Prostate cancer is the most common cancer in American men (after skin cancers). This year, an estimated 180,890 men will be diagnosed with prostate cancer, and 26,120 men will die of prostate cancer. In fact, 1 in 7 men will be diagnosed with prostate cancer during their lifetime, and many more men likely have prostate cancer that will never be diagnosed. 1 in 39 men will die of prostate cancer, and prostate cancer is the second leading cause of cancer death in behind only lung cancer. The good news is that most men diagnosed with prostate cancer will not die of their disease, and there are an estimated 2.9 million men in the United States who consider themselves prostate cancer survivors. Given these statistics, all of us are likely to know someone who is affected by prostate cancer.
How is prostate cancer found? Most prostate cancers are found by a routine prostate cancer screening which is composed of both a prostate specific antigen blood test (PSA) and a digital rectal exam (DRE) performed by a physician. Whether or not to have a prostate cancer screening on a regular basis is a controversial topic. The U.S. Preventative Services Task Force recommends against PSA screenings. In addition, not all physicians perform enough DREs to be proficient at them. The American Urologic Association (AUA) recommends a discussion between the patient and their primary care physician regarding the pros and cons of PSA testing for men between the ages of 55-69, or starting at 40 years of age if there is a family history of prostate cancer or for African Americans. Some men over the age of 70 may also benefit from screening if they are in excellent health and have a life expectancy greater than 10 years.
If there is suspicion for prostate cancer, you will likely be referred to a urologist who may recommend a prostate biopsy which can often be performed as an outpatient procedure. If the prostate biopsy demonstrates prostate cancer, you should have a thoughtful discussion with your urologist and/or a radiation oncologist regarding treatment options for your cancer.
How is prostate cancer treated? One recommended treatment strategy may be active surveillance. This strategy is more likely to be recommended if your cancer is lower risk, if you are an older patient, or if you have other serious medical conditions. Active surveillance typically consists of no active treatment, but your PSA will be checked periodically and prostate biopsies will be performed on a regular basis to ensure that your prostate cancer is not becoming more aggressive. Curative treatment may be recommended later if there is evidence of progression.
In terms of curative treatment options for prostate cancer, there are often many options to choose from. Some prostate cancers can be cured with a prostatectomy, or surgery to remove the prostate gland. This is particularly effective for cancers that are thought to be confined to the prostate gland.
There are also good radiation therapy options for curing prostate cancer with external beam radiation therapy that can be delivered over many weeks. Sometimes external beam radiation therapy is combined with hormone therapy that can improve outcomes for higher risk prostate cancers. Some prostate cancers can also be cured with a permanent radioactive seed implant procedure in which numerous radioactive seeds are carefully placed into the prostate gland in the operating room. These seed implant procedures can also be performed in combination with external beam radiation therapy for higher risk cancers.
Proton beam therapy can also be an option, although this type of therapy has not been proven superior to standard external beam radiation therapy with x-rays. Finally, stereotactic body radiation therapy (SBRT) has shown promise in treating lower risk prostate cancers with high doses of radiation delivered to the prostate gland in a relatively small number of treatments. However, patients treated with SBRT have only been followed for a few years, and the long term effectiveness and side effect profile of the treatment is unknown. Therefore, SBRT is considered experimental by some physicians and some health insurers.
In conclusion, prostate cancer is a relatively common cancer that is highly curable. For those who will be diagnosed with prostate cancer, choices of treatment are many. The Tri-Cities Cancer Center is forming a support group for those who have been diagnosed and are considering treatment or have completed treatment. For more information contact Chaplain Margaret Ley at (509) 737-3400.