Doctors recommend early screenings for prostate cancer

While men and women can get breast cancer, local doctors say men also have to be on the lookout for another type of cancer that is common — prostate cancer.

Data from the U.S. Centers for Disease Control and Prevention (CDC), Southern Regional Health System, and the American Cancer Society shows prostate cancer is a leading type of cancer seen in males. That is partly because the cancer feeds, to a degree, off of testosterone, which is typically found in men, according to Dr. Darrell Carmen, an urologist from Georgia Urology P.A.'s office in Riverdale.

The CDC reports prostate cancer was prevalent in 169 out of every 100,000 males in Georgia, in 2007, the most recent year for which data was available.

Broken down by race, the CDC's data shows prostate cancer was far more prevalent among African-American males (254 out of every 100,000 men) than men of other ethnicities. African-American males were followed by Caucasian males (169 out of every 100,000 men), Hispanic males (102.7 out of every 100,000 men) and Asian/Pacific Islander males (61.7 out of every 100,000 men).

"It is still the cancer that is [the] most common type of cancer seen in men," said Carmen, who treats patients at Southern Regional Medical Center. "It is particularly prominent, and aggressive among African-American men."

Prostate cancer became a topic of discussion earlier this month when the U.S. Preventive Services Task Force released a controversial draft recommendation that encourages people to not undergo Prostate-Specific Antigen (PSA) Screenings. The PSA screening is used by doctors as an early indicator of sorts, to help determine if a male has this particular form of cancer.

"Most cancers are silent, which means you don't notice any symptoms at first," said urologist, Dr. Barry Zisholtz, also from Georgia Urology's Riverdale office. "That's the bad thing about cancer. You don't immediately know you have it unless you undergo regular screenings."

Southern Regional has more current, and more localized data than the CDC on its web site, and that information offers a view of how prevalent prostate cancer is in the Southern Crescent. Prostate cancer constituted 23.5 percent of new cancer cases in men diagnosed at the Riverdale-based hospital in 2009, which is the most recent year for which data is available from the hospital's web site.

The hospital's data shows prostate cancer is just barely ahead of lung cancer (22.6 percent of new cases of cancer in men) as the leading type of new cancer diagnosis among men at Southern Regional, as of two years ago.

Carmen and Zisholtz said they recommend men begin undergoing the PSA screenings on a regular basis, and as early as their 20s, or 30s.

"I recommend men begin taking PSA screenings before the age of 40," Carmen said. "If they have a family history of prostate cancer, I say the earlier [regular screenings begin], the better, because some cases could be hereditary."

Carmen said one of the youngest patients he has diagnosed with prostate cancer in his 16-year medical career was a 36-year-old African-American firefighter who had a family history of prostate cancer. "Six months later, his twin brother came in for a screening, and it was the same thing," the doctor said.

Zisholtz said, however, that the PSA test is used as only one of a few methods of detecting whether a male has prostate cancer. He added that abnormal results on the test do not always mean a man has cancer. "It could just be that you have a urinary tract infection or an enlarged prostate," he said.

Zisholtz, who has practiced medicine since 1988, said men whose PSA results are abnormal should then have ultrasounds and biopsies performed to find out if prostate cancer is the cause behind the results. "You have to take it in conjunction with the whole picture," he said.

Carmen added, "the only way to make a diagnosis is to get a tissue sample." Both doctors said the Gleason score, which reflects the number of cancer cells in the prostate tissue, indicates how severe or aggressive the cancer is. The score is named for Dr. Donald Gleason, a pathologist who created the grading score in the 1960s.

"The higher the score, the more aggressive the cancer is," Carmen explained.

The doctors explained there are four stages of prostate cancer. The first and second stages are the less-severe stages, the doctors said, because that is when the cancers are confined within the prostate. At stage three, they said, the cancer cells have begun to move beyond the prostate, but are still confined to a man's pelvic region.

Once a patient reaches stage four, however, the disease has become highly severe because the cancer cells have spread extensively to other parts of the body, such as the kidneys, lungs and bones.

Carmen said once a diagnosis of prostate cancer has been made, a doctor and his patient will sit down and discuss the many treatment options available.

He said those options include: observation, where the doctor monitors subsequent PSA screenings to see if the number of antigens continues to increase; bone scans; surgery (which they said can be minimally invasive, using a robot to remove the cancer); radiation treatments; cryotherapy, and hormone therapy, since prostate cancer is stimulated by testosterone, which is itself a hormone.

"It has to be individualized to fit the patient," Zisholtz added. "It has to be based on the patient's health, based on the patient's age, based on the patient's desires, and based on the patient's pathology."

Carmen explained: "At the end of the day, it's the patient who decides what treatment he is going to receive. The doctor just guides him through the process of evaluating his options."

But, Zisholtz said not encouraging men to undergo PSA screenings in the first place puts them at risk of not having their prostate cancer discovered until it has already reached an advanced stage, where it is more difficult to treat.

"In the mid-1980s, 50 percent of men diagnosed with prostate cancer were diagnosed after it was already [spread into] their bones," he said. "There was no PSA screening back then. In 2011, that number is down to only 5 percent of those who are diagnosed already have it in their bones. If we stop encouraging men to get PSA screenings, that number will go back up."


On the net:

U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/

Southern Regional Health System: http://www.southernregional.org/

Georgia Urology P.A.: http://www.gaurology.com/