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Massachusetts Medical Society's
Physician Focus

March 2010

Prostate Cancer

PROGRAM HIGHLIGHTS:

  • Prostate cancer affects 1 in 6 men and is the most common cancer in American men other than skin cancer

  • Screening with a digital rectal exam and PSA test should begin at age 50; for those at increased risk, screening should begin at age 40

  • Genetics plays a key role; men with a father or brother who have had prostate cancer are four times more likely to get the disease. African American men with family histories are eight times more likely.

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 ADDITIONAL RESOURCES

Mass. Prostate Cancer Coalition

National Cancer Institute

American Cancer Society

Prostate Cancer Foundation

"Prostate Cancer"
30 sec. PSA

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Left to right: Richard Babayan, M.D., John Fromson, M.D., Thomas Kingston, M.D.
hi-res photo
promo slide

Prostate cancer affects one in six men and is the most common cancer in American men other than skin cancer. Each year, more than 192,000 new cases of prostate cancer will be diagnosed, and more than 27,000 men will die from the disease. 

The disease doesn’t discriminate; it hits the famous, as well as the not-so-famous. Golfing legend Arnold Palmer, Generals Colin Powell and Norman Schwarzkopf, Senator Bob Dole and New York Mayor Rudy Giuliani, and entertainers Robert Goulet and Harry Belafonte have all been afflicted with the condition. (And to their credit, all have done their part in informational campaigns to alert other men to the disease.) 

“It’s the second leading cause of death in men,” said Thomas Kingston, M.D., president of the Massachusetts Association of Practicing Urologists and a board-certified urologist with Urology Consultants of the North Shore in Salem. “It warrants close attention by primary care providers and patients. Men should take control of their health and discuss having a PSA test and digital rectal exam with their primary care provider.” 

The caution was echoed by Richard Babayan, M.D., a Professor and Chairman of Urology at the Boston University School of Medicine and Chief of Urology at Boston Medical Center. “There are no true signs or symptoms or early prostate cancer,” Dr. Babayan said. “If you wait until there are symptoms, and cancer is the cause, it’s probably too late to solve the problem.”

Dr. Kingston and Dr. Babayan were guests on the March edition of Physician Focus with the Massachusetts Medical Society, hosted by John Fromson, M.D., Associate Director of Graduate Medical Education at Massachusetts General Hospital. 

The doctors explained that the prostate functions as a lubricating organ for the urinary tract and a conduit through which semen come out. Early in life, it is a reproductive organ, and later in life tends to enlarge and degrade into cancerous condition. Enlargement starts to happen between 40-50 years of age. Annual screening is recommended, therefore, at age 50. 

Detection of prostate cancer has advanced in recent years with improved screening techniques. The screening includes a digital rectal exam by a physician and a PSA (Prostate Specific Antigen) test, a test that measures the presence of an enzyme specific to the prostate gland. 

An “elevated” PSA test – a numeric value outside normal ranges – can indicate one of three things: benign enlargement, inflammation, or prostate cancer. That's where the urologist steps in, to differentiate among the conditions. 

The risk factors for prostate cancer include diet, lifestyle, and age. A “Western-style” diet high in fat has been linked to a higher incidence of prostate cancer. The incidence of prostate cancer also increases with age, so as each decade goes by, the number of people with prostate cancer increases. 

Genetics plays a key role as well. 

“If you have a father or brother who’s had prostate cancer,” said Dr. Babayan, “your risk is four times higher than the average man. If you’re African American and have a family member, your risk is eight times higher.” Men falling into those categories should being screening at age 40. 

As well as advances in detection with the PSA test and Gleason score (a scale that determine how aggressive the cancer is), treatments have advanced as well. “We try to tailor the treatments to the specific patient,” says Dr. Kingston, “based on his medical history, overall health, the aggressiveness and extent of the cancer, and patient desires. We don’t dictate to the patient, but rather discuss the pros and cons of each treatment option and let the patient and his family decide.” 

Three types of treatment exist: (1) radiation therapy – external beam or implanted radioactive seeds; (2) surgical removal of the prostate, with open incision or minimally invasive laporoscopic or robotic surgery; and (3) ‘active observation,’ suited for patients with low-grade, slow-growing cancer, particularly older patients. 

“If men take control of their prostate health, the devastation of prostate cancer can be averted," says Dr. Babayan. "The era of the macho man who only sees the doctor when things are bad is really over, and we should take charge of our health. That’s why taking care of one’s prostate health early is essential.” 

Text:
MMS/Richard Gulla