Your Prostate Your Decision

As a mom, your job is never done.  Not only do you have to keep track of your kids, but you always have to keep after your husband or other men in your life.  Why?  Because notoriously men like to put things off until it is too late or they have no other choice – especially when it comes to visiting the doctor.  Do you know that Joe Torre four-time world champion baseball hall of famer is a prostate cancer survivor?  Torre has teamed up to create a public service announcement to bring awareness about prostate cancer and the choices that are available for treatment.

In conjunction with the PSA, I was given the opportunity to interview (no, not Joe Torre) Dr. Ketan Badani about prostate cancer.  Dr. Badani is the Vice Chairman of Urology & Robotic Operations, Mount Sinai Health System, Director of Robotic Surgery at Mount Sinai, St. Luke’s, & Roosevelt Hospitals, and Professor of Urology, Icahn School of Medicine at Mount Sinai Hospital.

1.  As a wife/girlfriend/mother, how can we help the men in our lives understand the importance of prostate cancer screenings?

It is not uncommon for women of a household to be the medical voice in the family.  Men tend to avoid doctors for preventative and screening care, and I see the woman who takes the initiative to bring her husband, father, son to the doctor’s office.  Prostate cancer is the #1 solid organ cancer in men, and the most common killer among men.  There is no specific cause that can be identified, and symptoms are rare until the cancer is advanced.  Therefore, screening is our best defense against prostate cancer.

2.  What are the most common symptoms of prostate cancer?

In general, prostate cancer is a silent disease.  When it is early and organ confined, there are rarely any symptoms.  When prostate cancer spreads and become more advanced, a man can experience urinary difficulty, back pain, leg weakness, weight loss, fatigue.

3.  What are the guidelines for preventive screenings for prostate cancer?

This is an area of high controversy, and guidelines range from one extreme, where no screening is recommended, to the other where all men of all ages should be screened for prostate cancer.  I believe a prudent and responsible screening plan should be from age 50 to 75, where every year, a man will get a PSA and digital rectal exam.  For those men with a family history of prostate cancer, or of African American, Latino, or Afro Caribbean descent, many advocate screening early starting at age 40.

4.  We hear a lot about PSA tests.  What is this?  What does it tell us?

PSA stands for Prostate Specific Antigen.  It is a protein specifically made by prostate cells, and prostate cancer cells.  Cancer cells make more PSA than normal prostate cells, so an elevated PSA suggest further evaluation may be required to check for prostate cancer.  Unfortunately, like many other “screening” tests, PSA is not perfect and many other causes can elevate PSA levels.  This requires a detailed conversation with your doctor to determine if your PSA is abnormal based on age, and prior history of PSA values.

5.  Describe how active surveillance is an option for some men, rather than aggressive treatment.  How can one make this decision with confidence?

For those men who are diagnosed with prostate cancer, this cancer comes in many different forms.  Up to 40% of men with prostate cancer have a very non-aggressive or “indolent” form of the cancer which does not spread or cause problems and therefore can be safely monitored over time without the need for intervention.  Keep in mind though, that a close surveillance by a qualified doctor is necessary as sometimes the cancer can become more aggressive and then will require treatment.  There are tools that can help determine who is a good candidate for surveillance – a man’s PSA, grade with is called Gleason Score, and stage (whether a cancer is confined to the prostate). We now also have more advanced and individualized tools to determine a specific man’s risk, including MRI imaging and genomic profiling with the Oncotype DX test, an individualized test that will tell us a man’s true risk of indolent versus aggressive disease.

 6.  What types of treatments are available for prostate cancer?

Treatment for prostate cancer if a man is not a good candidate for active surveillance is a complex decision-making process.  This can include factors like patient’s age, overall health status, aggressiveness of his cancer, stage, and of course, patient preference.  The common treatment is surgery to remove the cancerous prostate, follow closely by radiation therapy.  There are many other options as well including freezing the prostate (cryotherapy), heat to kill cancer cells (HIFU), and newer forms of radiation including proton beam and cyberknife.  This decision requires a long and thorough discussion with your urologist to determine which treatment is best for each individual.

Prostate cancer is the #1 solid organ cancer in men, and the most common killer among men. ~ Dr. Badani

As I mentioned above, Joe Torre has teamed up with Your Prostate Your Decision to developed a public service campaign with support from Genomic Health in partnership with three national prostate cancer organizations: ZERO – The End of Prostate Cancer, Prostate Health Education Network, and Men’s Health Network.

I encourage you to visit www.YourProstateYourDecision.com and learn more about prostate cancer, testing and treatment options.

Making informed decisions are crucial with prostate or any type of cancers.  Force the men in your life to go to the doctor and make sure you are armed with the facts and treatment options.  While half of all new prostate cancer cases are low-risk¹, 90% will receive immediate invasive treatment², despite only a 3% chance of the disease progressing and becoming deadly³.  

This post was written for social good.  All information and graphics used with permission.  No compensation was received in exchange for this post.

_{1,3 Boorjian. 2008. Urol.  2 Cooperberg. 2010. JCO.}