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Features Health & Wellness Screening key to surviving prostate cancer

Editor’s note: September is Prostate Cancer Awareness Month and Dr. Charles C. Thomas of the Macon Cancer Center shares information on its prevention and treatment.

Prostate cancer is the second leading cause of cancer death in men in this country. It will affect about one in six men in their lifetime. I have practiced medicine for greater than 30 years, and as a young man, this was most commonly diagnosed by producing urinary obstruction or the cancer spreading to bony structures and producing severe pain in the back, pelvis and hips.

All cancers have two basic properties. They have local invasive and destructive growth, much like ivy or kudzu in your yard, and they have the ability to make cells or seeds that spread to distant body sites and these are called metastases.

The prostate gland is located immediately below a man’s bladder, and his urethra (the tube that allows him to urinate) passes directly through the center of the gland. A man’s rectum is attached to the back of the prostate gland, and the gland is therefore examined by performing a digital rectal examination. As the cancer progresses, cells will be shed into the bloodstream and are typically found in bony structures or lymph nodes. The prostate cancer cells produce bony destruction much like termites in a piece of wood. In far advanced or terminal prostate cancer, the tumor can spread to all of the body’s organs, but this has been less common in recent times.

One of the great advances in oncology in my practice lifetime has been the ability to treat cancers at a very early and oftentimes curable stage. The mortality from breast, colon, cervix and prostate cancer has been considerably reduced because early diagnosis due to proactive screening. Most cancers are treated with better results at an early stage than when advanced or after they have spread.

The treatment results for lung cancer, pancreas cancer, and ovarian cancer are a little better than 20 years ago but remain poor because theses cancers are almost always found at an advanced stage because of absence of any reasonable screening method. I believe that this is in the process of changing for these cancers.

The PSA test stands for prostate-specific antigen. This is a protein, made by a man’s prostate, and typically exits the body through the urinary tract. Any process that obstructs this tract can produce an elevated PSA. An elevated PSA can be found with prostatitis, trauma, or prostate cancer.

One of the dilemmas with prostate cancer is that it has a relatively slow and oftentimes benign course in 50 to 60 percent of men. An elderly gentleman with a low-grade prostate cancer and other health problems can oftentimes be successfully watched or monitored and this is often the best treatment. Regrettably, there are about 40 percent of men in whom the cancer is aggressive and early treatment and intervention makes a major difference in the quality of their life.

The decision to have a PSA test can be made with the patient’s physician, and important factors would include age, health-related issues, family history of prostate cancer, and the grade or stage of the cancer upon presentation. A biopsy with microscopic analysis allows the tumor to be graded, which is a very important factor in making these decisions.

In recent years, there have been some conflicting and confusing recommendations for cancer screening. This includes, particularly, mammography, Pap smears and PSA determinations.

The American Urological Association has suggested PSA testing in men 55 to 69 years of age who are at average risk and asymptomatic. Other general guidelines include any man with a life expectancy of 10 years which, in all honesty, is very hard to define.

I believe that careful and prudent screening and diagnosis is much different than ignoring. For example, an older gentleman with other health problems and a small volume of low-grade prostate cancer may very prudently decide to watch this with his family physician as opposed to intervention.

Treatment methods for prostate cancer include:

  1. Surgical resection is the oldest method. This can certainly be associated with complications, particularly for urinary incontinence, but the techniques and outcomes have clearly improved in the last 10 years.
  2. Radiation therapy has markedly advanced in the last 10 years with IMRT and image guidance and though there is a real risk of injury to the bladder and rectum, this is thankfully less than in previous years.
  3. Hormonal therapy is an excellent option for many men.
  4. Prostate cancer that has spread or become incurable has many chemotherapy options and has allowed many men to live out a full life and attain their expected life expectancy.
  5. Proton beam therapy has some controversy and is probably the most expensive method. It does not seem to be better than IMRT radiation but a nationally sponsored trial is under way.

Dr. Charles Thomas II, MD, FACRO received his medical degree from the University Of North Carolina School Of Medicine. He completed a fellowship in Radiation Oncology at Duke University Medical Center. He is Board Certified in Radiation Oncology and Diagnostic Radiology by the American Board of Radiology. He is a fellow in the American College of Radiation Oncology. Dr. Thomas is a member of the staff at the Macon Cancer Center, 190 Riverview Street in Franklin and can be reached at (828)369-4257.

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