Prostate Cancer: A Roller Coaster of a Ride

Prostate cancer is the most frequently diagnosed type of cancer in American men. According to the American Cancer Society, “about 1 man in 6 will be diagnosed with prostate cancer during his lifetime.” Out of every 36 American men, one will actually die from prostate cancer.

Although that is an unpleasant statistic, there are at least two million American men who have been diagnosed with prostate cancer that are still alive today, thanks to ongoing advancements in cancer treatments.

Prostate cancer is exactly what it sounds like: it’s cancer of the prostate (the male reproductive gland found in the urethra that secretes semen). Slowly over time cells located in the prostate glands begin to mutate into cancerous cells. In some cases, the cancer spreads quickly, but in most cases it spreads slowly over time. In fact, most men live their entire lives without exhibiting symptoms of prostate cancer.

Stanley M. Redwood, M.D. FACS, Chief of the Department of Urology at Sinai Hospital, gave an enthusiastic Grand Rounds presentation last week that addressed prostate cancer, its risk factors and its various methods of treatment titled “The Prostate Cancer: A Roller Coaster.” For those who aren't familiar with the disease, some of the symptoms include:

• Frequent urination
• Burning during urination
• Painful ejaculation
• Inability to have an erection
• Blood in the urine and semen

If left untreated, advanced prostate cancer can spread to other parts of the body such as the pelvis, ribs and spine. It can also lead to bone pain and tenderness.

Although prostate cancer causes many physical problems in men, Dr. Redwood explained that it can also be a major cause of male insecurity. Since women naturally go through menstruation, society is more accepting that they need to buy items such as feminine pads. But for a man with prostate cancer who can’t control his bladder, it’s almost always humiliating to walk down an isle in a store to buy male sanitary napkins.

Dr. Redwood also explained the different risk factors for prostate cancer. These include:
• Genetics – Occurs in 5-10 percent of males.
• Diet – A diet higher in fat leads to an increased risk of prostate cancer. Soy products are a great way to reduce the risk of prostate cancer.
• Hormones – Using anabolic steroids increases the risk of prostate cancer.
• Race - African American males have a much higher risk for prostate cancer than Caucasian males. In fact, darker pigmented males (such as those of native African descent) are at an even higher risk of getting prostate cancer.

Here is an age-related breakdown of prostate cancer cases found in African American men:

AGE	RISK
0-39	1 in 10149
40-59	1 in 38
60-69	1 in 14
70-79	1 in 7
80-Death	1 in 6

Treatment options for prostate cancer include:

• Anti-Androgen Hormone Therapy – Using hormones to block certain cell receptors.
• Taxotere (Docetaxel Injection) – Used with other medications to stop the spread of cancer cells.
• Brachytherapy – Implanting radioactive “seeds” into the cancerous tissue.
• CyberKnife® – A non-invasive robotic surgery that uses beams of radiation, available at Sinai Hospital.
• Taxotere Chemotherapy – Intravenous chemotherapy.
• Radical Robotic Prostatectomy – Surgery performed remotely using a robot.
• Intensity-Modulate Radiation Therapy - Small radiation beams are aimed at a tumor from different angles.
• Da Vinci Surgical System – Surgeons control a robotic platform with their hands, available at LifeBridge Health.

Even though it’s rare for men to get prostate cancer before they are 40 years old, it is still wise for men in their 20s and 30s to get an exam every few years. Once they hit 45, they should get one every year.

To learn more about prostate cancer and other cancer-related conditions visit the Alvin & Lois Lapidus Cancer Institute.

You can also read these previous blog posts about prostate cancer:
• Prostate Cancer Screening at Northwest Hospital
• Guidelines for Prostate Cancer Screening Revised

-Trish Smith

Prostate Cancer Screening At Northwest Hospital

In 2010, nearly 218,000 men will be diagnosed with prostate cancer, and more than 32,000 men will die from it. If you are a man over the age of 50, it's likely time for a prostate exam.

September is National Prostate Cancer Awareness Month. A screening, which includes an exam by a urologist and a PSA blood test, is being held on Monday, September 20 at 4:30 p.m. at Northwest Hospital. An appointment is necessary. Call 410-601-WELL (9355) to sign up.

If you are age 40 and African-American, or have a family history of prostate cancer, talk to your physician about an exam, as the guidelines for the screening of prostate cancer recently changed. There have been great advances in prostate cancer treatment, resulting in the overall death rate declining steadily since 1994. However, there is still a disparity in prostate cancer death rates between white and African-American men.

Since there are no noticeable signs of prostate cancer in its early stages, screening is the best option in catching the cancer and ensuring a successful outcome. You can read what Dr. Mark Redwood, chief of the Sinai Hospital Department of Urology, had to say on this topic by clicking here. You may also want to read "Understanding Prostate Changes: A Health Guide for Men," from the National Cancer Institute.

Guidelines for Prostate Cancer Screening Revised

by Sandra Crockett

When it comes to cancer screening, the process of early detection and treatment seem straightforward. But slightly revised guidelines from the American Cancer Society encourage physicians and patients to have a conversation about prostate cancer. The goal is to help men in their decision-making process regarding screening.

“We are now at the beginning of a very large conversation with the public over treatment of prostate cancer,” says S. Mark Redwood, M.D., Chief of Department of Urology at Sinai Hospital.

The guidelines focus on men with no symptoms of prostate cancer who can expect to live at least 10 more years. These men are encouraged to discuss the uncertainties, risks, and potential benefits associated with prostate cancer screening with their physician, with the talks starting at age 50. Men with no symptoms who are not expected to live more than 10 years (due to their age or health conditions) should not be offered prostate cancer screening.

The risks or side effects of treatment may outweigh the benefits of treatment, the ACS says.

“What is new is the direct statement that if a patient has many (serious) conditions such as diabetes, heart disease, or other illnesses that would shorten his life, less aggressive approaches should be taken with respect to screening for prostate cancer,” Dr. Redwood says.

However, this opens another dilemma. “The problem arises in the judgment of what constitutes a serious co-morbid condition and what is less life threatening,” he says.

What also hasn’t changed is the ACS recommendation that African-American men, and men who have a father, brother, or son diagnosed with prostate cancer before age 65 begin discussing screening options at age 45. Men with multiple family members affected by the disease before age 65 can start at age 40.

Prostate cancers are now being classified into low, intermediate and high risk, Dr. Redwood says. If the man is still undecided after talking with their doctor, ACS recommends the doctor make the call based on his or her knowledge of the patient's health preferences and values.

“We are fortunate to have multiple modalities for prostate cancer treatment, including Cyberknife, prostatic brachytherapy, da Vinci Robotic Prostatectomy and cryoablation of the prostate at the the Alvin & Lois Lapidus Cancer Institute at LifeBridge Health,” Dr. Redwood says.

It would benefit the patient and his family to have these conversations with a LifeBridge physician who is comfortable with presenting all aspects of management.

“We provide comprehensive care of prostate cancer,” Dr. Redwood says.

For patient education and availability of comprehensive services for prostate cancer management, LifeBridge Health invites patients and their families to participate in this new dialogue now encouraged by the ACS guidelines.

To make an appointment with a urologist, please call 410-601-WELL (9355).