By Dr. Dudley Danoff
Prostate cancer accounts for a shocking 24 per cent of all male cancer cases in Canada, while in America, an estimated 240,000 men will be diagnosed with this disease this year. The launch of popular awareness-raising campaign Movember has helped to boost funds and increase research, but there’s still more work to be done. The success of Movember is undoubtedly an impressive accomplishment, and everyone involved should be proud, but it’s equally important that men (both mustache-sporting and clean shaven) take the personal steps necessary to protect and educate themselves about the disease. Patient awareness not only makes the urologist’s job easier in the event of a diagnosis, but also allows patients to assume a proactive and participatory role in the treatment process.
Early diagnosis is critical because nearly all cases discovered while the cancer is confined to the prostate are curable. Since there are few clear symptoms associated with early-stage prostate cancer, the key to early diagnosis is PSA (prostate-specific antigen) screening, a simple office-based blood test. PSA screening – when properly interpreted and integrated into a comprehensive screening protocol – can save lives.
If you are male and over the age of 40, I recommend that you get an annual PSA test and a digital rectal exam. If either test is abnormal, consult your urologist immediately. Further testing and evaluation will be required and might include the following:
- Prostate biopsy
- CT scan
- Bone scan
Your urologist should also review any medical conditions you may have, including hypertension, diabetes, and coronary artery disease. In addition, your lifestyle, sexual activity, anxiety level, and accessibility to a prostate cancer treatment center should be considered before a treatment plan can be determined.
If prostate cancer runs in your family or you’re African American, annual PSA screenings are even more important, as the chance of suffering from aggressive prostate cancer is higher among these groups.
If you do face a personal prostate cancer diagnosis, your urologist will determine whether it’s a slow-growing, nonaggressive, and organ-confined tumor, If this is the case, then your urologist should discuss active surveillance with you. This is a conservative strategy that involves the following:
- Blood testing (annually)
- Ultrasonic imaging (annually)
- Prostatic MRI (annually)
- Possible repeat biopsy (annually)
- Serial PSA screening
Most urologists and radiation oncologists regard active surveillance as an effective strategy for managing low-risk prostate cancer. Studies indicate that this approach does not decrease the survival rate from early-stage prostate cancer.
On the other hand, if your urologist determines that you have an aggressive prostate cancer that will impact your life expectancy, surgical intervention may be recommended.
If you and your urologist decide that surgery is the best course in your particular case, consider this: a recent report published in peer-reviewed journal Cancer Prevention Research stated that men who ate a low-fat diet with fish oil supplements for four to six weeks before having their prostate surgically removed had a slower cancer-cell growth in the prostate tissue than men who ate a traditional, high-fat Western diet.
Since widespread PSA testing began in the early to mid-1990s, the 10-year survival rate for prostate cancer has increased from 53 per cent to over 97 per cent. In addition, the death rate from prostate cancer in the United States has decreased by nearly 40 per cent. During this interval, however, the incidence of prostate cancer has been virtually unchanged. I encourage every man over 40 to get screened, find a qualified urologist, and follow his or her advice.
Dudley Seth Danoff, MD, FACS, is president and founder of the Cedars-Sinai Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of two books on men’s health.