HEALTH MATTERS: Treating prostate cancer with ‘watchful waiting’

The ‘watchful waiting’ approach involves closely monitoring the cancer without treating it through surgery or radiation.

By Sidney Goldfarb, M.D. Princeton HealthCare System
    Prostate cancer is the most common type of cancer found in American men other than skin cancer. According to the American Cancer Society, more than 186,000 American men will be diagnosed with the disease in 2008.
    Prostate cancer is one of the leading causes of cancer death in men, second only to lung cancer. About 28,000 men will die of the disease this year, according to the American Cancer Society.
    When detected early, however, prostate cancer can be treated and the majority of men will make a full recovery. Indeed, more than 2 million men in the United States who have had prostate cancer at some point in their lives are alive today.
    Nonetheless, prostate cancer is still a life-altering experience for most men and their families, and can, in some cases, have a significant impact on urinary, bowel and sexual function.
    The prostate is a gland the size of a walnut located just below the bladder and in front of the rectum. The urethra runs directly through the prostate, which sits alongside and is connected to nerves that control erectile function.
    As a man grows older, his risk for developing prostate cancer increases. In fact, age is the strongest risk factor for prostate cancer. Consider the chance of getting prostate cancer goes up quickly after a man reaches 50, and about 2 out of every 3 prostate cancers are found in men over age 65, according to the American Cancer Society.
    Race also plays an important role in determining risk for prostate cancer, which is more common among African-American men than men of other races. Additionally, African-American men are more likely to have more advanced prostate cancer and are more likely to die of the disease.
    Family history is another risk factor. Men are more likely to develop prostate cancer if their father or brother had the disease. Moreover, men whose mothers had ovarian or breast cancer are also at greater risk.
    There are few symptoms associated with early ýPage=009 Column=002 OK,0033.02þ prostate cancer, but signs of more advanced prostate cancer may include the need to urinate frequently, especially at night; difficulty starting urination or holding back urine; weak or interrupted urine flow; painful or burning urination; difficulty having an erection; painful ejaculation; blood in the urine or semen, or frequent pain or stiffness in the lower back, hips or upper thighs.
    The American Cancer Society recommends annual screenings beginning at age 50 for men who do not have any major medical problems and can be expected to live at least 10 more years. Men at high risk should begin testing at age 45.
    Screening includes a simple blood test to measure the level of prostate-specific antigen (PSA) in the blood. as well as a digital rectal exam. If abnormalities are detected, a physician will order a biopsy of the prostate to confirm the presence of cancer.
    Once confirmed, the cancer is graded to predict how fast it is likely to grow and spread. The grading system is known as the Gleason scale and the cancer is assigned a Gleason score between 2 and 10. The higher the number the quicker the cancer is likely to grow and spread. Further tests will identify whether the cancer has spread and will help doctors determine the stage of the disease.
    Treatment options vary depending on the stage and a man’s age and overall health, and typically range from “watchful waiting” to surgery or radiation.
    The “watchful” waiting approach involves closely monitoring the cancer without treating it through surgery or radiation. This approach may be appropriate in older men who have other major health problems and if the cancer is slow-growing. For younger men, who are otherwise healthy, surgery or radiation is generally recommended.
   ýPage=009 Column=003 OK,0020.07þ There are risks associated with these treatments, however. While the majority of men recover fully, some may experience uncomfortable side effects, such as incontinence and impotence. Both can be treated with the help of a doctor.
    In determining the best course of treatment, it is critical that men talk with their physician and consider their age, their overall health, goals for treatment and feelings about potential side effects.
    At this moment, preventing prostate cancer is difficult. Some suggest a diet low in fat and high in fruits and vegetables, especially tomatoes, may help lower the risk of prostate cancer, but research is still ongoing. Researchers are also looking at the roles of vitamin E and selenium in preventing the disease.
    In addition, researchers announced this spring that an existing drug commonly used to treat enlarged prostrates has been proven to significantly reduce incidences of prostate cancer that require surgery and prevent high-grade prostate cancer by nearly 30 percent.
    The Federal Drug Administration has not yet approved the drug — finasteride — for use for the prevention of prostate cancer, but it is recommended that men concerned about developing the disease discuss the option with their doctor.
    With these advances in medicine and ongoing research, preventing prostate cancer may soon get easier. Until then, men should have regular screenings and consult with their physician regarding the best course of action against the disease.
To find a physician with Princeton HealthCare System, call 888-742-7496 or visit www.princetonhcs.org.
Dr. Sidney Goldfarb is a board-certified urologist and member of the medical staff at Princeton HealthCare System.
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