Health & Wellness
Staying Informed About Prostate Cancer

Staying Informed About Prostate Cancer

Prostate cancer survivors and doctors speak out
By Sarah K. Ricciardelli

There are perks to getting older – finally settling into a career, dishing out wisdom to younger generations and having more time to practice that golf swing. But there are cons too, some of which are the rising health concerns as we age. Men in particular have a unique health concern: prostate cancer. Their risk increases drastically as they approach 50, and more than 70 percent of all prostate cancers are diagnosed in men over the age of 65. Prostate cancer, the most common non-skin cancer among men, affects the prostate gland and shows virtually no symptoms. "When the cancer is curable, there are zero symptoms," says Dr. Frank Critz, founder and medical director of Radiotherapy Clinics of Georgia. "When prostate cancer shows symptoms, it may have moved to your bones and you develop back aches – this is when it's too late."

About one man in six will be diagnosed
with prostate cancer during his lifetime.

- The American Cancer Society

In 2012, more than 241,000 American men were diagnosed with the disease – in the U.S., one in six men will be affected by prostate cancer in their lifetime. "There are 30,000 men that die annually because of prostate cancer – it's a really broad spectrum of disease," Dr. Critz says. "We know that with the slow growing disease, you can have it for 20 or 30 years with no issue. The hard part is determining which treatment to choose when you are diagnosed." Before the anxiety sets in, it's important to know what you're dealing with, and since September is Prostate Cancer Awareness Month, now is as good a time as any to get educated.

As with many forms of cancer, certain groups will be affected more than others. According to Dr. James Benton, a board-certified radiation oncologist and president of Radiotherapy Clinics of Georgia, "Men with a first-degree relative with prostate cancer, and men of African-American heritage, have a 2-2.5-fold increased risk of developing prostate cancer."

The American Cancer Society recently reported that the five-year survival rate for men with prostate cancer is nearly 100 percent, while the 15-year survival rate is 91 percent. However, the survival rate for men with prostate cancer depends on the location or spread of the cancer. Recent data from the National Cancer Institute shows that the survival rate for men with localized cancer, contained just to the prostate, is nearly 100 percent. This rate drops to just 29 percent once the cancer has spread to distant lymph nodes, bones, and other organs.

Early detection testing, such as a prostate-specific antigen (PSA) test or digital rectal exam (DRE), are the most common forms of prostate cancer screening. A PSA blood test measures the level of PSA, a substance made by the prostate gland, found in the blood – most healthy levels are under four nanograms per milliliter. A rising PSA level may indicate the presence of cancer.

Currently, the American Cancer Society recommends men discuss their testing options with their health care provider and make an informed decision. This discussion should take place at age 50 for men at an average risk for prostate cancer, at age 45 for men with a high risk (family history, African-American race), and at age 40 for men with more than one close family member who has had prostate cancer at an early age. The practice of earlier PSA testing is somewhat controversial – some urologists agree with the recommendation to test as necessary, while others feel this should only be an annual screening after a man reaches a certain age.

"The argument is that of all the people who have an annual PSA, a percentage may not have prostate cancer, and they still go through the cost of the testing and a biopsy if PSA levels are high," says Dr. Scott Miller of Georgia Urology. "The second argument is if someone is diagnosed, a lot of prostate cancer doesn't need to be treated immediately, but can be monitored. You don't want to over treat." Dr. Miller says, "However, the death rate is down 40 percent or greater since the introduction of PSA testing. The other side of the argument is that prostate cancer does not really cause symptoms while it is still curable. A PSA test is the only thing we have to detect at a time when [prostate cancer] is still curable. If we eliminate PSA, we don't know what the number of deaths would be."

Know Your Options

Over the last few years, there have been multiple advancements in screening and treatment. Before you decide which option is best for you, Dr. Benton says to ask your primary care physician three simple questions: What should be my PSA value for my age? What is the real risk of screening? What is the benefit and risk of treating prostate cancer? "Of note, there is little or no risk to screening, whether through a PSA or DRE test," he says.

New screening tests are on their way, such as a prostate cancer antigen 3 (PCA3) test, which looks at the level of PCA3 in the urine. There is also a genetic test being developed to look at the DNA of cancer cells to assess the degree of aggressiveness. The treatment options for prostate cancer have improved from rudimentary surgery to advanced and minimally invasive procedures.

According to Dr. Benton, current treatment strategies include open or robotic surgery, various radiation approaches, cryotherapy, hormonal therapy, high intensity focus ultrasound, and immunotherapy. "I suspect in the future, other immunotherapies, biological agents, and possibly genetic management will be available," he says. "At this time, there are a number of therapeutic and diagnostic options on the horizon. Specifically, researchers are studying multi-gene panels to determine which prostate cancers are more likely to be virulent or indolent, and therefore, which cancer will benefit from immediate treatment, delayed treatment, or no treatment."

Just this year, Dr. Critz and Dr. Benton, along with Dr. Philip Shrake and Dr. Mark Merlin at RCOG, published the first prostate cancer study of its kind, analyzing 25 years of follow-up data after radiation therapy treatment in prostate cancer patients. The study analyzed men who received I-125 radioactive seed implants followed by beam radiation, and it concluded 73 percent of men who received this treatment had no evidence of prostate cancer 25 years after completion. "It's important to determine how long we should study men after they are cancer free. It used to be 10 years was good enough, and we find now that it's at least 15 years that we need to follow up. Five percent of the patients had cancer come back after 10 years," explains Dr. Critz.

Another important thing to note is patients may also be able to live with prostate cancer, under surveillance and annual check-ups, for years with little to no issue. "The biggest movement right now is the implementation of active surveillance. You don't necessarily have to be treated for prostate cancer if you are diagnosed," Dr. Critz says. "We need to educate the medical profession that there are people out there who can be observed."

When choosing a treatment option or educating yourself on the risks and signs, it's important to know the facts. With all of the information out there, Dr. Miller offers this simple advice: "Any male over the age of 40 needs to know their risk of prostate cancer and needs to know their risk of screening. One size does not fit all." Remember to seek advice from your doctor and most importantly, choose the option that works best for you.

Editorial Resources
Dr. Scott D. Miller – Georgia Urology, www.LapaRoboticSurgery.com
Dr. James Benton – Dr. Frank Critz, Radiotherapy Clinics of Georgia, www.rcog.com


clark-howard

 

Clark Howard
Consumer expert/radio personality

When Clark Howard found out he was diagnosed with prostate cancer he was in Shanghai, China. "My wife got a call from the doctor that I had prostate cancer, and she had the unhappy task of telling me over the phone," he recalls. "I was disappointed, but that was about all as I knew I had very early stage. My Gleason score, a measurement of the severity of my cancer, was a 6, which is the lowest score you can have with a cancer diagnosis." Howard admits he didn't know of any family history of the disease, but nevertheless he was quick to start learning all he could about it. "While I was still in China, I found enormous information in medical journals. I read and read and read."

What was the first thing you did after you were diagnosed?

Continued sightseeing in coastal China. When I returned about a week later, I went with my wife to meet the urologist, Dr. Bruce Green and the surgeon, Dr. Nikki Shah.

What type of treatment did you undergo?

After my consultation with them and a follow-up with a cousin of mine, Dr. Skip Holden, who is a urologist in Los Angeles, I entered a program called active surveillance. I have a blood test every 90 days and at first, a biopsy every 12 months. My cancer has shown no growth in these five years, so now I have a biopsy every 18 months.

What do you feel is the biggest misconception about prostate cancer?

That treatment must begin immediately. Prostate cancer is unique among all cancers. It comes in more than two dozen genetic varieties of various levels of aggressiveness. Somewhere between 25 percent and 50 percent of men with prostate cancer have a variety that is so low growth that it is likely to have a zero percent chance of danger to your life or life span. The other 50 percent to 75 percent of men (the exact percent is still being debated in science) must move quickly into treatment. The key is knowing which genetic group you are in. New testing can determine with a high degree of certainty which group you are in.

How has your diet changed since you were diagnosed?

I eat a lot more vegetables.  I even eat broccoli, and I hate broccoli but have it at least twice a week.

How has your outlook on life and health in general changed?

I have always had a sunny disposition.  That has stayed the same.  I eat much better and watch my weight like a hawk.  I weigh myself every day of my life.

What involvement do you have in raising awareness for prostate health?

I participate in prostate cancer run/walks, speak to organizations devoted to men's health and have joined the board of the Prostate Cancer Foundation.  I have used the microphone to spread the word on my syndicated radio show. I give an update once a year on the air and on clarkhoward.com.

What is your advice to men about this disease?

Don't panic.  If you find out you have prostate cancer, explore all your options.  If you are considered low risk, think about doing active surveillance.

Name something on your Bucket List

I want to go to Iceland and New Zealand.  I have been to every continent except Antarctica.  I always thought I wanted to go there, but they don't have chain restaurants.

Last book you read?

"Hot, Flat and Crowded" by Thomas Friedman

Who is your hero?

I have two:  Margaret Thatcher and Martin Luther King, Jr.

 

jerry-carnes

 

Jerry Carnes
Reporter with WXIA-TV, 11Alive

When Jerry Carnes was diagnosed with prostate cancer in August 2008, he was not surprised. "My father was diagnosed the year before with what would turn out to be incurable prostate cancer," he explains. "I kind of suspected it would pay me a visit at some point. The only real surprise was that it would come so early." Besides his father, cancer has also affected his sister's life. "My sister is currently beginning her fourth battle with breast cancer, but she is so upbeat it is unbelievable. If anyone can beat it, she can," he says. For his cancer, Carnes underwent robotic surgery and walked away with minimal side effects and a clean bill of health. "I had surgery and the cancer is gone. I'm really one of the really lucky ones."

What was the first thing you did after you were diagnosed?

I took a trip to North Carolina to visit a friend. I had a long drive to reflect and decided it was only proper for me to go public. I started a blog soon after and have kept it going for almost five years now.

Where did you go to find support?

I talked to a lot of people who've endured the same cancer and treatment. There are plenty of support groups out there, including the one at St. Joseph's Hospital where I had surgery. Most of all, I've relied on my family, mainly my wife, and on God.

What was the best piece of advice you received?

Do your research, talk to people who've been through it, and do what makes you feel comfortable. Treatment may not be necessary. There are low aggressive forms of cancer that you can survive for years. My cancer was not aggressive, and I could have picked a "wait and watch" approach. My fear was waiting 20 years before facing a cancer that decided to spread. I'd rather have surgery at 49 than 69. Don't limit your discussions to one doctor or one potential treatment. And include your wife. She'll ask the most pertinent and vital questions. Take her to every single doctor's appointment.

What do you feel is the biggest misconception about prostate cancer?

That it's an old man's disease and it's no big deal. There are people in their 30s who've been diagnosed with it.

How has your outlook on life changed?

I've grown closer to God. It's not that I feel I had a brush with death. That's not it at all. It was a signal that I've reached an inevitable stage in my life. The stage where I need to acknowledge that I'm not so strong and that God is the only real source of true strength.

What involvement do you have in raising awareness for prostate health?

I talk, and I write. I've appeared at dozens of events to spread awareness. There's the Blue Ties luncheon every year and the Dash4Dads event at Father's Day that I promote. I'm a board member of the Men's Health and Wellness Center and the Georgia Prostate Cancer Coalition. The station, 11Alive, has also supported my efforts. They started a campaign called Wear the Gown as a way to spread the word about the dangers of prostate cancer.

What is your advice to men about this disease?

Don't be afraid to talk about it. Ask questions. It's nothing to be embarrassed about. There are a lot of us out there who've been through it, and we'll be honest with you. Just don't ignore it, that's deadly. I know so many men who don't even get yearly physicals and it breaks my heart. Knowledge is key.

Name something on your bucket list.

Do something significant in the fight against cancer.

Who is your hero?

My father.

 

ken-stevens

 

Ken Stevens
Georgia Prostate Cancer Coalition board member

Ken Stevens was diagnosed with prostate cancer in 1987, before PSA was used as a detection tool. He went in for an exam and came out with the diagnosis of a lump on his prostate. "They sent me to a urologist who sent me to DeKalb Medical Center for a biopsy. They were done then by finding the target with a Digital Rectal Examination — no ultrasonic-guided technology was yet available," he explains. "The total time I spent at the hospital was three days — now it takes about one hour." After that exam, the results were still inconclusive, so Stevens returned later for more analysis. Eventually his diagnosis was unequivocal carcinoma of the prostate, and the orders were to schedule surgery.

He had a radical prostatectomy in February of 1989. It was discovered after his post-op procedures that Stevens was already at stage 3 in his cancer. Stevens says his first thought about the diagnosis was, "OK, let's get this thing out, and I'll go on about my business." His wife, a nurse at the Shepherd Center at the time, told him that his lack of reaction was because he didn't have a clue about what he was going through. Looking back, Stevens agrees, "Boy, was she right!"

What was the first thing you did after you were diagnosed?

I went to St. Simons and spent a week playing golf.

Where did you go to find support?

American Cancer Society. I had heard lots about BRCa and precious little about prostate cancer even though they had the same statistics. I swore I would strive to change that and volunteered to be a spokesman for the ACS. I've been doing that ever since. That was my support therapy.

What was the best piece of advice you received?

Keep on keepin' on. Spread the word. Talk about it.

What do you feel is the biggest misconception about prostate cancer?

Number one on a "Myths about PCa" list is "You will not be able to have sex after treatment."  The myth can become reality if the PCa is found in an advanced stage.

How has your outlook on life changed?

I give thanks every day that I am vertical.  I used to take it for granted.

What involvement do you have in raising awareness for prostate health?

I've been a spokesman since 1990 for American Cancer Society. In 2000, a like-minded group of survivors (seven of us) founded the Georgia Prostate Cancer Coalition.  Our mission is to promote prostate cancer awareness.  We now number 17 on the board and some 35 to 40 like-minded survivors, all volunteers.

What is your advice to men about this disease?

Talk about it, learn about it and get information about it so that if you find it, you can make an educated decision. Remember that the first answer of this response is that the procedures are changing, and then, so must your knowledge.

Name something on your bucket list.

Get up in the morning. "There is no such thing as a bad day," says Hamilton Jordon, author of a book by the same name.

Last book you read?

"Surviving and Thriving — Candid, Real Life Stories of Prostate Cancer, A Complete Guide For Every Man (And Woman)," written and published by the staff at Midtown Urology.  My story is in chapter 13.

Who is your hero?

Roosevelt Grier, one of the fearsome foursome, a PC survivor, speaker about prostate cancer, and the best needlepoint artist of all time.

 

bill-buckley

 

Bill Buckley
Member of the Georgia Prostate Coalition/Former 13WMAZ anchor

Bill Buckley was diagnosed with prostate cancer in January of 2012. Buckley had no family history of this cancer, but when his regular doctor saw his PSA rise during physicals over an 18-month period of time, he referred him to a urologist for a biopsy. "PSA testing saved my life," he says. In March of 2012, Buckley opted to have his prostate removed. "'When in doubt, take it out' is the motto I heard a lot, and it was just the best option for me. There were side effects that occurred instantly as a result of the surgery such as incontinence and impotence. And while they lasted longer than I would have liked, I am now fully recovered and thankful that I chose the route I did. I am very fortunate."

What was the first thing you did after you were diagnosed?

I had to decide how I was going to go forward.  I could either fall down on the floor in self-pity, or I could simply realize how lucky I was to have found out early and return the favor by making certain other guys knew to get tested and watch their PSA levels.  Having a "mission" that I felt was worthy helped me focus on others and not on myself.  I remembered a phrase that I grew up with:  "God doesn't give you things you can't handle." I have since added to that, "But, he also expects you to handle what he gives you."

What was the best piece of advice you received?

To be patient. Recovering from surgery is a process. I'm sure the same is true with radiation or any other treatment.

What do you feel is the biggest misconception about prostate cancer?

That it "won't happen to me." Too many guys are walking around now, completely unaware that they have the early stages of prostate cancer. One in six will get it. We need more guys to go to the doctor on a regular basis, get tested, and then to know their (PSA) score the way they know their golf score.

How has your outlook on life changed?

I know how much I am blessed to have excellent health care. I have a greater sense of how important it is to take care of myself.  I am still around at age 62 for a reason. I'd like to continue to be a survivor for a long, long time.

What involvement do you have in raising awareness for prostate health?

I have joined the Georgia Prostate Cancer Coalition (GPCC), a terrific organization that focuses on awareness. It's made up almost entirely of prostate cancer survivors who have a passion for awareness.

What is your advice to men about this disease?

Get regular checkups that include a physical exam of your prostate and a blood test that measures your PSA.  If you are going to have prostate cancer, find it early, while you still have choices (as I did). It's lousy not to have choices other than a dramatic, negative effect on your lifestyle and a shorter life.

Name something on your bucket list.

My wife and I never had a honeymoon when we were married. I couldn't afford it. I want to take her on a trip to Italy.

Last book you read?

"The Dragonfly Effect" by Andy Smith and Jennifer Aaker.

Who is your hero?

My father, who taught me early on in life to get a printed copy of the lab results from visits to the doctor so that I could know the actual results and keep up with them. That advice helped me see the value of PSA testing and played a major role in the awareness and early detection that saved my life.

 

 

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