Men can do well in dealing with prostate cancer
by Nancy Maes
Most men can rattle off all sorts of statistics about sports; football, baseball, ultimate fighting… But many of them have no clue about a particularly important and potentially life-saving number: their prostate-specific antigen (PSA) score.
The PSA score, determined by a simple blood test, may indicate the presence of cancer in the prostate, a walnut-sized gland in the reproductive system. To encourage more men to take charge of their prostate health, the National Football League recently joined forces with the American Urological Association (AUA) to spearhead an awareness campaign called Know Your Stats. Though prostate cancer is the second leading cause of cancer death for men in the United States, the campaign emphasizes the fact that with early detection, treatment can be very successful.
Dr. Mark Fisher, a urologic oncologist with the DuPage Medical Group, says that the AUA recommends that men get their first PSA screening at age 40, therefore giving them a baseline for future tests, which are scheduled depending on factors such as family history. If a patient has a one-time PSA score that is elevated for his age group, the test is repeated to ensure accuracy.
When a PSA test indicates the possibility of cancer, a biopsy may be performed. “The overall risk of the biopsy is low, with infection, bleeding and discomfort being the main concerns of the procedure. Antibiotics and local anesthetics decrease these risks,” Dr. Fisher says.
After the biopsy, patients diagnosed with cancer have a range of options. Depending on the cancer’s type and aggressiveness, doctors may recommend only active surveillance to closely monitor the progression of the disease. “The goal is to limit side effects in men who are not going to have symptoms from their cancer or die of the disease,” Fisher says.
In some cases, more drastic measures, particularly the removal of the prostate, are necessary. Robot-assisted laparoscopic surgery, a system of surgical tools controlled from outside the patient’s body, is the latest technological advancement in performing prostatectomies.
“The cancer control is equal to traditional open surgery, but there is less pain and blood loss, while minimizing damage to surrounding structures that affect urinary control and erectile function,” Fisher says. “There is an earlier return of continence and sexual function, and the patient can often leave the hospital the next day.”
Still, it’s important to note that robot-assisted surgery has only been common in the past five to seven years. Accordingly, Fisher suggests that prostate cancer patients ask their surgeons for the number of procedures they have performed and for details about their patients’ outcomes. Another treatment option is radiation, which can come in a few forms. Pellets containing high doses of radiation can be placed in the prostate during a procedure that takes about an hour and does not require a hospital stay. There is also external-beam radiation, which may require treatment five days a week for about six weeks.
“One of the issues with prostate cancer is that there are many modalities to treat it, and the approach needs to be tailored to the individual,” Fisher says. “It depends on the aggressiveness of the tumor, a man’s general health and his ability to tolerate potential side effects.”
Dr. Russell Szmulewitz, an instructor of medicine in the hematology/oncology section at the University of Chicago (U of C) Medical Center, where he treats prostate cancer patients and performs clinical and laboratory research, says that the hospital is participating in an international clinical trial in hopes of helping to determine whether all patients with early-stage and low-grade prostate cancer need aggressive treatment, or whether active surveillance is an appropriate and safe option for some.
“There is a growing concern that there is a population of patients with prostate cancer that we may be overtreating, because current measures, such as the PSA, are not very predictive,” he says. “For patients with low-grade disease, we want to figure out whether there is a subset that is dangerous and a subset that is safe to actively survey. Then, we can fine-tune our diagnostic and predicative markers to help us with decision making.”
The majority of Dr. Szmulewitz’s patients have metastatic disease, which is incurable (although they may have been diagnosed much earlier, when their disease was thought to be nonmetastatic). In these cases, the goal is to slow the growth of the disease and relieve symptoms as much as possible. One standard treatment is hormonal therapy that reduces testosterone, the hormone that fuels prostate cancer. Unfortunately, the treatment can have serious short-term and long-term side effects. Today, research conducted at U of C aims to find out how to use hormonal therapy more judiciously including determining the best time to begin the treatment and whether it can be used intermittently.
Another known issue with hormonal therapy is patients’ tendencies to become resistant. Thus, much research is focused on alternative treatments, Szmulewitz says. The FDA recently approved an immune-based therapy called Sipuleucel-T that manipulates a patient’s own white blood cells to fight the disease. Currently, it’s in clinical stages at the U of C Medical Center, the only regional institution presently offering the therapy.
“It has been shown to have some survival advantages, but it is very controversial, because the measures of efficacy are not clear, the supply is limited and the cost is high,” Szmulewitz says. “But it has a very low toxicity compared to chemotherapy and other agents, so it’s a pretty exciting area of research.”
Prostate cancer is undoubtedly a complicated disease. It requires a host of decisions, and the decisions are complex. But particularly here in the Windy City, Szmulewitz is optimistic.
“Chicagoans have the luxury of having multiple academic centers where they can get second opinions,” he says. “I encourage people who are faced with the issues of prostate cancer to avail themselves of the resources and experts in our community in order to make the best decisions.”
Published in Chicago Health Summer 2011