Greenville Business Magazine 2009 September Issue : Page 17

››columns Test or Treat for Prostate Cancer? Not a Clear Call BY GERALD W. HULL, M.D. ostate. ostate cancer is the most common type of cancer found ican men, other than skin cancer. Prostate cancer is the second leading cause of cancer death in men (lung cancer is ever, the death rate for prostate cancer is going and the disease is being found earlier as well. While we w exactly what causes prostate cancer,we do tain risk factors are linked to the disease. for prostate cancer Age is the strongest risk factor. The chance of getting ostate cancer goes up quickly after a man reaches age 50. o out of every three prostate cancers are found in er the age of 65. or unknown reasons, prostate cancer is more common ican-American men than among men of other ostate cancer occurs less often in Asian-American and Hispanic/Latino men. The reasons are not clear. Prostate cancer is most common in North ica and northwestern Europe, but less common in Asia, Central and South America. The reasons are not clear. y: Prostate cancer seems to run in some families. family members (father or brother) who have ncer are more likely to get it themselves, espe- atives were young when they got the disease. ts have found several inherited genes that seem to ncer’s risk, but more study is needed in this area. ››columns ››columns ››columns ››columns ››columns ››columns ››columns ››columns ››columns ››columns ››columns ››columns umns Test or Treat for Prostate Cancer? Not a Clear Call BY GERALD W. HULL, M.D. ostate. ostate canc t or Treat for Prostate Cancer? Not a Clear Call BY GERALD W. HULL, M.D. ostate. ostate cancer is the most common type of cancer found ican men, other than skin cancer. Prostate cancer is the second leading cause of cancer death in men (lung cancer is ever, the death rate for prostate cancer is going and the disease is being found earlier as well. While we w exactly what causes prostate cancer,we do tain risk factors are linked to the disease. for prostate cancer Age is the strongest risk factor. The chance of getting ostate cancer goes up quickly after a man reaches age 50. o out of every three prostate cancers are found in er the age of 65. or unknown reasons, prostate cancer is more common ican-American men than among men of other ostate cancer occurs less often in Asian-American and Hispanic/Latino men. The reasons are not clear. Prostate cancer is most common in North ica and northwestern Europe, but less common in Asia, Central and South America. The reasons are not clear. y: Prostate cancer seems to run in some families. family members (father or brother) who have ncer are more likely to get it themselves, espe- atives were young when they got the disease. ts have found several inherited genes that seem to ncer’s risk, but more study is needed in this area. Pre-cancerous Pre-cancerous changes of the prostate Some doctors believe that prostate cancer begins with very small changes in the size and shape of the prostate gland cells. These changes are known as PIN (prostatic intraepithelial neoplasia). Almost half of all men have PIN by the time they reach 50. If you have had a prostate biopsy that showed high- grade PIN, there is a greater chance that there are cancer cells 14 GREENVILLE BUSINESS MAGAZINE | SEPTEMBER 2009 The exact role of diet in prostate cancer is not clear. Men who eat a lot of red meat or high-fat dairy products seem eater chance of getting prostate cancer. e don’t know the exact cause of prostate cancer, le to prevent most cases of the disease. But some cases might be prevented. The American Cancer Society suggests eating less red meat and fat and eating more vegeta- and whole grains. Eat five or more servings of fruits les each day. olumns Test or Treat for Prostate Cancer? Not a Clear Call BY GERALD W. HULL, M.D. ostate. ostate cancer is the most common type of cancer found ican men, other than skin cancer. Prostate cancer is the second leading cause of cancer death in men (lung cancer is ever, the death rate for prostate cancer is going and the disease is being found earlier as well. While we w exactly what causes prostate cancer,we do tain risk factors are linked to the disease. for prostate cancer Age is the strongest risk factor. The chance of getting ostate cancer goes up quickly after a man reaches age 50. o out of every three prostate cancers are found in er the age of 65. or unknown reasons, prostate cancer is more common ican-American men than among men of other ostate cancer occurs less often in Asian-American and Hispanic/Latino men. The reasons are not clear. Prostate cancer is most common in North ica and northwestern Europe, but less common in Asia, Central and South America. The reasons are not clear. y: Prostate cancer seems to run in some families. family members (father or brother) who have ncer are more likely to get it themselves, espe- atives were young when they got the disease. ts have found several inherited genes that seem to ncer’s risk, but more study is needed in this area. Pre-cancerous changes of the prostate Some doctors believe that prostate cancer begins with very small changes in the size and shape of the prostate gland cells. These changes are known as PIN (prostatic intraepithelial neoplasia). Almost half of all men have PIN by the time they reach 50. If you have had a prostate biopsy that showed high- grade PIN, there is a greater chance that there are cancer cells 14 GREENVILLE BUSINESS MAGAZINE | SEPTEMBER 2009 The exact role of diet in prostate cancer is not clear. Men who eat a lot of red meat or high-fat dairy products seem eater chance of getting prostate cancer. e don’t know the exact cause of prostate cancer, le to prevent most cases of the disease. But some cases might be prevented. The American Cancer Society suggests eating less red meat and fat and eating more vegeta- and whole grains. Eat five or more servings of fruits les each day. cer cer can often be detected early by testing the specific antigen) level in a man’s blood and by xam (DRE). Since about 1990 it has become for men to have tests to find prostate cancer early. The prostate cancer death rate has dropped, too. Still, the ACS estimates 192,280 new cases of prostate cancer in the United States for 2009 There is no question that the PSA test can help spot prostate cancer, but it can’t tell how dangerous the cancer is. The problem is that some prostate cancers are slow-growing and may never cause problems. But because of a high PSA level, many men will be found to have

>>columns - Test or Treat for Prostate Cancer? Not a Clear Call

Gerald W. Hull, M.D.

Prostate cancer presents a somewhat confusing scenario when it is diagnosed. And, whether to treat it or not may depend on a man’s health and age. The prostate gland begins to develop before birth and keeps on growing until a man reaches adulthood. In older men, though, the part of the prostate around the urethra may keep on growing. This causes BPH (benign prostatic hyperplasia) which can result in problems passing urine. BPH is a problem that must be treated, but it is not cancer. However, nearly all prostate cancers start in the prostate gland’s cells. Most of the time, prostate cancer grows slowly. Studies show that as many as seven to nine out of 10 men had prostate cancer by age 80 and were unaware they had it.

Pre-cancerous changes of the prostate

Some doctors believe that prostate cancer begins with very small changes in the size and shape of the prostate gland cells. These changes are known as PIN (prostatic intraepithelial neoplasia). Almost half of all men have PIN by the time they reach 50. If you have had a prostate biopsy that showed high-grade PIN, there is a greater chance that there are cancer cells in your prostate.

Prostate cancer is the most common type of cancer found in American men, other than skin cancer. Prostate cancer is the second leading cause of cancer death in men (lung cancer is the first). However, the death rate for prostate cancer is going down, and the disease is being found earlier as well. While we do not yet know exactly what causes prostate cancer, we do know that certain risk factors are linked to the disease.

Risk factors for prostate cancer

Age: Age is the strongest risk factor. The chance of getting prostate cancer goes up quickly after a man reaches age 50. Almost two out of every three prostate cancers are found in men over the age of 65.

Race: For unknown reasons, prostate cancer is more common among African-American men than among men of other races. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men. The reasons are not clear.

Nationality: Prostate cancer is most common in North America and northwestern Europe, but less common in Asia, Africa, Central and South America. The reasons are not clear.

Family history: Prostate cancer seems to run in some families. Men with close family members (father or brother) who have had prostate cancer are more likely to get it themselves, especially if their relatives were young when they got the disease.

Genes: Scientists have found several inherited genes that seem to raise prostate cancer’s risk, but more study is needed in this area.
Diet: The exact role of diet in prostate cancer is not clear. Men who eat a lot of red meat or high-fat dairy products seem to have a greater chance of getting prostate cancer.

Because we don’t know the exact cause of prostate cancer, it is not possible to prevent most cases of the disease. But some cases might be prevented. The American Cancer Society suggests eating less red meat and fat and eating more vegetables, fruits, and whole grains. Eat five or more servings of fruits and vegetables each day.

Find it early

Prostate cancer can often be detected early by testing the PSA (prostate-specific antigen) level in a man’s blood and by digital rectal exam (DRE). Since about 1990 it has become more common for men to have tests to find prostate cancer early. The prostate cancer death rate has dropped, too. Still, the ACS estimates 192,280 new cases of prostate cancer in the United States for 2009 There is no question that the PSA test can help spot prostate cancer, but it can’t tell how dangerous the cancer is. The problem is that some prostate cancers are slow-growing and may never cause problems. But because of a high PSA level, many men will be found to have prostate cancer that would never have led to their deaths. Often these men are being treated with either surgery or radiation, either because their doctor can’t be sure how fast the cancer might spread, or because they are uncomfortable not having treatment. Doctors and patients are still striving to determine who should get treatment and who can be followed without treatment.

Treatment options

Treatment options include watchful waiting (careful follow-up with your doctor) or hormone therapy to radiation and surgery. Newer types of surgery, laparoscopic prostatectomy and robotic-assisted prostatectomy, are among the considerations you should discuss with you doctor to determine which avenue is right for you.

Until more is known, you should talk to your doctor about whether or not you want to be tested. Things to take into account are your age and your health. If you are young and you get prostate cancer, it will probably shorten your life if it is not caught early. But if you are older or in poor health, then prostate cancer may never become a major problem because it often grows so slowly. The AMC recommends that if a man chooses to be tested, the tests should include a PSA blood test and DRE (digital rectal exam) yearly, beginning at age 50, for men at average risk.

Dr. Hull, a fellowship-trained urologic oncologist, is associated with Urology Center of Spartanburg.

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