Ask the Expert - Prostate Cancer
Matthew E. Karlovsky, MD is on staff at Banner Desert Medical Center .
Question: What are risks for prostate cancer, how can I prevent it?
Answer: Prostate cancer is the most common cancer in men, affecting one in six. Fortunately, it grows slowly, and is treatable even if somewhat aggressive. The most common risk factors for developing prostate cancer is a positive family history, such a brother, father or grandfather who had it, or being African-American. Regular screening for prostate cancer begins at the age of fifty with a prostate exam and PSA (prostate-specific antigen) blood test, or age 40 for men at higher risk. Much controversy has surrounded whether the PSA is a useful tool, yet long-term studies from Sweden reveal that not only does prostate cancer kill a majority of men within a decade of diagnosis, but early screening with PSA allows for early diagnosis and treatment.
Good heart-health is also good for the prostate. Zinc, selenium, vitamin E, soy products, and lycopene (found in tomatoes) all promote prostate health, and some have been shown to lessen the risk for prostate cancer. Avoiding obesity also reduces the risk as well.
Question: What is PSA?
Answer: As men grow older, the prostate produces more PSA, and we expect a natural steady rise in PSA from decade to decade. Yet if the PSA is too high for a man’s age, or it jumps too high after being steady for a while, this may signify the development of prostate cancer. However, other common problems can also often cause PSA to rise such as benign growth of the prostate, prostate or bladder infections, having a urinary catheter in place, or even a vigorous prostate exam before the test. A firm nodule on the prostate is also a suspicious finding. A prostate biopsy, which is an in-office procedure, is done to make the diagnosis.
Answer: Most prostate cancer for the past twenty-five years has been diagnosed by the PSA test, which increases the chances of it being diagnosed early. The two most common treatments to cure prostate cancer are surgery and radiation. Generally speaking, they have nearly the same cure rates at approximately ten years, but some patients are more appropriate for one versus the other.
Radical surgery involves removing the entire prostate, seminal vesicles (attached to the prostate) and lymph nodes near the prostate. It requires a short hospital stay (2-4 days), but necessitates having a urinary catheter in for about 2 weeks. Full recovery takes about 6 weeks. Incontinence (loss of urine with straining) and erectile dysfunction can occur, depending on age, health and technique used to remove the prostate. The PSA test must continue to be checked, but should remain close to zero.
Radiation can either be given as external beam or as radioactive seeds placed within the prostate. External beam radiation is given in approximately 40 daily small doses, while seeds are placed under anesthesia on an out-patient basis. Urinary symptoms, diarrhea and nausea can occur during or after treatment. Prostate cancer slowly dies over time, and the PSA will decrease slowly as well. Each treatment can also cause incontinence and erectile dysfunction, and, uncommonly, injury to the bladder or rectum, such as bleeding, diarrhea, or mucous.
Hormone treatments are indicated in those where prostate cancer has spread systemically. If cancer recurs after surgery, radiation can be an appropriate second cure, whereas after radiation, freezing the prostate (cryotherapy) may be used. If diagnosed in the very sick or elderly, watchful waiting can be done.