Three things you might not know about prostate cancer
A few things are widely understood about prostate cancer. It’s the most common cancer diagnosis among men, and it’s also the second most common cause of cancer deaths in men. But prostate cancer is a very curable disease if caught in the early stages.
There are some other things about prostate cancer that are sometimes sources of misinformation, so we turned to urologist Evangelos Geraniotis MD, who practices at Urology Associates of Cape Cod, for clarification.
“Having a little bit of knowledge about prostate cancer is important,” he said. “The number of aggressive prostate cancers that we find is a relatively smaller number than the many tiny cancers that we find. So, I don't think of prostate cancer as a killer the way other types of cancer are. I would reassure men if they have symptoms, it doesn’t necessarily mean that something very, very bad is lurking inside them.”
Here are some other things to know about prostate cancer, according to Dr. Geraniotis.
Does an elevated (prostate-specific antigen) test automatically mean cancer?
“A man can have a high PSA and have no signs of cancer, and a man can have a normal PSA or even a very low PSA and nonetheless have cancer present,” he said. “So, the PSA test by itself doesn't give you a diagnosis. It only gives you a hint that something may be going on.
“The best way to catch it early is to be evaluated either by your primary care physician or a urologist, which would include a (digital) rectal exam to feel for abnormalities in the prostate, and a PSA blood test to look for higher levels than normal. Abnormalities in either of those categories would lead to a biopsy being made, which is the only way to make a diagnosis.
“Primary care physicians in the last seven to eight years have gotten away from doing digital exams routinely. Their practice pattern is to talk to men individually about the pros and cons of screening and then to do PSA and or rectal exam based on that conversation.”
After a diagnosis, is there a rush to make a decision about treatment?
“If a man is found to have a tiny spot of cancer or a couple of tiny spots that we don’t think are harmful or carry a lot of risk at the moment, instead of treating that cancer aggressively with surgery or radiation, we would put the man on a watchful waiting protocol where he comes in every six months and we check his PSA and examine him. Then in some interval, say a year or 18 months later, we would re-biopsy him to see if the cancer is growing and then treat him or not treat him based on those results. And this treatment is becoming increasingly popular because we are finding that many of these small cancers do not in fact progress. Men may live with a small quiet cancer for 10, 15, 20 years without any harm.
“Even in the case where we do treat it with surgery or radiation, we don’t rush into either of those because the biopsy to diagnose prostate cancer causes inflammation and tissue swelling and treating a man with surgery while the prostate’s inflamed, carries a higher risk of side effects. We will often wait six to eight weeks before treatment while we go through the evaluation and consultations. It buys a little time and allows the man to think about the situation, to think about the treatment. Men always have the option of changing their mind. They may decide on one course and then think about it and decide they want to do something else.”
What are the potential side effects of treatments?
“The main curative treatments for prostate cancer are removing the prostate through surgery or radiating the prostate with a course of radiation of different lengths and doses,” he said. ‘All of those treatments can have sexual side effects. They also can have urinary side effects, and, in the case of radiation therapy, they can have side effects on the bowel and in the rectal area. Your doctor will help you devise the treatment plan that’s best for you.
“The surgery for prostate cancer has advanced to robotics in the last 10 years and is much, much better than it was. Radiation therapy has advanced to CT guided dosing with high precision. So, the side effects from radiation are much fewer than we used to see. And with active surveillance or watchful waiting, there's really no side effects because you just leave the body as it is, and you function normally without any changes.”
What are some other things to know about prostate cancer?
“Prostate cancer can be very prevalent and very common without causing any symptoms and without causing harm to men. Because 50 percent of men at the age of 80 will have some degree of prostate cancer, but most of those men will not die of prostate cancer.
“I think that men always have a fear or a concern that something may be going on as they get older, and their urinary symptoms start to change. It’s always appropriate to have an evaluation if you have any type of symptoms at all, especially if prostate cancer runs in your family.
“The other thing I would say is that we have very good diagnostic tools these days. The prostate biopsy, which used to be a very painful, uncomfortable procedure, is now much better tolerated. Men should not be as afraid of it as they were 10 years ago.
