Prostate Cancer Part II - Diagnosis and Treatment

We are continuing our discussion of prostate cancer today, focusing on diagnosis and treatment.  Over the next few weeks, we will continue to spotlight men’s health issues, including testicular cancer and mental health.

Is there routine screening for prostate cancer?

Screening for prostate cancer is controversial.  Part of the reason for this is that prostate cancer screening finds both the slow growing kind that might never cause any problems along with the aggressive kinds.  That makes the research harder to sort out and determine if the benefits of testing outweigh the potential risks involved.  

Most medical organizations encourage men in their 50s to discuss the risks and potential benefits of prostate cancer screening with their doctors.  This will include your own specific circumstances including race, family history, personal preferences, etc.  

Black men or men with a family history of prostate cancer may want to have this discussion earlier.

What are the screening tests?

• Digital rectal exam - The prostate can be felt by your doctor on a rectal exam because the prostate is directly adjacent to the rectum.  Your doctor feels for any abnormalities in the size or shape of the prostate, as well as feeling for any lumps or change in texture.
• Prostate-specific antigen test (PSA) - This is a blood test that checks the level of a substance produced by the prostate.  If the level is higher than expected, this may indicate prostate cancer.  The level can also be high due to noncancerous conditions such as an enlarged prostate or inflammation, so the PSA test cannot diagnose prostate cancer.  Sometimes the test is repeated later to see if the elevation was just temporary.
  

What if the screening test is abnormal?  How is the diagnosis made?

There are several tests that can be done to make a definitive diagnosis.

• Ultrasound - An ultrasound uses sound waves to create a picture of the prostate.
• MRI - This can create a more detailed picture of the prostate, as well as the surrounding tissues such as lymph nodes.
• Biopsy - Collecting a tissue sample that can be analyzed to look for cancer cells.

How can you tell if the cancer is aggressive or not?

• Cancer Grading - Once the cancer cells are seen on the biopsy, the pathologist will determine the “grade” of the cancer, which is a level of the aggressiveness determined by how different the cells are from normal cells.  The scale used to evaluate the grade is called the Gleason score.  Most scores range from 6-10.  A score of 6 is low-grade, 7 is medium-grade, and 8 through 10 are considered high-grade cancers.
• Cancer Staging - There are several imaging tests that can be done to determine if prostate cancer has spread and the extent of the spread.  Your doctor will help determine which test is right for you.  These results are used to assign a “stage”, using Roman numerals I through IV.  Stage I is confined to the prostate.  Stage IV is the widest spread to other areas of the body.

How is prostate cancer treated?

Treatment depends on many things, including the grade and stage of your cancer, your underlying health status, and the potential benefits and risks or side effects of treatment.

• Active Surveillance - If your cancer appears to be slow growing and confined to a small area of the prostate, you may not require any treatment.  Your doctor may instead recommend what is called “active surveillance”.  This involves regular follow-up tests to monitor your cancer.  If the tests show progression of cancer, your doctor may recommend treatment.  This option may also be considered for a man of advanced age, or one who has serious medical conditions that may make treatment more difficult or who might have more risk than benefit from treatment.
• Surgery - Prostate cancer surgery involves removing the entire prostate gland, some of the surrounding tissue, and a few lymph nodes.  Surgery may be used for cancer confined to the prostate or in combination with other treatments in more advanced cancer.
• Radiation Therapy - Radiation treatments can be used instead of surgery in some cases, or after surgery to kill any potential remaining cancer cells.  It can also be used to treat cancer spread to other areas, such as the bones.  
• Hormone Therapy - Because prostate cancer cells rely on testosterone to grow, cutting off the supply of testosterone can cause cancer cells to die or to grow more slowly.  There are several hormone therapy options available.  
• Chemotherapy - This is sometimes used for prostate cancer that has spread to other areas of the body or if the cancer does not respond to hormone therapy.
• Immunotherapy - One of the most recent treatment options for prostate cancer is immunotherapy.  This type of therapy helps your immune system to see the cancer as foreign and start attacking those cancer cells.

We will continue to focus on the men’s health issues spotlighted by The Movember Foundation over the next couple of weeks. 

If you have any questions about prostate cancer, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Men's Health - Prostate Cancer

The Movember Foundation is a charitable organization that leads a campaign during the month of November putting a spotlight on men's health issues.  You may have seen men growing a mustache for Movember - Mo for moustache.  The focus is primarily on three important issues that can shorten the lives of men - prostate cancer, testicular cancer, and mental health and suicide prevention.  Today, we'll start by talking about prostate cancer.  We will talk about the other issues over the next several weeks.

What is prostate cancer?

The prostate is a small organ that produces the seminal fluid that nourishes and transports sperm.  Cancer of the prostate is one of the most common types of cancer.  Some types of prostate cancer grow very slowly and do not spread to other areas.  These cancers may not cause any real harm.  However, there are other types of prostate cancer that are aggressive and can spread quickly to the bones and other areas of the body.

What causes prostate cancer?

Unfortunately, we don't really know what causes prostate cancer.  As with other cancers, we do know that it starts when cells within the prostate develop changes within their DNA.  These changes make the cells grow and divide more rapidly and live longer.  These cells form a tumor and sometimes cells can break away and spread to other areas of the body.  We are still doing research to find out why the DNA changes start in the first place.

What are the risk factors for prostate cancer?

• Age - Risk increases with age, being most common after age 50.
• Family history - Your risk is higher if you have a blood relative with prostate cancer.  Your risk is also higher if you have a strong family history of breast cancer, which may be related to genes that increase the risk of breast cancer (BRCA1 and BRCA2), which can also increase the risk of prostate cancer in men.
• Race - Black men have a greater risk of prostate cancer than other races.  Prostate cancer is also more likely to be aggressive in black men.  Unfortunately, we don't yet know the reason for this.
• Obesity - Research shows some mixed results but does suggest that obesity may increase the risk of prostate cancer.  Obese men who develop prostate cancer are more likely to have an aggressive cancer that is also more likely to return after treatment.
  

What are the symptoms of prostate cancer?

In the early stages, there may be no symptoms.  As prostate cancer becomes more advanced it may cause the following symptoms:

• Trouble urinating
• Decreased force of urine flow
• Blood in the urine or semen
• Bone pain
• Weight loss (without trying)
• Erectile dysfunction
  

Can prostate cancer be prevented?

You can reduce your risk of prostate cancer by making some healthy choices.  Here they are:

• Eat a healthy diet with a variety of fruits, vegetables, and whole grains.  
• Maintain a healthy weight.
• Choose healthy foods over supplements.  No studies have shown that any supplements reduce your risk of prostate cancer.
• Exercise most days of the week.  Exercise improves your overall health and helps you maintain a healthy weight.
• Know your family history.  Keep track of medical conditions that run in your family, including breast cancer, which may impact your risk of prostate cancer.
• Talk with your doctor about your risk of prostate cancer. 

Next week, we will talk more about prostate cancer, including the diagnosis and treatment.  

Here is a link to the Movember foundation

Movember - About Us - The Movember Foundation

If you have any questions about prostate cancer, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Screening Guidelines for Breast Cancer in Women

The screening guidelines for breast cancer differ depending on who is issuing the guidelines.  The U.S. Preventive Services Task Force (USPSTF), The American Cancer Society, and The American Society of Breast Surgeons, all have slightly different recommendations for screening.  The following recommendations are from the American Cancer Society.  We'll also talk today about some risk factors for breast cancer that you can control.

What are the screening guidelines for breast cancer in women?

Screening recommendations for women at average risk:

• Women between age 40 and 44 have the option to start screening with a mammogram yearly.
• Women 45-54 should get mammograms every year.
• Women 55 and older can switch to mammograms every other year, or they can choose to continue yearly mammograms.  Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
• All women should understand what to expect when getting a mammogram for breast cancer screening - what the test can and cannot do.
  

Screening recommendations are different for women at high risk for developing breast cancer.  There are several things that increase your risk for breast cancer, including your family history, certain genetic conditions, and having a history of radiation therapy to the chest.  If you are at high risk for breast cancer, your doctor may recommend that you start screening much earlier and may also recommend using a breast MRI in addition to a mammogram for screening.

How do you know if you are at high risk for breast cancer?

If you think that you might be at high risk for breast cancer, you should talk with your doctor about your concerns.  You and your healthcare provider can discuss your family history and other possible risk factors, and work through some different risk assessment tools to determine your overall risk.  Depending on your family history, your doctor may recommend that you meet with a genetic counselor and/or have genetic testing before making a final determination of your risk.

Can you lower your risk of developing breast cancer?

Absolutely!  There are some risk factors that you cannot change, such as your family history.  But there are several breast cancer risk factors that you can change by making some changes to your lifestyle.  Here are some of the risk factors that you can control:

• Drinking alcohol - Alcohol consumption is clearly linked to an increased risk of breast cancer, with the risk increasing with the amount of alcohol consumed.  Women who have one alcoholic drink a day have a small increased risk compared to nondrinkers, but women who have 2-3 drinks a day have about a 20% higher risk than nondrinkers.  
• Being overweight or obese - The link between weight and breast cancer is complex and may be different for certain types of breast cancer.  To lower your risk of breast cancer, you should try to stay at a healthy weight.
• Physical activity level - Regular physical activity reduces breast cancer risk, especially in women past menopause.  
• Not having children - Women who do not have children or who have their first child after age 30 have a slightly higher breast cancer risk overall.  

Please encourage your female friends and family members to have their breast cancer screening.  If you do not have insurance and cannot afford to pay for a mammogram, there are several organizations that may be able to help.  Your healthcare provider can help put you in touch with one in your area.

If you have any questions about breast cancer screening, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor