Facts, Questions and Answers about Prostate Cancer

Today, the National Prostate Cancer Coalition reports that only slightly more than half (53.7 percent) of all men over 50 have been screened for prostate cancer, and only about 25 percent get screened annually.

Screening for the disease is easy and can include a PSA test, which measures the amount of prostate-specific antigen (PSA) in your blood, or a digital rectal exam (DRE) by your physician. If you are age 50 or older, talk with your doctor today about getting screened, and reduce your risk of developing prostate and other types of cancer by eating a healthy diet, exercising regularly and not smoking.

Risk Factors for Prostate Cancer

We don’t yet completely understand the causes of prostate cancer, but researchers have found several factors that change the risk of getting it. For some of these factors, the link to prostate cancer risk is not yet clear. If you have any of these risk factors, you should discuss them with your physician.

• Age. Age is the strongest risk factor for prostate cancer. The majority of prostate cancer is found in men over the age of 65.
• Race/ethnicity. Prostate cancer occurs more often in African-American men than in men of other races.
• Family history. The chance of developing prostate cancer rises when immediate family members have the disease.
• Nationality. Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands.
• Diet. A diet that includes a lot of red meat and/or high-fat dairy products can yield a greater risk of prostate cancer.
• Exercise. Some studies have found that high levels of physical activity, particularly in older men, may lower the risk of advanced prostate cancer.

FAQs about Prostate Cancer

Medical oncologist Dr. Ian Schnadig from Northwest Cancer Specialists provided these answers to often-asked questions about prostate cancer.

Q: I have just been diagnosed with prostate cancer and was told that it has not spread outside the gland. There are so many treatment options: surveillance, surgery, radiation, or seed implants. How do I know which treatment is right for me?

A: Choice of treatment depends primarily upon your risk of recurrence. Your risk can be calculated based on your Gleason score (a score assigned to the biopsy result), the extent of disease when your physician examines the gland, and your PSA.

For lower risk disease, radioactive seed implants, called brachytherapy, is a reasonable, effective and probably less toxic option. For intermediate or high-risk prostate cancer, external radiation or surgery are the most effective options.

Both treatments carry a similar risk of impotence and incontinence. Cure rates for men treated with external radiation seem to be about the same as for men having surgery. You should meet with both a radiation oncologist as well as a urologist to discuss the pros and cons of these approaches.

If you are 70 years or older, have other serious health problems, and have lower risk disease, active surveillance is a safe alternative. With active surveillance, your doctor follows your PSA closely along with regular exams, and treatment is started only if your cancer seems to be growing or getting worse. Active surveillance is not appropriate for many patients who are younger, healthier, or have a faster-growing cancer.

Q: I have been told that my prostate cancer is not curable with radiation or surgery. My doctor has recommended I start hormone therapy. What is it and what kind of side effects can I expect?

A: Hormone therapy lowers the levels of the male hormone, testosterone. Reducing the amount of testosterone in the body makes prostate cancer shrink or grow more slowly. Hormone therapy does not cure prostate cancer, but can control it, often for long periods of time.

Hormones are used in men who do not have surgery or radiation as treatment options, or in whom the disease has spread to other parts of the body. It is sometimes used in combination with radiation in patients who are at high risk of the cancer coming back after treatment.

Reducing the amount of testosterone in the body can cause a number of important side effects including: less sexual desire, impotence (not being able to get an erection), hot flashes, breast tenderness or growth of breast tissue, fatigue or loss of muscle and decreased mental sharpness. Many of these side effects can be treated if and when they occur.

Some doctors use an on-again, off-again approach called intermittent therapy. With this approach, hormones are given for a while, then stopped, then started again if the PSA rises beyond a certain point. The approach seeks to minimize side effects, and several studies have shown that the treatment outcomes are similar to giving the drugs without interruption.

Q: I am on hormone therapy, but my PSA is rising. Do I need chemotherapy now? If not now, when?

A: Nearly all prostate cancers become resistant to hormone therapy over time. But even after that happens, there are still a number of effective treatments. If you are not having symptoms and your disease is not causing other health problems, many doctors will recommend different types of hormonal treatment than you have been receiving, to slow or stop the disease growth. Chemotherapy is only offered when the prostate cancer is causing pain or illness despite multiple different hormonal drugs or other therapies.

Northwest Cancer Specialists plays a major role in helping men in the Portland and Vancouver communities and their families win the battle against prostate cancer. There are currently hundreds of ongoing clinical trials in the United States. NCS has more than 30 open trials for cancer treatment and over 500 NCS patients have been involved in a clinical research study. By offering community-based clinical research focusing on leading-edge cancer treatments, NCS continues to search for better ways to treat cancer patients. More information about clinical trials can be found on our website at www.nwcancer.com/Clinical_Trials.

Category: Articles, Cancer