Prostate Cancer Awareness Month
September is Prostate Cancer Awareness Month, a nationwide effort to educate men about their most common internal cancer—it afflicts about 1 in 7. It’s almost always curable, but the key is early detection.
“Unfortunately, there are usually no ‘early warning signs’ for prostate cancer,” said Paul M. Berger, M.D., a urologist with St. Luke’s University Health Network. “By the time you actually see indicators”—including problems urinating, more frequent urges, or blood in the urine—“the cancer has already spread. Typically, it will go to the spine, ribs or kidneys, but can spread anywhere.”
But those same symptoms are often present in cases of benign prostatic hyperplasia (BPH), a condition that afflicts approximately 50% of men.
That’s why yearly cancer screening is so important. “The earlier that prostate cancer is detected, the better your chances for a cure. I usually tell my patients to begin screening at the age of 50. But if they are already displaying some symptoms, are African-American, or have a family history of the disease, I recommend starting when in their 40s,” he says.
There is no typical patient, and no preventative action you can take, although Berger offers one observation: “The incidence of prostate cancer in Asian men who follow the typical Asian diet – that is, lots of fish and plants, and little fat – tends to be very low. But when they adopt our Western diet, the rate of prostate cancer goes up,” he says.
Two commonly used tests for prostate cancer are the PSA test and digital rectal examination. The digital exam is self-explanatory—a physician inserts a gloved finger and palpates the prostate, looking for anything unusual.
A PSA (prostate-specific antigen) test measures the level of that protein in your blood. While a PSA level of 4.0 ng/mL is considered normal, a man’s PSA level can fluctuate because of a urinary tract infection, age, even some of the medications that treat BPH. “It’s a very sensitive test,” Berger says, “and sometimes provides false-positive results, but it’s probably the best indicator of prostate cancer we have available.”
The only definitive method of detecting cancer is to perform a biopsy—removing a tiny portion of prostate tissue—and examining it under a microscope for cancerous cells.
Radical prostatectomy removes the entire prostate gland and some of the tissue surrounding it. Limited to cancer confined to the prostate itself, the operation is usually done laparoscopically. It’s often used on men aged 75 and under who are expected to live another 10 years or more. Berger adds that the procedure offers good outcomes; 10 years after prostate removal, 80% of those patients won’t need additional treatment.
Cryotherapy is a less invasive approach. “It involves placing multiple hollow needles into the prostate at strategic locations,” Berger says. “The needles circulate extremely cold argon gas, and 3cm–4cm ice balls form at the tips. The ice kills the cancerous cells plus a small area around them. It’s followed by a heating probe, and then we repeat the cycle one more time.” The ice balls are as cold as -70°C/-95°F, killing the malignancy essentially via frostbite.
One of the most common approaches to treating prostate cancer is radiation therapy. And while you might imagine it to be like getting an X-ray at your dentist’s office, the reality is far different and much more sophisticated.
“Basically, we use high-energy X-ray beams,” said Nimisha Deb, M.D., Chief of Radiation Oncology for St. Luke’s Cancer Center. “They’re tightly focused and targeted to only the cancerous portions, and we modulate the dosage as required.” And the beam can approach from any angle, allowing for full coverage.
“After exposure to radiation, the cancer cells die,” she said, “while the healthy tissue can recover from the radiation’s effects.” In every session (usually occurring 5 days each week), patients receive just a portion of the total required dose. That means they will receive a therapeutic dose of radiation with minimal effects on surrounding tissues.
The prostate gland is located between the bladder and rectum, and radiation exposure can affect those tissues as well. But the risk of damage can be mitigated with SpaceOAR hydrogel—a substance that’s injected between the rectum and prostate. It provides about ½-inch of extra space, reducing the rectal radiation dose and protecting healthy tissue.
SpaceOAR is applied prior to a radiation program in an ambulatory-patient center, says Berger, and may eventually become an office procedure.
“We’ve seen it reduce symptoms of proctitis by about 75%,” he added. “And it can help reduce the number of treatment sessions because it allows the radiation oncologist to use higher doses. A typical program consists of 44 treatments over the course of 7 to 9 weeks. If SpaceOAR is in place, you might require as few as 25 sessions.” The injected substance eventually degrades and is absorbed by the body.
“We don’t see many guys dying from prostate cancer anymore; we’ve learned to manage the disease very well, with less-invasive treatment approaches,” Berger concludes.
