Archive for the ‘prostate specific antigen’ Category

Treating Prostate Cancer By Close Monitoring or ActiveSurveillance

November 25, 2016

Prostate cancer is the most common cancer in older men and second most common cause of death due to cancer in men over the age of 50.  This year more than 180,000 men will be diagnosed with prostate cancer and more than 30,000 men will die of this disease.  There are multiple treatment options for prostate cancer including surgery, radiation, hormone therapy and now there’s a new option: watchful waiting or active surveillance.  Active surveillance means no treatment but careful monitoring with regular digital rectal exams, PSA testing, and possible other tests and\or imaging studies.  This blog is intended to help men who have received a diagnosis of prostate cancer to help guide them in the decision of active surveillance or more aggressive standard treatment options.

What you need to know

The prostate gland is a walnut-sized organ at the base the bladder and surrounds the urethra or the tube in the penis that transports urine from the bladder to the outside of the body.  The prostate gland’s function is to make the fluid that mixes with the sperm and provides the sperm with nourishment to help fertilize an egg and start the process of conception.

For the first part of a man’s life the prostate gland provides pleasure and enjoyment.  After age 50 for reasons not entirely known, the prostate gland starts to grow and compresses the tube or the urethra and produces difficulty with urination.  Again, for reasons not entirely known the prostate cells grow uncontrollably and this results in prostate cancer.

Prostate cancer is a very common as one in seven American men will develop prostate cancer.

There are two tests used to detect prostate cancer: 1) the digital rectal exam and 2) the PSA or prostate specific antigen test.  PSA is a protein made by the prostate gland.  An increased level of PSA can be a sign of prostate cancer but an elevation is also seen in men with prostate gland infections and benign enlargement of the prostate gland.

Active surveillance is now considered an acceptable management option in certain men with prostate cancer.  Active surveillance is a type of close follow up. In addition to the PSA and digital rectal exam, a repeat biopsy may be indicated.  A biopsy test called a fusion-guided biopsy is one of these newer tests that combines the MRI with real-time ultrasound images of the prostate.  Genomic tests are another development for prostate cancer assessment.  These tests look at the DNA of the cancer to decide if the cancer is stable or growing.  If any of these tests indicate that the cancer is growing, you may require additional treatment.

At the present time there is no universal agreement about how often the tests should be done for men who are participating in active surveillance.  Patients who are at low risk, that is have a low PSA and a biopsy that reveals a reasonably favorable pathology report, then he can have his PSA check every six months.  It is also common to have a repeat biopsy 12-18 months after the diagnosis.

Candidates for Active Surveillance

Men with early stage prostate cancer that is confined to the prostate gland are the best candidates for active surveillance.  Also, good candidates are men without symptoms and have prostate cancer that is slow growing.  Finally, older men with serious other medical problems which may interfere with treatment are potential active surveillance candidates.

The benefits of active surveillance is that it is low cost, safe, and has no side effects.  Men are able to maintain day-to-day quality of life and not have any of the complications of treatment such as impotence\ED or urinary incontinence.  The risk is that men can become complement and not follow up as often as they should and that the cancer can grow and become more aggressive.

Bottom Line:  Prostate cancer is a common problem in middle age and older men.  Most men if they live long enough will develop prostate cancer.  However, most men with the diagnosis of prostate cancer will die with the cancer and not from it.  My best advice is to have a conversation with your doctor and see if active surveillance is right for you and your cancer.

PSA Testing for Prostate Cancer-To Screen or Not to Screen That is the Question

September 28, 2016

Today, nothing is more confusing for men than the concept of screening for prostate cancer.  Prostate cancer is the second most common cancer in men, following lung cancer, and there are 250,000 men each year diagnosed with prostate cancer and causes nearly 30,000 deaths a year.  About one in seven men will be diagnosed with prostate cancer during his lifetime.

But some prostate cancers develop slowly, and, as the disease is more common in elderly men, most men with prostate cancer die with it and not from it. Thus, screening, diagnosis and treatment of the disease are controversial.

There is no consensus about prostate cancer screening as early diagnosis can be associated with very bothersome side effects such as erectile dysfunction and urinary incontinence.  Also screening has not been universally shown to increase survival or decrease the death rate from prostate cancer.  This article will discuss the pros and cons of PSA screening for men.

Men who opt for screening undergo a digital rectal exam and a blood draw to measure a chemical called PSA or prostate specific antigen. This level of PSA can be increased in men with prostate cancer. Other conditions may cause the increase in the PSA such as benign enlargement of the prostate gland and prostate infections.

The best way to detect an early potentially deadly case is to collect yearly PSA tests over three to five years so trends can be assessed.

I like most other urologists are concerned about over treatment of prostate cancer — in other words, being too aggressive in using surgery or radiation when a small amount of potentially slow-growing cancer is found on a biopsy.

The federal government has also become concerned about this issue. A large medical research trial called the Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Study released results from 2009 showing no benefit from screening for prostate cancer when comparing a large group of unscreened men to a large group of aggressively screened men.

Researchers across the country are assessing the effects of the USPSTF recommendations on prostate cancer mortality since 2012. In a recent study from Northwestern University in Chicago, researchers found a significant increase in the cases of advanced prostate cancer already spread to other parts of the body from 2004 to 2013. As a result we could be missing serious cancers because of decreased screening.

Prostate cancer also has a hereditary predilection and men with a father, brother, cousin, or uncle should consider having screening around age 40.  This also applies to African-American men who have a greater risk of prostate cancer than Caucasian men and should also have testing after age 40.

My best advice is to ask your doctor\urologist about the decision to undergo prostate cancer screening.

Screening For Prostate Cancer-What You Need To Discuss With your Doctor

September 22, 2014

Prostate cancer remains the most common cancer in men and the second most common cause of death in men due to cancer in men. Because of advanced treatments, curing prostate cancer has become more common. There now are more than 2.5 million survivors in the United States. Still, many men suffer from side effects after treatment, which may be a deterrent to obtaining care or even discussing the matter with a doctor. But early diagnosis and appropriate treatment will provide the best outcomes. I suggest that men should discuss the pros and cons of screening with their doctors as they approach 50. This blog will provide you with the information you need to discuss with your doctor.

Treatment options for prostate cancer

The treatment options for prostate cancer have improved significantly over the years. There are three basic choices available to treat localized prostate cancer. These include surgical approaches, most importantly robotic prostatectomy (i.e., robot-assisted laparoscopic surgery); various types of radiation treatments including brachytherapy (placing radioactive seeds in the prostate gland); and active surveillance. Most common long-term side effects of any treatment for prostate cancer are related to urinary issues, including incontinence (difficulty controlling urination), urgency and frequency, as well as sexual problems (erectile dysfunction).


Side effects from treatment

Although these side effects are not necessarily harmful in terms of longevity, obviously if these problems occur they will have a significant effect on one’s quality of life. Fortunately, with the advent of robotic surgery and brachytherapy, these side effects are greatly reduced. The incidence of long-term urinary incontinence is less than 5 percent, and preservation of sexual function is as high as 70 percent to 80 percent. The patient’s pre-treatment health and age will certainly have an effect on the post-treatment outcomes.

Many of these side effects will improve with time. It may take as long as six months for urinary incontinence to resolve after surgery. It may take longer, usually six months to a year, for return of normal sexual function after surgery. After radiation treatment, these urinary issues (including frequency and urgency) usually will resolve in a shorter period of time, although the sexual problems tend to occur in a delayed fashion, usually presenting at six months to 1 year after radiation. Certainly if either of these problems persist, it is best to be treated by one’s urologist. There are several treatments for incontinence/ including medication, urethral injections and, if necessary, surgical correction. There is also a broad array of options to treat impotency. Again, the spectrum will range from medical intervention to ultimately surgical correction if necessary.

Follow-Up After Treatment For Prostate Cancer

Because of the advances in urology, cure rates for localized prostate cancer have become extremely high, approaching 90 percent. Continued follow-up is quite important. Usually, men should be seen every six months for the first five years after treatment and then yearly after that. The follow-up usually includes a physical exam as well as continuous monitoring of the patient’s PSA blood levels. Further testing may be necessary if the PSA levels do start to increase. Additional treatments may be necessary if there appears to be a recurrence. It is quite important that this be done at an early point in time for more successful outcomes.

Get Support From Support Groups

There are prostate cancer support groups available. It is often quite helpful to hear that other men have gone through similar issues during their recovery. Other patients with similar problems are a great resource for information. These support groups are generally found through various websites, including the Prostate Cancer Foundation and the American Urological Association. Also the Mercy website can be used as a link.

Bottom Line: Prostate cancer if detected when it is confined to the prostate gland is curable. The best screening device is an annual exam for men after age 50 and a PSA blood test. Before getting the blood test, talk to your doctor about the diagnosis and the treatment so that you know the consequences of prostate cancer screening.