Myth: Prostate Cancer Isn’t Deadly
Fact:;While the five-year survival rate with prostate cancer is very high 90 percent, according to the ACS its still the second leading cause of cancer death in men. The only cancer that kills more men is lung cancer.
Most prostate cancers are what doctors call indolent, which means that they grow slowly and can often be actively monitored over the course of many years without other treatment. But sometimes prostate cancer is aggressive, and grows quickly.
While most men dont have a prostate cancer thats fast and deadly, acknowledges Sartor, it does exist. And you wont know which type you have until its thoroughly checked out.
In other words, assuming prostate cancer isnt serious and not having further testing because of this misconception could be a downright deadly way of approaching the illness.
The dangers and risks of prostate cancer arent distributed evenly among American men, either. The U.S. Department of Health and Human Services Office of Minority Health reports that African-American men are 2.3 times as likely to die from prostate cancer as compared to non-Hispanic white men.
Myth: Psa Tests Are Bad For You
Fact:;Some prostate cancer experts recommend against regular PSA testing, but not necessarily because of the test itself which is just a simple blood test. PSA screening certainly isnt perfect, but it doesnt pose any actual danger to your health. The real hazard is anxiety and sometimes faulty decision-making when it comes to interpreting and acting on PSA results. According to the ACS, PSA levels usually go above 4 when prostate cancer develops. However, a PSA level between 4 and 10 results in a prostate cancer diagnosis only about 25 percent of the time.
Causes of a high PSA can range from things like bicycling to ejaculation. As a result, some men are given invasive biopsies that arent needed. Or, if they do have cancer, they may be treated aggressively for slow-growing tumors that might never have caused any issues.
Which is not to say that PSA tests arent valuable or that they cant save lives. In the years since theyve been widely used, says Dr. Wei, prostate cancer diagnoses have gone up but the death rate is going down. This is at least in part because PSA tests lead to more investigation, which can find cancer early when its more receptive to treatment. Talk with your doctor about whether and how often you should be screened for prostate cancer.
Are Older Men Undertreated
Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.
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Who Dies From This Cancer
Because we have screening for prostate cancer, most of the time it is caught before it spreads to other parts of the body. Men who have prostate cancer that is characterized as localized or regional are not as likely to die as men whose cancer is distant. In general prostate cancer has excellent survival rates, but death rates are higher in African American men, men who have advanced stage cancer, and men who are between the ages of 75 and 84. Prostate cancer is the fifth leading cause of cancer death in the United States. The death rate was 19.0 per 100,000 men per year based on 20142018, age-adjusted.
Death Rate per 100,000 Persons by Race/Ethnicity: Prostate Cancer
Four Key Mistakes To Avoid If You Are Diagnosed With Low
Here are key mistakes Dr. Hu has identified
- Mistake: Automatically opting for treatment when you have low-risk prostate cancer.;Even though treatment for low-risk prostate cancer is generally;not;recommended, in the recent study, more than 85% of the men with low-risk prostate cancer chose to have some sort of treatment. The most common treatment was radiation therapy , and the second most common was surgery . Just 15% opted to skip treatment. The good news is that, as the study went on, there was a trend toward a greater percentage of men opting for active surveillancea trend that has accelerated according to recent surveys. However, Dr. Hu thinks too many men are;still;missing out on this proven approach.
- Mistake: Choosing active surveillancebut not doing follow-up tests.;According to the results of this study,;fewer than 5%;of the men who skipped treatment complied with recommended monitoring. They had fewer office visits, and fewer repeat PSA tests, compared with men who had some form of active treatmentand only 13% underwent a second biopsy within two years, as recommended.
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Indications For Urologic Referral
If abnormalities are detected on the digital rectal examination or PSA test, patients should undergo urologic evaluation with transrectal ultrasound-guided prostate biopsy. No further urologic evaluation is necessary in patients who have an unremarkable digital rectal examination and a normal serum PSA level, because the incidence of prostate cancer is only 0.4 percent in this group.15
Transrectal ultrasound examination and guided prostate biopsies are office-based procedures that are well tolerated by patients. The procedures require no adjuvant sedation or analgesia. Rare complications of transrectal prostate biopsy include rectal bleeding and sepsis. Most patients report only mild rectal spotting, hematospermia or hematuria after the test.
Before transrectal prostate biopsy is performed, the patient should stop taking warfarin , aspirin and other nonsteroidal anti-inflammatory medications for 10 days and should not have a urinary tract infection. On the morning of the examination, the patient should have a saline laxative enema . The patient should also be given an oral dose of a broad-spectrum antibiotic.
Diagnosis And Treatment Of Prostate Cancer
JOHN NAITOH, M.D., University of California, Los Angeles, School of Medicine, Los Angeles, California
REBECCA L. ZEINER, M.D., Southern California Kaiser Permanente Medical Group, West Los Angeles, California
JEAN B. DEKERNION, M.D., University of California, Los Angeles, School of Medicine, Los Angeles, California
Am Fam Physician.;1998;Apr;1;57:1531-1539.
Prostate cancer is second only to lung cancer as the leading cause of cancer deaths in American men. In 1997, approximately 209,900 new cases of prostate cancer were diagnosed, and more than 41,800 deaths were attributed to this malignancy.1 At present, chemotherapy and immunotherapy cannot cure prostate cancer once it has spread beyond the gland. Therefore, curative treatment for localized tumors may be the best hope of lowering the mortality rate for prostate cancer.1 According to this viewpoint, the primary focus of prostate cancer management should be the detection and aggressive treatment of tumors while they are still confined to the prostate.
The controversial aspects of prostate cancer screening are reviewed in this article. An attempt is also made to identify the patient groups that definitely would benefit from prostate cancer screening. Current treatment approaches for tumors confined to the prostate are also reviewed.
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Prostate Cancer Surgery Won’t Boost Survival In Men With Early
Men with early-stage prostate cancer often face a difficult choice as to treatment: Do they opt for radiation, surgery or “watchful waiting” to see if the cancer gets worse.
A new study in the New England Journal of Medicine finds men who opt to surgically remove their prostate gland – a procedure called a radical prostatectomy – are no less likely to die than men who choose wait and monitor their symptoms to see if the cancer progresses.
The study adds to the ongoing debate surrounding prostate-specific antigen testing and whether the tests pick up cancers that may be too slow-growing to ever cause a problem.
In May,;;the U.S. Preventive Services Task Force,;a panel of advisors on government medical guidelines, reviewed existing research and reported in its final recommendation that healthy men of all ages should not take a PSA test because the potential harms from a positive test outweigh the benefits from catching the cancer early.
The study tracked 731 men with early-stage prostate cancer found through PSA testing, average age of 67, who agreed to be randomized to either receive radical prostatectomy or just observation from a doctor between November 1994 through January 2002. The men were followed-up with by January 2010 to see how they fared.
The National Cancer Institute has more for men on choosing a treatment for early-stage prostate cancer.
What A Psa Score Really Means For Your Prostate
The best way to know if you have prostate cancer at the earliest possible stage is not the PSA or the digital rectal exam. The best indication is a test called PSA velocity testing.
With PSA velocity testing, its possible to diagnose an early cancer even when the PSA and the rectal exam are normal.
PSA velocity describes how high the value of a mans PSA tests increase in one year. For example, if a you have a PSA test and its 0.5 higher than it was the year before, you have a PSA velocity score of 0.5. If the last time you had a PSA was five years ago, and this years test was 1.0 higher, then your PSA velocity is 0.2, or 1.0 divided by the five years.
As a man ages, due to the normal age-related increase in prostate size, his PSA is likely to rise ever so slightly. But as long as the PSA velocity is minimal, the odds are that if he has a latent cancer, his immune system is still keeping it in check. In fact, a PSA velocity of 0.03 or less per year has been shown to be accurate proof that no prostate cancer exists. Thats an optimal velocity. Although the values may vary slightly from year to year, there should not be any consistent overall increase greater than 0.03.
And all of this is true even if the highest PSA number is still in the normal range. So any PSA velocity greater than 0.15 should be a cause for immediate treatment.
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Risk Prostate Cancer And Being 70 To 80 Years Of Age
So a relatively new article in Reviews in Urology caught your Sitemasters eye this morning and worried him because it seemed to be communicating a conclusion of questionable accuracy, which we will explore below. And if we have misinterpreted the data provide in the paper, we are more than willing to be corrected.
The new paper by Shah and Ioffe is based on a retrospective analysis of data from 5,100 patients of between 70 and 80 years, all of whom received radiation therapy of some type for the treatment of prostate cancer over a 10-year period from 2005 to 2015. The authors state that:
Multiple studies in peer-reviewed journals document that men 70 years and older have more prevalence of prostate cancer, more high-grade disease, more metastases, and more prostate cancer-specific deaths compared with men under 70 years.
That they have a higher prevalence of prostate cancer and more prostate cancer-specific deaths than men of < 70 years is probably undisputed, for the simple reason that they are older, incidence of prostate cancer is well understood to be age-related, and many such patients may well have at least micrometastatic disease by the time they are initially diagnosed . Whether they really have more high-grade disease at time of diagnosis, however, is not quite as clear.
So the first thing that worries us about this study is that it appears to include exclusively men who received treatment for prostate cancer. The authors state this very clearly:
Approach To Prostate Cancer Screening
Patients generally should be evaluated by a urologist if physical examination of the prostate reveals any area of asymmetry, nodularity or induration, because up to 50 percent of these findings will be caused by prostate cancer.8 The problem with using only the digital rectal examination as a screening tool is that it does not detect cancers before they have spread beyond the prostate. More than 50 percent of prostate cancers diagnosed by digital rectal examination have spread locally or have metastasized to lymph nodes or bone.
The approach to screening has been revolutionized by the discovery of PSA as a serum marker that is 70 to 80 percent sensitive for prostate cancer. This serum marker is a protein made only by prostate cells. Serum PSA levels are proportional to either the total volume of prostate tissue or the amount of irritation in the prostate . Either increased volume or irritation causes PSA to spill from the prostate into the bloodstream.
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Once a patient reaches 70 years of age or competing comorbid conditions limit survival beyond 10 to 15 years, consideration can be given to terminating prostate screening as long as the patient remains asymptomatic.
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Prostate Cancer Screening Controversy
The effectiveness of a cancer screening program depends on a number of factors. The malignancy must be detectable with minimal harm and cost, and early diagnosis must be able to improve the quantity and quality of the patient’s life. An effective treatment for the cancer must be available, and this treatment should have few side effects. Finally, treatment of the asymptomatic patient must provide a better outcome than treatment after the disease has become clinically evident.
At this time, prostate cancer screening does not fulfill all of the requirements for an effective screening program. Some evidence shows that, compared with screening by rectal examination alone, routine screening of asymptomatic patients with PSA testing and digital rectal examinations detects a higher percentage of cancers that are localized to the prostate.2 However, both the American Academy of Family Physicians3 and the U.S. Preventive Services Task Force4 recently recommended against the use of routine prostate cancer screening for two reasons: early prostate cancer detection has no proven benefit and the potential side effects of treatment may outweigh the benefits. In contrast, the American Cancer Society and the American Urological Association5 recommend the use of a PSA-based screening program to detect prostate cancer in men 50 years of age and older.
Half Of Men Over 60 Have Prostate Cancer But Most Die Of Other Causes
A new study;looking at the prevalence of prostate cancer in men over 60 years of age found that just about 50 percent of men have the cancer. This statistic isn’t as distrubing as it sounds; most prostate cancers never develop into a harmful form of the disease and a large proportion of men will pass away from other causes without their prostate cancer progressing and becoming invasive.
The current study, published in the Journal of the National Cancer Institute,;examined 320 men from Russia and Japan who had died at the age of 60 or older between 2010 and 2011. None of the men had been diagnosed with prostate cancer before their death. Men from Russia were used for the survey because they have similar fat intakes and sun exposures compared to North American men. Japanese men were examined because the incidence of prostate cancer is lower in the male population of Japan, most likely resulting in different diet compared to Caucasian North American men.
How often men should be tested for prostate cancer is a topic of debate among healthcare professionals. After all, the bottom line is that most American men will get prostate cancer if they live long enough. But many of them never experience any ill effects from the cancer, and typically die of natural causes having nothing to do with the prostate. And in fact, many doctors believe that prostate cancer is over-treated because not all men progress;to a dangerous form of the disease.
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Who Is At Risk For Prostate Cancer
All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.
All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.
The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.
Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.
As Screening Falls Will More Men Die From Prostate Cancer
In active monitoring, men with localized prostate cancer do not get surgery or radiation right after theyre diagnosed. Instead, they have regular biopsies, blood tests, and MRIs to see if their cancer is progressing. If it is, they can receive treatment.
Although some oncologists advise men with early, low-grade prostate cancer to choose active surveillance and professional groups such as the American Society of Clinical Oncology recommend it; many patients recoil at;what sounds like lets just wait for your cancer to become really advanced.;A decade ago fewer than 10 percent of;men diagnosed with prostate cancer chose monitoring, UCLA researchers found. But that is changing. Now at least half;of men do.
That made sense to Garth Callaghan, author of the best-selling Napkin Notes, a book;of missives he tucked into his daughters lunch box. Diagnosed with early prostate cancer in 2012, he said, none of the choices seemed particularly attractive to a 43-year-old man who dreaded the possibility of side effects of surgery or radiation, including incontinence and impotence. I was completely torn. My previous experience was, just get it out of my body. But after his doctor explained that prostate cancer is grossly overtreated in the United States, I did a complete 180 and chose active monitoring.
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