Posts Tagged ‘prostate cancer screening’

The Latest Advice on Screening for Prostate Cancer

April 5, 2017

The concept of screening for prostate cancer is a moving target. Screening for this common cancer in men has undergone significant changes in the past ten years. This blog is intended to provide you with advice on whether you should participate in prostate cancer screening.

 

Another progress being made is that men with early-stage tumors have been spared the side effects of treatment, such as erectile dysfunction (impotence) and urinary incontinence, which can be devastating. A recent report notes that 15 years after diagnosis, that 87% of men who underwent surgery and 94% of men who had radiotherapy were unable to engage in sexual intimacy.

 

So what do you need to know about prostate cancer screening?

 

Talk to your doctor about obtaining a PSA tests if you are at high risk for prostate cancer. These include African American men who are twice as likely to be diagnosed with prostate cancer and have an aggressive form of the disease and 2.4 times more likely to die from it than Caucasian men.

 

Men with a family history of prostate cancer are twice as likely to have prostate cancer and to die from it.

 

New tests for prostate cancer

We have been looking for a test that will better predict prostate cancer than an elevated PSA level. There are four new tests to enhance the diagnosis of prostate cancer.

 

A urine test, PCA3 looks for the presence of a specific prostate cancer gene. This test is more accurate than the PSA test in deciding whether a man needs a prostate biopsy.

 

The Prostate Health Index (PHI) blood test evaluates three different components of PSA to determine whether the elevated PSA level is due to infection, benign prostate disease or possibly prostate cancer.

 

The 4K score blood test is similar to the PHI test but looks at four components which can predict a man’s risk of developing prostate cancer.

 

Finally, the prostate MRI or magnetic resonance imaging test which can accurately diagnose aggressive prostate cancer.

 

If any of these four tests are positive, then the next step is a prostate biopsy.

 

So what is my “bottom line” on prostate cancer screening? I suggest a baseline PSA test for all men at age 50 and for higher risk patients at age 45. Men with very low PSA levels, less than 0.7ng\ml at baseline can have the PSA test every 5 years, and those 60 and older with levels less than 2.0ng\ml or lower may be able to avoid future PSA testing for the rest of their lives….as long as they remain symptom free. If you have any questions, check with your doctor.

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The Care and Feeding of the Enlarged Prostate Gland

October 21, 2016

If you are a man, then you have a prostate gland.  If you have a prostate gland, then you are likely to be one of the 14 million American men who experience bothersome symptoms beginning around age 50.  This article will discuss the diagnosis of the enlarged prostate gland and what are some of the available treatment options that can reduce the symptoms associated with this common condition.  It is a walnut sized organ at the base of the bladder and surrounds the urethra or tube that is in the penis and transports urine from the bladder to the outside of the body.  It is common and even normal for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until middle age or around 50. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have symptoms of BPH.

The prostate gland encircles the urethra like a donut, so problems with urination can occur if the gland restricts urine flow through the urethra. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

  • The bladder wall becomes thicker and will contract without the owner’s permission causing urgency of urination.
  • The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
  • Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder.

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

  • Urinating more often during the day
  • Need to urinate frequently during the night
  • Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time and soil your clothing-very embarrassing!
  • The urine stream is slow to start
  • Dribbling after urination
  • A sensation that the bladder isn’t emptied after urination
  • Lack of force to the urine flow, which makes aiming more difficult
  • The sensation of needing to go again a few minutes after urinating

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor can determine the size of the prostate gland during a physical examination.

The diagnosis is made with several of the following tests:

Symptom Score

This is a brief questionnaire that provides a numerical value to the symptoms associated with urination.  The higher the score (maximum is 25), the more symptoms a man has and the more likely he will want to have treatment for relief of his symptoms.

Urinalysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis. 

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).

Urine flow rate

This test consists of a man urinating in private over a funnel which measures the volume of urine and the time that it takes to empty the bladder.  The urine flow rate is expressed in milliliters per second.  Normal is greater than 15 ml\second.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Imaging studies

The ultrasound examination evaluates the size of the prostate gland which often determines the treatment option which is best for your situation.  It is a painless examination consisting of the insertion of a small pencil-size probe into the rectum and uses sound waves to determine the appropriate treatment for prostate gland enlargement.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment options

  1. Watchful waiting-If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.
  1. Drug therapyYour doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.
  1. Minimally invasive treatments-The prostatic urethral lift or UroLift is an implant of several polyester sutures connected by two small metallic tabs that opens the prostate gland located in the urethra and improves the flow of urine thus decreasing the symptoms of the enlarged prostate gland. UroLift has been approved by the FDA to relieve the symptoms of the enlarged prostate gland. There have been nearly xx thousand of men who have had the treatment which reports favorable results up to 4 years. Most insurance companies will now pay for the UroLift procedure 
  1. Surgery-Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (Trans Urethral Resection of the Prostate). This procedure requires an admission to the hospital, a general anesthesia, a urinary catheter for several days, and the risk of sexual problems afterwards.

Bottom Line:  Nearly all men will experience the problems associated with the enlarged prostate gland.  The enlarged prostate gland impacts a man’s quality of life.  Help is available and nearly all men can be helped.  If you have symptoms associated with urination, speak to your doctor.

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.

Men Need To Let Doctors Look Under the Hood!

May 2, 2015

We have an attitude in our community if it ain’t broke, don’t fix it. This may apply to your car but not to our boides and our health. Mos men

Most men do more preventive maintenance on their cars than on their bodies. Many men don’t come in for checkups because they fell that they have a big S tattooed on their chests, i.e, Superman. Fortunately for men – and the women in their lives – this attitude is slowly changing. Women live 5-7 years on average longer than men. If men practiced preventive health as women do with Pap smears and regular breast exams the gap between women’s and men’s life expectancy may close.

Reasons for the change:

National public-awareness campaigns, such as Men’s Health Week (June 14-20). Increasing media coverage of men’s health issues and more public comfort with medical words such as prostate, penis, impotence (ED) and colon helps, as does the growth in men’s clinics that are dedicated to men’s health.

New treatments. Before the PSA – prostate-specific antigen – screening test for prostate cancer, which became widely available in the 1990s, there was no male equivalent for the Pap test and mammograms that drive women into the doctor’s office on a regular basis. In recent years, men have been lured by conservative therapy options available to treat early-stage illness and can actually cure men of some of these severe medical conditions.

Drugs for treating impotence. Not surprisingly, one of the biggest draws in recent years has been Viagra, Levitra, and Cialis – the impotence drugs that has brought men to the physician where other conditions such as prostate cancer can be investigated.

Sensitivity. Doctors are learning they have to look at the male patient as a whole and not just as an organ system. Doctors are making an effort to communicating more effectively with men.

At-work health screenings. Many businesses are now giving “health fairs” that offer simple on-site baseline tests, like blood pressure, diabetes, and prostate or cholesterol screening. There’s no better place than the workplace to reach men.

Bottom Line: Men need to be proactive about their health and take as good care of their body as they do of their cars and their lawns.

Elevated PSA Linked to Shiftwork

February 16, 2015

Men who work night shifts or rotating shifts are more likely to have elevated PSA levels than men who do not.
In an analysis of data from the National Health and Nutrition Examination Survey (2005-2010), Erin E. Flynn-Evans, PhD, of Brigham and Women’s Hospital in Boston, and colleagues found shiftworkers had a 2.6 times increased risk of an elevated PSA (4.0 ng/mL or higher) compared with non-shiftworkers after adjusting for confounders.
The researchers, who published their findings online ahead of print in the Journal of the National Cancer Institute, concluded that sleep or circadian disruption is associated with elevated PSA, indicating that shiftworking men likely have an increased risk of developing prostate cancer.
A previous prospective cohort study of Japanese rotating-shift workers demonstrated that, compared with day workers, rotating-shift workers had a significant threefold increased risk of prostate cancer after adjusting for age, family history of prostate cancer, and other potential confounders, according to a report in the American Journal of Epidemiology (2006;164;549-555).

Take Home Message: If you are caring for a middle age man who does shift work, it is a good idea to encourage him to get a PSA and a digital rectal exam annually.

What Every Woman Should Know….About Her Man

November 26, 2014

Men live 5-7 years less than women and often have poorer health than their female counterparts. This may be due to many factors but certainly one is that men seek out preventive healthcare much less often than women. This blog is intended to give you an overview of the unique healthcare problems of men and what women can do to help their men lead happier and healthier lives.

ED\Impotence
ED is a common condition that affects as many as 30 million American men. Most men are uncomfortable discussing their sexual problems with either their partners or their healthcare providers. As a result men feel embarrassed and women often feel that the man in their life doesn’t find them attractive.

About 70% of the time, ED is caused by an underlying health problem, most often diabetes, high blood pressure, high cholesterol levels, or heart disease. The remaining 30% of men suffer from ED caused by stress, anxiety, depression, the side effects of medication, or drug and alcohol abuse.

In most cases, ED is treatable, which means that it doesn’t have to be a natural or inevitable part of growing older. Treatments include drug therapy (Cialis, Levitra, or Viagra) vacuum devices, injections, or penile implants. If your partner is suffering from ED, encourage him to seek medical care as certainly this condition can be effectively treated.

Testosterone
Testosterone is one of the most important hormones for the normal growth and development of male sex and reproductive organs. It is responsible for the development of male characteristics such as body and facial hair, muscle growth and strength, and deep voice.

Men’s testosterone levels naturally decrease as men age. But if the levels drop below the normal range, some uncomfortable and often distressing symptoms may develop, including:
Decreased libido or sex drive
Importance or ED
Depression
Fatigue or loss of energy
Loss of muscle mass

As many as 10 million men suffer from low testosterone (low T) but only 5% are being treated.

The diagnosis is made with a simple blood test that measures the blood level of testosterone. If the T level is decreased and the man has symptoms of low T, then replacement therapy with injections, topical gels, or pellets can be prescribed.

Prostate
The prostate is a walnut-sized gland that manufactures fluid for semen. It is located at the base of the bladder and surrounds the urethra or the tube that transports urine from the bladder through the penis to the outside of the body.

Prostatitis is a condition often caused by a bacterial infection or an inflammatory response similar to that seen with allergies and asthma. Symptoms may include a discharge, discomfort, pain in the area underneath the scrotum or testicles, frequent urination, and burning with urination. Treatment usually consists of medication and medications t decrease the inflammatory response in the prostate gland.

Benign prostate gland enlargement affects most men after age 50. The symptoms consist of frequent urination, getting up at night to urinate, and a decrease in the force and the caliber of the urine stream. Treatment consists of oral medication to reduce the size of the prostate gland, or medication that can relax the prostate and improve the urine flow. Now there are minimally invasive treatments such as microwaves, lasers, and even a new treatment, UroLift, that pins open the prostate gland in a 15 minute procedure in an outpatient setting.

Prostate cancer is the most common cancer in men. Nearly 240,000 new cases are diagnosed every year and causes 30,000 deaths each year making it the second most common cause of death due to cancer in men. The diagnosis is made by a digital rectal exam and a blood test, PSA test. If prostate cancer is caught early, it is often curable and nearly always treatable.

In the early stages, prostate cancer usually causes NO symptoms. However, as the disease progresses, so do the symptoms such as hip or back pain, difficulty with urination, painful or burning on urination or blood in the urine.

Every man should consider a baseline PSA test and a digital rectal examination at age 40. Additionally, African Americans and men with a family history of prostate cancer see a physician annually beginning at age 40.

Treatment options for prostate cancer include surgical removal of the prostate gland, radiation therapy, hormone therapy, immunotherapy or cryosurgery. Some men with localized, low risk prostate cancer might select active surveillance or watchful waiting which closes monitors the cancer to see if it progresses or becomes aggressive. If the cancer progresses, then treatment is usually instituted.

Testicular cancer
Cancer of the testicle is the most common cancer in men between the ages of 15-35. Although, there is nothing to prevent testicular cancer, if the cancer is diagnosed early, there is a high cure rate. Early detection is the key to success.

Symptoms of testicle cancer include:
Lumps or enlargement of either testicle
A feeling of pulling or unusual weight in the scrotum
Pain or discomfort in the testicle or scrotum
Dull ache in the lower abdomen
Enlargement or tenderness of the breasts

The best way to diagnose testicle cancer is be doing a testicle self-examination. Men\boys should examine themselves once a month just as women are recommended to do a monthly breast self examination. If a man experiences a lump or bump on the testicle or in the scrotum, contact your physician as soon as possible.

So what do I recommend?
In your 20s
A physical examination every three years
Check blood pressure every year
Screening for cancers of the thyroid, testicles, lymph nodes, mouth, and skin every three years
Cholesterol test every three years
Testicular self-exam every month

In your 30s
All of the above and a physical exam every two years

In your 40s
A physical exam every two years
A PSA test and a digital rectal exam if you are in a high-risk group
A stool test for colon and rectal cancer every year

At age 50 and above
A colonoscopy every 5 years or as recommended by your physician
A PSA and digital rectal exam every year

Bottom Line: Women can be so helpful in guiding men to good health. If you love your man, encourage him to follow these guidelines.

In the next blog we will discuss what men need to know about women’s health.

Movember-A reminder To Have a Prostate Check With Your Doctor

November 4, 2014

November is a month dedicated to men’s health and male health awareness.  Thousands of men will change their appearance this month by growing a moustache for the 30 days of Movember.

Not only are the ‘Mo bros’ bring back the moustache, they are raising funds and awareness for prostate cancer, testicular cancer and mental health.

By taking a few simple steps such as maintaining a good diet and taking action early when experiencing a health issue, every man can improve their chances of living a happy and healthy life.

If prostate cancer is spotted early, prostate cancer can be very effectively treated. And many men will be able to lead a normal life for years to come. Prostate cancer has one of the best survival rates of all cancers.

The most important thing to remember about prostate cancer is that even if the doctors confirm you have it, it doesn’t mean you will die of it,

Many of the men immediately start thinking about their own mortality and worrying about their families and loved ones after they are gone.

This is why ‘Movember’ is so important – to encourage men to be more proactive about looking after their own health.”

Prostate cancer is the most common cancer in men with 250,000 new cases each year and nearly 30,000 deaths in the U.S. It is often slow-growing, but there are more aggressive forms which need active treatment.

The prostate is a walnut-sized gland located between the bladder and the penis which secretes fluid that nourishes and protects sperm.

Conditions that can affect the prostate include infections, enlarged prostate – the gland grows in nearly all men over 50, prostate infections, and prostate cancer.

The first step is to make an appointment with your primary care physician and request a PSA test. If you have an elevated PSA level, your doctor will often refer you to a urologist.  The urologist may recommend a prostate biopsy and will treat you as an individual and work out what the best treatment is depending on your age, health and other conditions you may have.

Surgery or radiotherapy is not right for everyone and sometimes a ‘watch and wait’ or surveillance plan of action is recommended if the prostate cancer is not aggressive.

A lot of men find it embarrassing to turn to a doctor about men’s issues about urinary symptoms as they fear they have prostate cancer.

A much more common condition is the enlarged prostate gland.  This is a benign condition that impacts nearly all men over the age of 60 and causes difficulty with urination such as a decrease in the force and caliber of the urinary stream, urinary frequency, urgency of urination, and getting up at night to urinate.

The condition makes life uncomfortable as it can place pressure on the bladder and urethra, the tube through which urine passes, and can make it difficult to urinate or cause a frequent need to.

Most men can be helped with oral medication such as alpha blockers and medications to actually reduce the size of the prostate gland such as Proscar or Avodart.  If medications are in effective, there are minimally invasive procedures such as microwaves, lasers and now the new Urolift procedure.  This procedure has FDA approval and consists of using an implant that pulls the prostate gland open the us making urination much easier and more comfortable.

Prostate cancer – what you need to know if you are a man:

  • Ask your primary care Dr. for a special test (called PSA) – spotting prostate cancer early is really important , this is especially important if you are in your 50s or have any risk factors
  • Many diagnoses of prostate cancer will not cause problems and can be effectively treated and cured
  • There are no symptoms of prostate cancer unless it is very advanced
  • Contrary to popular belief difficulty in passing water is not a necessarily a sign of prostate cancer
  • You are three or four times more likely to develop the disease if your brother, father or close male relative has been diagnosed with it
  • If you are African American, then there is an increased risk you will develop prostate cancer.
  • It is a known fact that all men will develop prostate cancer if they live long enough.

Prostate and prostate cancer facts:

  • The prostate is a walnut-sized gland located between the bladder and the penis. It secretes fluid that nourishes and protects sperm
  • Conditions that can affect the prostate include infections, enlarged prostate (the gland grows in nearly all men over 50) and prostate cancer.
  • Prostate cancer is the most common cancer in men with 250,000 new cases each year and 30,000 deaths in the U.S.
  • Prostate cancer is often slow-growing, but there are more aggressive forms need active treatment
  • Most men who are diagnosed with prostate cancer survive 10 years or more
  • Familial inheritance represents 1-5% of all prostate cancers diagnosed
  • It is predicted that there will be 60% more diagnoses over the next 20 years
  • The number of advanced cancers is falling as awareness spreads

Prostate cancer – what happens:

The doctor will take some blood and test it to measure the amount of protein called prostate specific antigen – PSA.

It is normal to have a small amount of PSA in your blood. An elevated PSA level may be a sign of prostate cancer but equally the elevated PSA could be something like a urine\prostate infection or an enlarged prostate which is a benign condition.

An elevated PSA level may require an ultrasound prostate biopsy, which is where a small part of the prostate removed for further testing, or recommend an MRI scan, or both

If the scans and the biopsy confirm prostate cancer, your urologist will examine the information to determine exactly what risk type of cancer it is

You may need to have further scans such as bone scan or a CT scan

Types of treatment include active surveillance, radiotherapy or surgery depending on the type and severity of the cancer.

The important thing to remember is that prostate cancer can be effectively treated and you can live a perfectly normal life

More information on treatment options are available on my website: http://neilbaum.com/services/prostate-cancer

Bottom Line: Prostate cancer is the most common cancer in men and the second most common cause of death in American men. Most men with prostate cancer can be successfully treated. It starts with a digital rectal exam and a blood test, PSA.

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.

The End Of Screening For Prostate Cancer In Men Over Age 75

October 4, 2013

In a move that could lead to significant changes in medical care for older men, a national task force on Monday recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group was causing more harm than good.

The guidelines, issued by the U.S. Preventive Services Task Force and published on Tuesday in the Annals of Internal Medicine, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence.
Screening is typically performed with a blood test measuring prostate-specific antigen, or PSA, levels. Widespread PSA testing has led to high rates of detection. Last year, more than 218,000 men learned they had the disease.
Yet various studies suggest the disease is “overdiagnosed” — that is, detected at a point when the disease most likely would not affect life expectancy — in 29 percent to 44 percent of cases. Prostate cancer often progresses very slowly, and a large number of these cancers discovered through screening will probably never cause symptoms during the patient’s lifetime, particularly for men in their 70s and 80s. At the same time, aggressive treatment of prostate cancer can greatly reduce a patient’s quality of life, resulting in complications like impotency and incontinence.
Past task force guidelines noted there was no benefit to prostate cancer screening in men with less than 10 years left to live. Since it can be difficult to assess life expectancy, it was an informal recommendation that had limited impact on screening practices. The new guidelines take a more definitive stand, however, stating that the age of 75 is clearly the point at which screening is no longer appropriate.
Dr. Calonge said it was important that the guidelines not be viewed as “giving up” on older men. While the new rules should discourage routine testing of older patients, the recommendations will not prevent a man from seeking screening if he desires it, Dr. Calonge said. The new guidelines are not expected to alter Medicare’s current reimbursement for annual PSA screening of older men.
The guidelines focus on the screening of healthy older men without symptoms and will not affect treatment of men who go to the doctor with symptoms of prostate cancer, like frequent or painful urination or blood in the urine or the semen.
While the verdict is still out on younger men, the data for older men are more conclusive, experts say. The American Cancer Society and the American Urological Association both say annual PSA screening should be offered to average-risk men 50 and older, but only if they have a greater than 10-year life expectancy.
Treatments for prostate cancer can cause significant harm, rendering men incontinent or impotent, or leaving them with other urethral, bowel or bladder problems. Hormone treatments can cause weight gain, hot flashes, loss of muscle tone and osteoporosis.
Bottom Line: If you are 75 years of age or older, you probably don’t need any additional screening for prostate cancer.

This blog was excerpted from The New York Times, October 4, 2013
http://www.nytimes.com/2008/08/05/health/research/05prostate.html?_r=0

Screening For Prostate Cancer-New Guidelines and One Doctor’s Advice

May 10, 2013

Prostate cancer is the most commonly diagnosed non–skin cancer among U.S. men. It can be life-threatening, and many men have cancer without knowing it. For those reasons, doctors sometimes look for prostate cancer in healthy men (screen for cancer) by measuring blood levels of prostate-specific antigen (PSA), a protein secreted by the prostate gland. High PSA levels can be caused by cancer and may lead a doctor to take a sample of prostate tissue to see whether cancer is present (biopsy). Most prostate cancer grows very slowly, however, and many men with prostate cancer die of other causes. Neither PSA testing nor prostate biopsy tells doctors with certainty which cases of prostate cancer are threatening and which require treatment. As a result, many men with slow-growing cancer have biopsies and treatment after PSA testing that they would not have needed if doctors had never tested them.

The value of the PSA test has recently come into question, however, with several studies suggesting it causes men more harm than good — spotting too many slow-growing tumors that, especially in older patients, may never lead to serious illness or death. In 2012, the U.S. Preventive Services Task Force, an influential government-appointed panel, advised against any routine use of the PSA test for prostate cancer in all men.

Since most urologists consider the Task Force’s guidelines and global ban on PSA testing far too stringent For that reason, a group of experts at the recent 2013 American Urologic Association’s annual meeting in San Diego recently recommended against annual testing and prostate biopsies at certain PSA levels, usually a level greater than 4.0ng\ml. It is possible that using the PSA test differently (for example, by testing less often) would still be useful but reduce the harms of unnecessary treatment such as urinary incontinence and erectile dysfunction that come from more frequent testing.

What are the new AUA recommendations? There are several ways of using the PSA test to help men make the diagnosis of prostate cancer while reducing the harms of testing. The first way is to stop screening after age 70 years because men older than 70 years tend to have higher PSA levels without having prostate cancer, or if they have cancer, it is usually the slow-growing variety and does not result in a cause of older men’s mortality. Another way to use the new guidelines included measuring PSA levels less frequently such as every two years in men whose levels are normal especially when the initial PSA levels are less than 1.0ng\ml. Finally, the doctor caring for older men might recommend that they have higher levels of PSA before recommending a biopsy and possible unnecessary treatment.

It is hoped that the new recommendations by the American Urologic Association will result in more personalized health management where discussions will take place between doctor and patient and where the risk of having prostate cancer and the age of the man are balanced against the value of screening.
The new AUA guidelines are more nuanced. The group does recommend against the PSA test for men under age 40 or for those aged 40 to 54 at average risk for prostate cancer.

The AUA says, however, that men aged 55 to 69 should talk to their doctors about the risks and benefits of PSA screening and make a decision based on their personal values and preferences.

Routine PSA screening is not recommended for men over age 70 or any man with less than a 10- to 15-year life expectancy.

The best evidence of benefit from PSA screening was among men aged 55 to 69 screened every two to four years. In this group, PSA testing was found to prevent one death a decade for every 1,000 men screened. The guidelines also said PSA screening could benefit men in other age groups who are at higher risk of prostate cancer due to factors such as race, i.e., African American men and men with family history of prostate cancer. These men should discuss their risk with a doctor and assess the benefits and potential harms of PSA testing.

Bottom Line: What do I recommend that you tell patients? I agree with the guidelines that men over age 70 probably do not need to be tested. Also men younger than age 50 do not need to be tested. The exception is African American men and men with a family history of prostate cancer. I would not test a man with multiple chronic conditions, which would decrease his life expectancy to less than 10 years. I would also suggest that men with very low PSA levels, i.e., less than 1.0ng\ml, be tested every two years.

Finally, the discussions between a patient and his doctor on the PSA test are extremely important. I suggest you ask the man if he gets a PSA test, would he submit to a prostate biopsy and if he has prostate cancer would he accept treatment for the condition? If the answer is no, then I would document this in the chart and not obtain the test.