Prostate Cancer 101
Of the many health issues that men face throughout their lives, prostate cancer ranks as one of the most prevalent. In fact, among males, prostate cancer is the most common type of cancer aside from skin cancer. Despite its frequent occurrence, however, the disease is often overlooked and misunderstood.
Below, Dr. Menon addresses the FAQs about prostate cancer diagnosis, treatment and more.
Q: What role does the prostate play in the body?
A: The prostate gland is a male accessory sex organ. In reality, no one really knows that it plays an essential role in the body — much like the appendix — but it most likely contributes to the nourishment of the human sperm.
Q: How does prostate cancer affect the body?
A: Oftentimes, prostate cancer is slow growing. That’s not to say that men don’t die of prostate cancer. Of the men who are diagnosed with prostate cancer, about one in every four to six will die of the disease. Luckily, we are now diagnosing it early and treating it so we are able to cure the vast majority of patients. Common symptoms include problems urinating, erectile dysfunction and blood in the urine or semen.
Q: Have rates of prostate cancer always been high?
A: Prostate cancer has always been one of the most common cancers, but in the 70s and 80s it was typically only diagnosed when it spread to the bones and the patient was terminal. (By that time, it was too late). In the 80s, the prostate-specific antigen (PSA) blood test was developed as a screening test. It gives you a good idea as to whether you may have prostate cancer. As the PSA test became more common, more and more cancers were being diagnosed, so it appeared as if the number of cases was going up. Truly, though, it was just that more cancers were being detected — not that they were happening more.
Q: What are the main causes of prostate cancer?
A: Prostate cancer seems to be related to the fact that there are high levels of androgens (hormones such as testosterone) in the body. When a man goes through puberty, something seems to change, which triggers the development of prostate cancer 40 or 50 years later.
Q: How is prostate cancer treated?
A: Many people who are newly diagnosed with prostate cancer will learn about the term “active surveillance.” During active surveillance, we know a patient has a cancer, and they’ve been diagnosed, but it’s most likely slow growing, so we refrain from treating it so the patient doesn’t need to endure the side effects of treatment. Instead, we actively monitor the cancer and gauge its growth with repeated biopsies. If the cancer starts growing, we’ll start treatment at that point. But if the cancer stays the same, which it could for a year or five or ten, then we won’t actively treat it.
Q: If you know a patient has prostate cancer, why wouldn’t you start treatment right away?
A: We use active surveillance for prostate cancer for two reasons: overtreatment and the downsides of treatment. The number of men over 50 years old who have prostate cancer cells in their body is roughly around 30 percent of the population. Only 20 percent of these men will ever die of prostate cancer. So the feeling is that you are over-treating 80 percent of men who would have survived their prostate cancer and would have gone on to die of natural causes. Secondly, the side effects of treatment can be challenging.
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Q: What are the side effects of prostate cancer treatment?
A: The main side effects that we worry about are urinary incontinence and erectile dysfunction. That’s why there’s a hesitancy to go in and treat the cancer if it is completely slow growing.
Q: What different types of treatment are available for prostate cancer?
A: We treat about a third of our patients with active surveillance. When treatment becomes necessary, the broad treatment approaches are typically radiation therapy or surgery. About 10 percent of cancers are aggressive, and for them, it’s better to use a combination of radiation, therapy and hormones. Bottom line: 30 percent of cancers, we can watch carefully. About 10 percent of cancers, you need to throw the kitchen sink at them. And that leaves about 60 percent of cancer where the choice is between surgery or radiation.
Q: How often should you get screened for prostate cancer?
A: We recommend discussing the possibility of prostate cancer once a year with your doctor and have a shared decision making process with him or her. In our practice, we recommend getting the Prostate Specific Antigen (PSA) every two years or a biopsy every five years. If you’ve been diagnosed with prostate cancer, you should get a biopsy every year.
As with all forms of cancer, the sooner a diagnosis is made, the more treatment options a patient has. And if you or a loved one receives a diagnosis, take comfort knowing that, to date, prostate cancer remains one of the most curable forms of cancer.
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Dr. Mani Menon is chairman of the Vattikuti Urology Institute at Henry Ford Health System and sees patients at Henry Ford Hospital and Henry Ford West Bloomfield Hospital. He is a pioneer of robotic surgery, and started the first robotic prostate surgery program in the United States at Henry Ford in 2001.