Cancer Care

Prostate Cancer: Diagnosis and Treatment

September 17, 2013

Prostate Cancer: Diagnosis and Treatment

September is Prostate Cancer Awareness Month

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 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.

One Comment
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    Stephen Leslie

    I respectfully disagree with some of the statements in the blog. For example, it is not true that treatment is only recommended in men under 65 years of age. It depends on the individual patient, his health and the degree/severity of the prostate cancer. And not all treatment is intended to be curative; we have lots of palliative therapies available that slow the growth of the cancer in men where a more aggressive treatment is not selected. There are also advances being made in genetic testing, surgical techniques such as robotics, and better chemotherapy that were not mentioned. The main controversy about prostate cancer is the debate over PSA testing. While current recommendations are all over the place, the most reasonable guideline I read recommended a baseline PSA test at age 40-45. If this is >1, then periodic retesting every 1-2 years is suggested. If the PSA is <1, then rechecking can be done less often. I do agree that only men with a 10 year reasonable life expectancy should consider definitive therapy for any prostate cancer because numerous studies have shown no real benefit for the first 10 years after treatment.

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