The Top 5 Patient Questions About Prostate Cancer
In 2015, about 220,800 new cases of prostate cancer will be diagnosed. Board-certified urologist David W. Hall, MD, discusses the five most common questions patients ask him about prostate cancer, and offers some insights on early detection.
Introduction to Prostate Cancer.
Prostate cancer and it’s screening has become one of the most controversial topics in today’s healthcare system. This controversy has unfortunately led to significant amounts of confusion for both patients and physicians. Thankfully, however, the confusion has opened up significant opportunities for discussion between prostate cancer experts and the public.
Prostate cancer screening involves a digital rectal exam (DRE) and a PSA (prostate specific antigen) blood test. Most of the controversy regarding prostate cancer screening revolves around the blood test portion of the screening process. The majority of my patient’s prostate cancer questions, however, do not.
Let’s look at the top 5 patient prostate cancer questions:
1. Do you think we’ve been over-screening for prostate cancer?
If you’ve been listening to the mainstream media and popular medical journals lately, you’d be pretty convinced that we’ve been over-screening for prostate cancer. I, however, disagree with their assessment.
As we learn more about cancer biology, however, it’s becoming evident that perhaps we’ve been over-treating prostate cancer. We should be focusing on our treatment protocols, not our screening protocols.
2. Why should I worry about prostate cancer screening? I’ve heard I won’t die from it anyways, right?
I hear this constantly. When you look at the population as a whole, yes, you’re more likely to die with prostate cancer than you are from prostate cancer. However, in 2014, approximately 30,000 men will die from the disease¹.
Interestingly enough, when I ask my patients to compare the annual number of breast cancer deaths to prostate cancer deaths, they invariably tell me that breast cancer kills exponentially more women than prostate cancer kills men.
In 2014, breast cancer will kill 40,000 women². My patients are shocked when I tell them that the number of deaths from prostate cancer and breast cancer are that similar.
3. Why do I need a PSA and/or DRE, I had a colonoscopy. The colonoscopy trumps the PSA/DRE, right?
Colonoscopies are important, life saving tests. While a rectal exam is typically performed in conjunction with a colonoscopy, the clinician doing the rectal exam at the time of the colonoscopy is more focused on their area of expertise, the colon.
While they do check the prostate during their exam, their primary goal is to rule out colorectal masses, not screen for prostate cancer. As such, it is not an adequate substitute for an annual rectal exam by your urologist. In addition, the screening recommendations include a PSA blood test in conjunction with the rectal exam.
4. What is the PSA, anyway?
The PSA (prostate specific antigen) is a protein made by the cells of the prostate. The PSA blood test simply measures the amount of PSA in a man’s blood stream. The PSA level is often elevated in men who have prostate cancer. Non-cancerous causes such as prostate infection and/or enlargement can also increase the PSA and must first be ruled out.
5. What are the various prostate cancer treatment options?
There are two broad treatment categories for prostate cancer patients: passive treatment and active treatment. Passive treatment options include “watchful waiting” and “active surveillance.” While the details of each are slightly different, the overall goal is to try and delay higher risks treatments until absolutely necessary.
Active treatment options include: surgery, radiation, hormones, chemotherapy, biologic therapy, and newer investigational therapies such as cryotherapy (freezing the prostate), high-intensity focused ultrasound (HIFU), and proton beam therapy. The correct option depends on multiple factors and should be extensively discussed with all prostate cancer patients and their families.
While prostate cancer and it’s screening has become a widely controversial topic, it is important to be fully informed about the risks/benefits of it’s every aspect. Prostate cancer is still the number one cancer in U.S. men and the second leading cause of cancer deaths³. Don’t be a statistic. Ask questions, get involved, take control.