Vail Health Magazine 2013 - page 46

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VailHealth
2013
The most common cancer
among American men, prostate
cancer, is not the deadliest one out
there — lung cancer is. But when it
comes to testing for prostate can-
cer and treating it, it is one of the
most complex and controversial.
Because the prostate is a gland
in the male reproductive system
(located below the bladder),
prostate cancer is unique to men,
although it is often compared to
breast cancer in women.
“As far as incidence rates, pros-
tate and breast cancer are similar
in men and women,” says Dr. Alec
Urquhart, medical oncologist at
Shaw Regional Cancer Center.
“Women can’t get prostate cancer,
but men can get breast cancer.
Androgen plays an important role
in both.”
Whereas a significant portion of
breast cancer cases (about seven
percent) occur in women younger
than 40 years, the risk for prostate
cancer doesn’t increase significant-
ly until after age 50.
Similar to women getting
mammograms to screen for
breast cancer, the screening
process for prostate cancer in
men begins with a PSA test,
(prostate-specific antigen), which
simply involves testing a blood
sample. Elevated levels of PSA
may indicate prostate cancer. The
catch is that certain harmless
conditions or circumstances
such as benign prostate enlarge-
ment (BPH) or inflammation
(prostatitis) can also lead to high
levels of PSA that don’t indicate a
presence of prostate cancer. This
is why PSA screening is a matter
of significant contention in the
medical world.
Screening: Yay or nay?
“I could speak ad nauseam about
the pros and cons of PSA screen-
ing,” says medical oncologist and
nationally renowned prostate
cancer specialist Dr. Michael
Glodé, who also happens to be a
recent prostate cancer survivor.
“The more you screen for it, the
more you find it. What’s happened
with PSA testing is that more men
were discovered to have elevated
PSAs. But some have that because
their prostate enlarges. There are
some men who have cancer with
normal PSA values, too, but when
you start biopsying, as one of my
colleagues puts it, ‘If you drill more
holes, you find more oil.’”
The thing is, there are types of
oil, or rather, prostate cancer, that
are indeed unveiled in biopsies
following PSA screening, but they
are low-grade and potentially not
much of a threat.
“In the last 10 years there was a
flurry of cases when PSA screening
became available,” Dr. Glodé points
out. “People said ‘oh my God, you
can find cancer, it needs to be
treated.’ Are we putting too many
men through biopsies when many
are low-grade cancers that may
have never bothered them?”
“All the screening has only had
a small effect on death rates,” he
says. “It has caused a lot of anxiety.
It makes sense to go through the
side effects [of treatment], if a
patient has more than a 15-year
life expectancy. But more than half
of the men diagnosed at age 70 will
be dead from another cause by 85.”
Dr. Connie Wolf, urologist at
Colorado Mountain Medical,
believes that screening is advisable
for younger men, but only after an
extensive exchange of information.
“I do believe that it should be
offered to certain men after a
discussion of the benefits and
risks surrounding prostate cancer
screening and treatment,” she says.
“Entire clinic appointments are
sometimes spent discussing this.”
The upside of PSA screening is
that if the cancer discovered in a
biopsy is more advanced, it can be
treated in a number of different ways
and prolong a patient’s survival.
“The good news is that even for
men with metastasized forms there
are five new drugs approved in the
last few years that have been shown
to treat it effectively,” Dr. Glodé says.
“Of all cancers, prostate cancer is
definitely one of the most treatable
and slowest growing.”
Treatment options
Prostate cancer is uniquely
dependant on androgens (male
hormones) for surviving and
spreading. The new drugs block
testosterone and target abnormal
proteins in the blood but also
come with side effects such as
swollen breasts, impotence and
urinary incontinence.
For non-metastatic (not spread
beyond the gland) prostate
cancer, surgically removing the
prostate is a frequently employed
treatment option.
Some men with higher grades
of prostate cancer choose to have
radiation, which is done by exter-
nal beams or radioactive “seeds”
placed in the prostate tissue.
Chemotherapy is reserved only
for patients with the most ad-
vanced forms of the disease. Unlike
chemotherapy however, hormonal
treatments don’t typically cause
By Shauna Farnell
From screening to
treatment, there are
a lot of options. Shaw
Regional Cancer Center
and its resident expert
know them better
than anybody
Dr. Alexander Urquhart
Dr. Michael Glodé
the ins and outs of
prostate cancer
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