The quiet banner of prostate cancer is a light-blue ribbon that is not nearly as recognizable as the pink-ribbon counterpart for breast cancer, or the bright red ribbons of heart disease and AIDS. Few people seem to know the pale wisp of a ribbon as the calling card of prostate cancer; similarly, so few men present with any symptoms of the disease early on.

Yet so many will develop prostate cancer over the course of their lifetimes: According to the American Cancer Society, one man in six will be diagnosed, and more than two million men in the United States who have been diagnosed with prostate cancer at some point are still alive today. The survivorship statistic is significant. Says Joshua Fiske, MD, chairperson of the Urology Tumor Board at Overlook’s Cancer Center and a member of Consultants in Urology in Westfield, “This is a disease that, for the most part, if found early, is not a killer. It’s slow-growing and very curable if found early.”

Unfortunately, prostate cancer generally does not present any early warning signs. “By the time of symptoms—pain, weight loss, urinary disruption—it’s late in the game,” says Fiske. “That’s why prostate-cancer detection is so important.”

For a long time, the standard rules called for an annual digital prostate exam and a blood test to detect prostate-specific antigen (PSA), beginning at age 50 (age 40 to 45 for African-Americans or men with a family history). But in April, the American Urological Association (AUA) amended this timeline, stating that baseline
PSA blood testing begin to be offered at age 40 to men of average risk. This has raised debate within the medical community, with many doctors believing that earlier screenings will lead to unnecessary follow-up tests. In fact, the American Cancer Society no longer recommends routine PSA screening for all men. Instead, its guidelines call for doctors and patients to weigh the benefits and risks of screening before deciding on any course of action. “Some medical experts feel prostate-cancer detection might be overdone,” explains Fiske. “Classically, prostate cancer is very slow-growing. A man with prostate cancer may live with it so long, he is more likely to die from something else, like diabetes or heart disease.”

Treatment Options

If screening tests reveal an elevated PSA level or a significant rise from a previous PSA test, or if an abnormal hardness or nodule of the prostate is detected during a digital prostate exam, a man will likely be sent for a prostate biopsy (a ten-minute office procedure performed under local anesthesia). If the biopsy comes back positive for cancer cells, there are several options for treatment.

The most aggressive of these options is prostatectomy, the surgical removal of the prostate. This has the highest cure rate, but also an increased risk for such complications as urinary problems and erectile dysfunction. Still, says Fiske, “For younger, healthy patients in their forties and fifties, we like to be very aggressive. They can handle surgery better than older patients, and it’s a better chance at a long-term cure.”

Older men in their seventies and eighties tend not to tolerate surgery as well and have a shorter life expectancy. Thus they are better suited for radiation therapy: either external radiation, or through radioactive pellets (or “seeds”) implanted directly in the prostate. CyberKnife, a unique radiosurgical alternative available at Overlook, combines the advantages of both external radiation and seeds. (For more on CyberKnife technology, read “Tools of the Trade,” beginning on page 38.)

Hormone therapy, another less-aggressive option, uses shots or pills to decrease testosterone levels, which, in turn, should thwart the progression of prostate cancer, as the cancer cells need testosterone in order to grow.

Cryotherapy, the least used of all options, creates an ice ball within the prostate, thereby freezing the growth of cancer cells.

Age is not the only factor in deciding a course of treatment, however. “In determining therapy, it’s important to look not only at a patient’s true age but at his adjusted age,” Fiske says. “Sometimes a healthy 70-year-old is healthier than a 50-year-old.”

The Possibility of Prevention?

Although there is no data yet to support that prostate cancer is preventable, Fiske advises patients to eat a healthy diet and stay away from fatty foods. “Japan has one of the lowest rates of prostate cancer,” he says, “and the thinking is that it’s because they don’t eat fatty foods.” For years doctors have also asserted that lycopene, a compound produced in cooked tomato products, may also offer some protective benefits.

There is additional discussion that treating benign prostate enlargement (BPE) may stave off prostate cancer. “BPE is a very common finding as men age,” Fiske says. “As we get older, the prostate becomes larger. As it becomes larger, it’s more difficult to urinate.” Drugs like Proscar and Avodart shrink the prostate to resolve BPE and have been shown to decrease the risk of developing prostate cancer, but they may also increase the risk of getting a more aggressive form of prostate cancer in men who do develop the disease. Still, says Fiske, for patients with a very strong family history, this might be a protective therapy.

To learn more about your risk for prostate cancer, talk to your doctor. “Not every man needs to see a urologist,” Fiske says. “Patients are sent to us when there is cause, but a PSA test and prostate exam can be administered by a primary care physician.”

The important thing is just to make sure these tests are performed. Says Fiske, “The key to saving lives is screening.”

For a referral to a urologist, call (800) 247-9580.
Prostate Screening - Thursday, June 25 6:00 to 8:00 P.M.
For men over 50 or those with a family history of prostate
cancer and not presently under the care of an urologist.
Registration required at 800-247-9580.
Overlook Hospital, Central Access, 5th floor,
99 Beauvoir Ave., Summit