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Progress On Prostate Cancer
Advances in early detection and effective treatment
are saving lives.
The past decade has seen a dramatic increase in the incidence of prostate
cancer, followed by an equally impressive decline. Yet even as the incidence
rose, fatalities dropped. What's going on? Two things: improved diagnosis and
improved treatment. And there may be a third factor as well � if it's true that
men are increasingly being prodded to take action by the women who love them.
So far, little can be done to prevent prostate cancer, though researchers are
studying dietary factors that may influence the risk (see The Dietary-Prostate
Connection ). But there's a lot that can be done to prevent fatal prostate
cancer. It all hinges on early detection.
Diagnostic Techniques
At its earliest, most curable stage, prostate cancer
produces no symptoms. That's why men should be routinely screened with a
digital rectal exam (DRE) and a blood test for prostate-specific antigen (PSA)
levels. The American Cancer Society recommends annual screening for all men
starting at age 50. Men at higher risk of prostate cancer � those with a family
history of the disease as well as African-American men � should begin testing
at age 40. A positive result from a DRE or a PSA test warrants follow-up
diagnostic tests, as necessary.
Digital Rectal Exam. In a time of high-tech diagnostic wonders, the digital
rectal exam is an old-fashioned, hands-on test � literally. The physician
inserts a gloved and lubricated finger into the rectum to feel for
abnormalities in the prostate gland, which sits under the bladder (where it
helps produce seminal fluid). Uncomfortable but mercifully brief, the DRE can
detect prostate nodules that might be cancerous. If the exam reveals nothing,
it's still possible that a growth may be located on a part of the prostate that
the doctor can't reach. This is why a PSA test is done in addition.
PSA Blood Test. High levels of the enzyme known as prostate-specific antigen,
or PSA, indicate some kind of prostate trouble, although not necessarily
cancer. It's called "prostate specific" and not "cancer specific" for good
reason: An elevated PSA level can also signal a simple infection or benign
enlarged prostate. Conversely, it's possible to have a low PSA level and still
have cancer.
In general, a man in his 40s should have a PSA level below 2.5 (nanograms per
milliliter), a man in his 50s should be under 3.5, and an older man, under 4.0.
For men with low PSA levels, the rate of increase in PSA should also be
followed. A consistent increase of more than 1.5 over two years signals
possible trouble. Again, that doesn't necessarily mean the patient has prostate
cancer. As with mammography, a positive test result needs confirmation.
Tran rectal Ultrasound. This is the same technology that produces images of
babies in the womb. While ultrasound can't distinguish healthy cells from
cancer cells, it can help direct a needle biopsy.
Biopsy. During a biopsy, a special needle is used to remove sample prostate
cells for study. Unlike cancers that typically form distinct, solid tumors,
prostate cancer often produces tumor cells interspersed among healthy cells. So
if the biopsy needle goes in a little too deep (or not quite deep enough), it
can miss cancerous cells at a higher (or lower) level.
For that reason, if other test results strongly suggest prostate cancer, a
biopsy that comes up negative may need to be repeated. If the biopsy confirms a
diagnosis of prostate cancer, tests such as a bone scan, CT scan or magnetic
resonance imaging (MRI) may be needed to help decide on the best treatment.
Treatment Options
Prostate cancer is most easily � and successfully �
treated when it's still "localized," meaning it has not yet spread outside the
gland. Since many prostate tumors grow slowly, the best treatment is sometimes
no treatment at all. In fact, many men die with the disease rather than of it.
For younger men and men with fast-growing tumors, today's treatment options can
extend lives. Improvements in technology and techniques have greatly reduced
the risk of side effects.
Here are the three main strategies for dealing with prostate cancer:
Watchful Waiting. In the case of an older man (with a life expectancy of less
than 10 years) who has a slow-growing tumor, it often makes the most sense to
postpone cancer treatment and take a wait-and-see approach, while monitoring
the condition closely. If the tumor continues to grow slowly, treatment � and
its possible side effects � can often be avoided altogether. If tumor growth
accelerates, however, radiation or hormone therapy can then be considered.
Radical Prostatectomy. Complete surgical removal of the prostate gland is the
best way to eradicate a localized tumor. This option is usually recommended for
younger, healthy men. A prime candidate would be a man in his 50s, who might
otherwise be expected to live another 20 years or more. In the hands of an
experienced surgeon, the risk of serious side effects � namely, incontinence
and impotence � is relatively low. Of course, the skill of the surgeon isn't
the only factor to influence the likelihood of side effects; age and overall
health have a great impact as well.
Radiation Therapy. Less invasive than surgery, radiation is often the best
option for older men, especially those in poorer health. But it doesn't always
kill all the cancer, even when the disease is still localized. And while
incontinence isn't an issue, radiation may cause impotence and damage the
rectum.
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