed with prostate cancer should consult with an urologist as well as his primary care physician to determine the proper course of treatment. The three most common treatment options for early-stage prostate cancer are watchful waiting, surgery and radiation therapy. Treatments for prostate cancer are serious and may have lasting side effects, such as incontinence — the inability to control urine — and impotence.
Therefore, the decision of when and if to begin treatment must be considered carefully and discussed with your physician. Watchful waiting doesn’t mean the cancer will be ignored; a doctor will conduct regular PSA and other tests to determine tumor growth. If the cancer starts growing faster than expected, treatment may be warranted.
“The trust that is developed between a patient and [a] primary care physician is an important and useful tool for all men dealing with a prostate cancer diagnosis or any other health issue,” said Drews. “Through the discussion of all options available, the patient and primary care physician can determine the treatment option that makes the most sense for the patient’s life in all cases.”