PROSTATE CANCER: THE GOOD NEWS
This is Prostate Cancer Awareness Month all across America. Prostate cancer is one of the most serious health problems in the United States. It has touched almost everyone by involving either a family member or a friend. More than 240,000 new cases of prostate cancer will be diagnosed in the United States this year. It is the most common male malignancy, and the second most common cause of death from all cancers.
A Bit of History
In the late 1980s, the number of prostate cancer cases detected each year began to rise sharply, due in part to the rising median age of our population, as well as our ability to detect the tumors at an earlier, more curable stage. However, there are no symptoms associated with early prostate cancer. The key to curing prostate cancer is early diagnosis.
The primary tool for early detection is a screening blood test—the PSA (prostate-specific antigen) test. All men aged 40 and over should get a yearly screening PSA blood test, as well as a digital rectal examination by a qualified physician. Heightened public awareness, which makes the early diagnosis of prostate cancer easier, has resulted in an increase in effective treatment and cure.
The PSA Test
There is considerable controversy about PSA testing. It is certainly not perfect. Many factors can elevate PSA levels. Unfortunately, one of them is prostate cancer. In addition, some prostate cancers do not produce PSA and therefore cannot be identified with a PSA test. Though the test is controversial, it is the best that we have. The results can be interpreted by a skilled medical professional and a biopsy can be done if warranted. Many argue that PSA results can be confusing and not conclusive. This is true. As a patient, however, I would rather have a test that may be confusing and controversial than no test at all. Lay the facts on the table and allow me to discuss all the variables and the relative viability of that test with my doctor, and let me, the patient, decide my course of treatment.
Until something better comes along, most urologists think that the PSA test and a rectal examination on an annual basis is still the best approach for the early diagnosis and treatment of prostate cancer.
The most essential aspect of ensuring the preservation of normal life expectancy and high quality of life is the early diagnosis and treatment of prostate cancer. If the cancer is detected while still confined to the prostate, it can best be cured surgically. The approach to treatment varies and is heavily dependent on the extent of the prostate cancer at the time of diagnosis. In general, patients whose cancer is confined to the prostate and who have an actuarial life expectancy of at least ten years are ideal candidates for nerve-sparing surgical removal of the diseased organ.
Today, most active urologic surgeons dealing with prostate cancer utilize the laparoscopic da Vinci robotic surgical technique. In the hands of a skilled, experienced surgeon, this method has an especially good outcome with regard to maintaining urinary continence and erectile function. The enormous success of the laparoscopic robotic technique is based upon an improved understanding of the anatomy and mechanism of the prostate. Another huge advantage of the da Vinci robot is the significant magnification of the operative field and the ability of the robotic arm to rotate and angulate with infinitely more efficiency than even the most skilled surgeon’s hands.
In spite of the new and improved technique afforded by the da Vinci robot, surgery is suited only for patients whose cancer is completely confined to the prostate. The key to finding these patients is early diagnosis.
Once the diagnosis of prostate cancer is made, treatment is based on the underlying stage of the disease. It is essential to differentiate between prostate cancers that are confined to the prostate and those that have spread beyond the margins of the prostate gland. The development of magnetic resonance imaging (MRI) has revolutionized prostatic imaging and has allowed us to visualize the internal architecture of the prostate. We can now map all the fatty connective tissue around the prostate, including the neurovascular bundles, the vessel complexes, and the regional lymph nodes, to make a precise diagnosis.
In appropriately selected patients, laparoscopic da Vinci robotic-assisted radical nerve-sparing prostatectomy can provide a disease-free survival rate comparable to the expected survival rate of similarly aged, healthy men. With early diagnosis and appropriate surgical treatment by a skilled team, even young men diagnosed with prostate cancer can look forward to living full and rich lives.
Non-Surgical but Effective
Although we have discussed the surgical treatment of prostate cancer, a number of other options are available for the treatment of prostate cancer, each with negative and positive features. All treatment options must be shared with the patient, and the decision-making process must flow freely between the physician and the patient.
Briefly, other treatment options that can be considered when a patient is diagnosed with early prostate cancer include pinpoint external beam radiation (also known as intensity-modulated radiation therapy or IMRT) and the implantation of radioactive seeds. Even for patients with more advanced cancers, including cancers that have spread beyond the confines of the prostate gland, there is still a lot of hope for fully curing the disease. These patients may not be suitable candidates for surgery, but there are well-established treatments utilizing hormonal manipulation, radiation, and chemotherapy, often in combination, that offer excellent results.
Prostate Cancer Awareness Month
During Prostate Cancer Awareness Month, patients should educate themselves as much as possible about the disease. Patient awareness not only makes the urologist’s job easier but also allows patients to assume a proactive and participatory role in the treatment process. There is no doubt in my mind that screening PSA blood tests in conjunction with standard digital rectal examinations dramatically increases the detection rate of early prostate cancer. Remember, early prostate cancer is rarely symptomatic.
There is no way to actually prevent prostate cancer—not by changing our diet or activity nor even by picking our parents wisely (although this helps). We must look to early diagnosis to beat the deadly potential of this disease. That way, if you are unfortunate enough to be a victim of the disease, you can survive and live to an old age and, in the end, die of something else. I have thousands of patients in my clinical practice who have lived long and productive lives with prostate cancer and have not died of prostate cancer.
The good news is that, provided the diagnosis of prostate cancer is made early enough to allow maximal effective treatment, life after prostate cancer and surgery, or other treatment options, can be full, rich, and rewarding, and a man can continue to be continent, sexually active, and vigorous in all areas of his life.
For more information: http://www.prostatehealthguide.com/.
Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of The Ultimate Guide To Male Sexual Health and Superpotency (Warner Books).