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Guy’s Guide to Prostate Cancer

Physician's column
By: Dr. David S. Yee Special to The News Messenger
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Prostate cancer is the most common malignancy in older men. One in approximately every six American men more than 50 years of age will be diagnosed with prostate cancer in his lifetime. The public is much more aware of this disease than it has ever been thanks to prostate cancer screenings, the medical community and advocacy group’s education efforts, and men feeling freer to share their own personal experiences with family and friends. This partnership is paying off, and we’re seeing more cases of prostate cancer at an early, curable stage. While treatment is often successful, prostate cancer is still the second leading cause of cancer deaths among men. Only lung cancer takes more male lives. So while being more educated about prostate cancer is important, action – when necessary – is vital too. Risk Factors Any man can be diagnosed with prostate cancer, but there are certain risk factors that play into the disease. Age is one of the biggest prostate cancer risk factors; however, the assumption that every man will receive a prostate cancer diagnosis if he lives long enough is not true. Others considered to be at high risk are men with a family history of prostate cancer and those who are African American. Obesity and diet also seem to play a role in whether men develop prostate cancer. Screenings In its early stages, prostate cancer doesn’t have any symptoms, which is why screening is critical. The American Urological Association and the National Comprehensive Cancer Network recommend screening at age 40. Traditional screening tools consist of a Prostate-Specific Antigen (PSA) test and a digital rectal exam. The PSA test picks up 80 to 90 percent of cases in their early stages, when treatment is overwhelmingly successful. And while there are those who are not fans of the rectal exam, 10 percent of prostate cancers will be missed without it – and those that don’t show up in a PSA test are often the most aggressive. More encouraging news for patients is that prostate cancer screening tools continue to evolve. One of the newest available tools is a urine test that looks for the presence of a specific genetic marker indicative of prostate cancer. This new test may be helpful in detecting prostate cancer and determining which cancers will be aggressive. Treatment There are numerous treatment options available for prostate cancer, which can be a relief but can create some anxiety and confusion too. All prostate cancers aren’t the same, and one therapy that makes sense for one patient may not work for another. Discussing all options with a physician will help patients make the most informed choice about how to move forward. Overall, the goal is to ensure patients lead a normal life after a successful course of therapy. One treatment is surgically removing the prostate. This can be by traditional open surgery or a laparoscopic surgery, which is less invasive. One common concern among men undergoing surgery is the possibility of nerve damage, which can lead to erectile dysfunction or incontinence. Techniques have been developed in both open and more recently in minimally invasive robotic surgery to help spare the nerves when appropriate. In some men, radiation is a preferred treatment option. External beam radiation consists of brief exposure five days a week for eight weeks. Another type of radiation is brachytherapy, which is where one-millimeter radioactive seeds are implanted into the prostate. The seeds slowly release radiation over a three-month period before becoming inert. Hormone therapy is another option, which can be combined with radiation. Testosterone-blocking shots are a treatment method also. In some cases, surveillance is used as a treatment, especially for men whose life expectancies are less than 10 years. It’s important to not have any preconceived notions about prostate cancer or any specific treatment option. By becoming more informed and consulting with their physician, patients put themselves in a position to make the best decision for them and their families. Dr. David S. Yee is a urologist who is fellowship-trained in urologic oncology. He sees patients in Roseville and is affiliated with Sutter Medical Foundation and Sutter Medical Group. He has privileges at Sutter Roseville Medical Center.