HEALTH MATTERS: Fighting prostate cancer

By Alexander P. Vukasin, M.D., and Henry Davison Jr., M.D.
Special to The Packet
   Prostate cancer is a cancer of the reproductive gland in men — the small, walnut-shaped gland that produces seminal fluid, the fluid that protects and transports sperm.
   Prostate cancer affects 1 in 6 men, making it the second most commonly occurring male cancer, exceeded only by skin cancer. It is also the second most deadly cancer for men, after lung cancer.
   The National Cancer Institute estimates that in 2007, 218,890 new cases of prostate cancer and more than 27,000 deaths associated with prostate cancer will be reported in the United States. An estimated 8 out of 10 men diagnosed with prostate cancer are older than 65. It is the younger male, however, age 40 and up, who — when undiagnosed — can suffer some of the disease’s most devastating consequences.
   Prostate cancer is also especially virulent in the African-American community, for reasons that researchers don’t know specifically, but are trying to answer by looking at such factors as heredity and diet. African-American men have a higher incidence of prostate cancer than white males and their mortality rate is more than twice as high. At the same time, African American men tend to be diagnosed in later stages of the disease than other ethnic groups. And while age influences prostate cancer outcome in white men — the younger the man, the better the chances for a more positive prognosis — it is not the same case for African Americans. In fact, young African-American men have shorter recurrence-free survival rates from prostate cancer; the rate is similar to that of older white men.
   A diagnosis of prostate cancer is frightening for most men, no matter what their race or age, and not just because of the grim statistics concerning the disease’s frequency and mortality rate. Because treatment for advanced prostate cancer can cause bladder control problems and erectile dysfunction, many men put off screening for the disease because they are afraid of the impact a diagnosis may have on their sexual function and quality of life.
   Yet screening has proven to be the most effective tool for the early diagnosis of prostate cancer, which is, as is the case with most cancers, a treatable disease if caught in its earliest stages. At the same time that reports of diagnosed cases have risen in recent years, mortality rates have been declining, most likely because of increased screening. Research shows that 80 to 90 percent of men treated early for prostate cancer can live normal lives.
   Some cancers, such as testicular cancer or breast cancer, manifest in the early stages with a lump that may be detected by an individual through a self-screening or by a physician during a physical exam. Prostate cancer, however, does not usually produce any specific signs or symptoms in its early stages, which is why many cases are not detected until the cancer has spread beyond the prostate. The first indication of an abnormality may come during routine screening tests, which is why the tests are so vital to an early diagnosis. In addition, the screening tests could detect other disorders that could be treated and improve quality of life.
   These tests include a digital rectal exam, which allows the physician to check the size of the prostate, located next to the rectum, and to detect any irregularities in texture or shape that might warrant further tests. The Prostate Specific Antigen (PSA) test is conducted by taking a blood sample from a vein and analyzing the levels of PSA, a substance that helps liquefy semen and is naturally produced by the prostate gland. It is normal for a certain amount of PSA to leak into the bloodstream. But abnormally high levels of leakage could indicate either infection or something more serious, such as prostate cancer.
   If the initial tests raise question marks, your physician may refer you to a urologist for further evaluation. A urologist may recommend a prostate biopsy, a 10-15 minute office-based procedure during which small tissue samples are taken to see if cancer cells are present.
   Symptoms such as frequent urination, especially at night, or the inability to urinate may not be indications of prostate cancer but should be looked at by a doctor. Blood in the urine, malaise, back pain, loss of weight and bone pain are typically symptoms of advanced disease, if they are related to prostate cancer.
   There is a promising new blood test on the horizon for a blood protein called early prostate cancer antigen-2 (EPCA-2) that one day may change the way men are screened for prostate cancer. To date, however, no single test for prostate cancer replaces the overall value of the PSA test as an early indicator of the disease.
   Who should be screened for prostate cancer? Guidelines established by the American Cancer Society (ACS) recommend both the PSA blood test and the digital rectal exam to be offered annually to men beginning at the age of 50. The ACS says men at high risk because they are African American or men who have a strong family history of one or more “first-degree” relatives (fathers or brothers) diagnosed before age 65 should begin testing at age 45. Some of the larger cancer centers and University Medical Center at Princeton are recommending even earlier screening, beginning at the age of 40 for those in the high-risk categories. 
Alexander P. Vukasin, M.D., FACS, is Chief, Section of Urology, Princeton HealthCare System, Henry Davison Jr., M.D., FACS, is a general surgeon and past president of the Medical and Dental Staff, Princeton HealthCare System.