Men and Health: It’s a Guy Thing had a chance to conduct an e-mail interview with Dr. Pablo Lavagnini, a board-certified radiation oncologist.

Since prostate issues start appearing in middle age, what do men (after the age of 40) need to focus on?

Prostate cancer is the most common type of cancer found in American men, after skin cancer. But luckily it is also one of the most curable types of cancer—if caught early. Men should receive regular checkups. After the age of 40, men should keep an eye out for burning urination and a decrease in flow of urine. Men should also look out for blood in their urine. This is most likely not related to the prostate, but can be linked to kidney cancer. This is very rare, but still worrisome.

Prostate cancer primarily strikes older men, but how young can a man be diagnosed with this disease?

It’s extremely rare, but men can be diagnosed with prostate cancer anywhere after their 20’s. However, as you age, the chances of being diagnosed with prostate cancer increase. Typically, after your 50’s, it’s recommended to have a periodic (2-3 years) Prostate-Specific Antigen (PSA) and a digital rectal exam as a screening method.

I have heard….you might confirm….that even a 20-something guy can have a very miniscule (tiny) amount of prostate cancer. Is this so?

Yes, this is true. But, consider this: If you take 100 men who are 75 yrs old who would die of other causes and do an autopsy on all of them, you would find that about 75% harbor an asymptomatic cancer in their prostate. However, in the general population only 8% of prostate cancers are significant enough to become clinically relevant.

The important takeaway here is that even if there are no symptoms, men after their 50’s should take precautions and be sure to see their doctors and get screening done so when and if prostate cancer is found, your doctor will advise you whether treatment is necessary and the kind of treatment that is best for you.

When diagnosed with early stage (confined to the prostate) cancer, a man may think he needs the prostate surgically removed the next week. Generally speaking, does a man have time to think about treatment options?

Absolutely! Most newly diagnosed prostate cancer patients have even two to three months to get second opinions and make a decision about treatment. It is important for any patient facing a cancer diagnosis to take the time to find a team of cancer experts who you trust. At Cancer Treatment Centers of America (CTCA) my colleagues and I place a lot of attention on education and communication. We want our patients to understand all of their options so that they can make the choice that is best for them, based on their individual case and situation.

In early stage disease, can radiation be as effective as surgery in treating, or perhaps, curing prostate cancer?

Yes, radiation can absolutely be as effective as surgery in treating prostate cancer. At CTCA, we use several different treatment options to treat prostate cancer, all of which are equally effective. They include:

Surgery – Prostatectomies

External beam radiation – Tomotherapy and Varian’s Trilogy are two advanced radiation technologies that allow highly focused, powerful radiation beams to reach the tumor, while sparing healthy surrounding tissue

Calypso® – Called “GPS for the Body,” transponders are implanted into the prostate so that movement of the tumor is monitored while delivering focused doses of external beam radiation

HDR Brachytherapy – a form of internal radiation that includes a procedure where a series of tiny catheters are placed in and around the tumor

Chemotherapy, Hormone therapy and other types of Immunotherapies and biotherapies might also be treatment options.

The main differences between choosing surgery or radiation are the side effects. Your physician should inform you of the side effects of each option in order to help you make an educated decision about which treatment option is best for you.

Explain external beam radiation vs. radiation seeds?

External Beam Radiation Therapy (EBRT) is targeted to the prostate, but delivered from outside of the body. Over the last 15 years, technologies including Tomotherapy and GPS guided radiation with Calypso have significantly improved the ability of EBRT in targeting the prostate and sparing healthy surrounding tissues like the bladder and especially the rectum.

Radiation seeds, better known as brachytherapy, is performed by placing permanent radioactive seeds like iodine 125, palladium or with a temporary high dose rate Iridium implant inside the prostate. One of the major benefits of brachytherapy is that the entire treatment only takes one and a half days, as opposed to the eight to nine weeks for ERBT. This is one reason that brachytherapy has become a more popular option over the last few years.

Can a younger man (diagnosed in his 50s) be a good candidate for radiation?

Yes. Age is generally not a factor when choosing the treatment option that is best for a patient.

When is it absolutely necessary to have the prostate removed…and quickly?

Personally, I would say it is never necessary to come to that type of decision hastily. You should always take the adequate time to get second opinions and make an educated and informed decision.

Are more men choosing radiation……or is surgery still preferred?

As of right now, men are choosing radiation and surgery equally. As mentioned before, a man has to weigh his options after learning about the side effects of each treatment option. There are many factors that come into play when faced with cancer and treatment planning, and every individual is different, as is their cancer.

What are some side effects of external beam radiation?

All treatments have potential side effects. Patients receiving external beam radiation could experience a higher risk of rectal irritation, bleeding and in some rare cases, ulceration. Fortunately, many of my patients benefit because of our integrated approach to cancer care. By working with complementary care providers, including nutritionists, naturopathic doctors, oncology rehabilitation therapists and mind/body medicine therapists, the physical pain and discomfort associated with traditional treatments, as well as the mental and emotional effects of the disease, can be minimized and made a lot more tolerable.

What are some side effects of brachytherapy (seeds)?

Patients receiving brachytherapy could experience a higher risk of acute burning of urination that can sometimes take a week to a few months to resolve. Some patients also may notice blood in their urine. These side effects are common and usually temporary.

How do you see prostate cancer treatment a decade from now? Could the PSA test be a thing of the past?

There will certainly be technological advances in both surgery and radiotherapy a decade from now, but I believe that both options will still remain an equal choice for patients. While it’s unlikely that the PSA test will be abandoned anytime soon, researchers are working hard to find better ways to screen prostate cancer, for the future.

In terms of treatment options there are also some exciting things on the horizon. For example, at CTCA we recently began offering patients intraoperative radiation therapy (IORT). We are currently the only hospital in the country to offer this technique using the Novac7 technology, which allows patients to receive a single, large dose of radiation while in the operating room undergoing surgery, thereby minimizing, and in some cases, eliminating the amount of external beam radiation therapy required. Patients experience few side effects and are able to get back to their lives faster than they previously thought possible. While we have been using IORT largely to treat breast cancer, the Novac7 technology also allows us to treat additional disease types. We hope that in the near future we will also be able to use IORT at the time of prostatectomies.

What are your closing thoughts about prostate cancer? What advice do you have for the middle-aged guy with no symptoms?

Don’t hide your head in the sand (pun intended). Visit your doctor regularly and get tested when you reach middle age. It’s better to be aware of an issue and take care of it while it’s manageable, than ignore and regret it later. There have been tremendous advancements in technology and treatment options, so find a doctor who you trust and who takes the time to explain them to you. Also, be aware of complementary therapies that can help improve quality of life and keep you feeling and acting like you!

Dr. Lavagnini serves as the Director of Radiation Oncology at Cancer Treatment Centers of America at Eastern Regional Medical Center.