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Monday, Nov. 10, 2014

PROSTATE CANCER

Lack of early symptoms requires vigilance

Prostate cancer is a cancer that originates in the prostate gland. The American Cancer Society estimates that one in six men will suffer from prostate cancer in his lifetime.

Dr. Loren Smith is a board-certified urologist at Willis-Knighton Pierremont. Smith said, “We diagnose over 200,000 men with prostate cancer in the United States every year. We estimate about 30,000 men will die because of prostate cancer.

“The prostate is a small gland which sits next to the bladder in men. It makes semen, which is necessary for fertility. Once men become older and generally not interested in having children, the prostate can become a source for problems like infections and cancer. Most often prostate cancer is a slowgrowing cancer, but sometimes it can be aggressive. It often takes years for the cancer to grow and spread to the point it causes problems or death.”

Smith said, “Prostate cancer has no symptoms for the most part. We detect it through screening, which requires a digital rectal exam and prostate-specific antigen blood test [a blood test which is a screening test for prostate cancer]. If either is abnormal, we may recommend a prostate biopsy. If men have symptoms related to prostate cancer, they generally indicate advanced disease or cancer that has spread well outside of the prostate. When the cancer spreads, we are not able to cure it, but we often are able to control it with a variety of medications.”

Smith said, “PSA is not a perfect test, and the ways we utilize the test has changed over the years.

“When we offer a biopsy, we detect cancer around 40 percent of the time. So we seem to perform too many biopsies based on the moderate percentage of positive results. But today, this is the best we have. In order to target and select men at higher risk for prostate cancer, we are looking at other technologies and lab tests. Percent Free PSA is another form of the blood marker, which can help us determine the need for biopsy. Other tests like MRI are starting to show promise for diagnosing the disease. Despite the screening tests available, the definitive diagnosis requires tissue from a biopsy.”

Smith said, “Prostate cancer is treatable. In general terms we can offer curative therapy in the form of radiation or surgery. In some men we may want to manage the disease with medicines to reduce the amount of testosterone available, reducing the growth of the prostate and the cancer. In some men who we think will not die from or suffer complications from the cancer we opt to observe or watch the disease closely.”

Smith said, “How we administer radiation treatments has changed significantly as has the surgery we offer. We now have cutting-edge Proton Therapy available locally, which should lessen the side effects associated with the treatment. Surgery is most often performed using the da Vinci robot. It is a tool which provides the surgeon dexterity or the ability to operate more precisely than he or she can without the device. There are some exciting genetic tests coming out which may help us determine who will benefit from aggressive treatment and who will benefit from observation or watching the cancer.”

The NIH divides prostate cancer development into four stages:

Stage I – The cancer is only in the prostate; it may be too small to feel during a digital rectal exam.

Stage II – The tumor is more advanced or a higher grade than Stage I, but the tumor does not extend beyond the prostate.

Stage III – The tumor extends beyond the prostate and may have invaded a seminal vesicle, but cancer cells haven’t spread to lymph nodes.

Stage IV – The tumor may have invaded the bladder, rectum or nearby structures. It may have spread to lymph nodes, bones or other parts of the body.

Smith said, “Men can eat a low-fat diet and exercise to reduce the risk of developing prostate cancer. These also may improve his outcome if he needs treatment for prostate cancer. There is data to suggest that Finasteride, a common medication used to treat prostate flow problems, may reduce the risk of developing prostate cancer. Statins, which reduce cholesterol, may be helpful.”

Smith said, “Prostate cancer is a common condition and can be lethal. We have many tools available to help determine who is at risk for developing prostate cancer, who we should recommend biopsy to and what treatments may benefit the individual patient. But it is the decision to screen, which is the first step. Every man should have a discussion with either his primary care doctor or urologist to determine if screening with DRE and PSA is right for him.”

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