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September is Prostate Cancer Awareness Month

28384_nguyen2924_2x3By Cam Nguyen, M.D., Radiation Oncologist

Perhaps one of the most hotly-debated subjects in the medical field today is whether or not to treat prostate cancer. It can be very slow-growing and is very common: studies have shown that 90 percent of men aged 90 and over have microscopic evidence of prostate cancer.

Two tests are commonly used to screen: a digital rectal exam and a prostate specific antigen test (PSA). PSA levels can be higher in men who have prostate cancer.

The big question is once you have a diagnosis in front of you, what do you do next? Because prostate cancer is so slow-growing, a treatment decision often is difficult. Which patients do we treat? Which ones do we leave alone? It’s like looking at a volcano and not knowing when it will explode.

Treatment might be recommended if a patient is 65 or under, or has a Gleason score of seven to 10 (the Gleason score evaluates the aggressiveness of the cancer). Also, he should have a life expectancy of at least 10 years.

Treatments include:

*Observation, where a digital rectal exam and a PSA test are done every six months. Watchful waiting may be best for older patients or those diagnosed with a very early stage of prostate cancer

*Surgery, which historically has been the preferred treatment since the 1960s, or

*New radiation therapy. Advances have made this technique as good as, if not better than, surgery. Doctors can now target prostate cancer cells more precisely.  This is less invasive and allows for a better quality of life with fewer side effects. Radiation therapy has gained in popularity and now surpasses surgery as a treatment. There can be side effects, however.

The debate continues. Men who are tested should understand what medical professionals know and what we don’t know about the risks and possible benefits of testing and treatment. They should learn enough about prostate cancer to be comfortable making decisions about treatment. And they should turn to trusted health care professionals for help in making informed decisions.

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