Should older men (75 and up) get the PSA test for prostate cancer?

exam table (Photo credit: Lynn Kelley Author)

Over the life of this blog, I have shared my experience with prostate cancer. I was diagnosed with the disease a few years ago. The cancer was found at an earlier stage, so I elected to have radiation treatment. So far, my PSA levels have been low, and that’s a good thing. HOWEVER, I respect the fact that cancer is a tough and sneaky foe, so I will continue with my PSA tests.

There is a study that came out in the October 16th issue of the Journal of the American Medical Association that suggests that many doctors order PSA tests for men 75 and older. Current guidelines, according to HealthDay.com, advise against PSA tests for elderly men. HealthDay reporter Steven Reinberg has the lastest information.

As I have stated many times in this blog, I am not a doctor or a health care professional. I’m simply a baby boomer trying to inspire other men to see the doctor. I certainly do not have the authority to suggest whether older men need these tests.

I do feel a guy needs to meet with his doctor to discuss prostate cancer screening, and the earlier the better. While many prostate cancers are slow growing, men 75 and older have a perfect right to discuss prostate cancer screening with their physicians.  At the end of the day, a decision needs to satisfy the doctor, the patient and the patient’s family.

Prostate cancer: A variety of treatment options

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.

Visit: www.cancercenter.com

 

 

 

It’s the prostate, not the prostrate — article by Scott Keith

The more I interview doctors and specialists for this blog, the more I notice that men do not have the same laser-sharp focus on their personal health as women seem to have. While women keep current on all their medical screenings, men find it hard to see the doctor, until they are doubled up in pain or frightened to death over a symptom.

A urologist who notices this is Dr. Edward Karpman, who specializes in the diagnosis and treatment of male sexual dysfunction. “It is true that women tend to be more proactive about their health care. They tend to see a doctor for their routine screenings, mammograms and tests…It’s hard to explain at a physiological or biochemical level.” Karpman says it may have something to do with our society and culture. “Guys have to appear resilient and indestructible. I think going to the doctor is almost an admission of some type of vulnerability in their armor…they don’t want to go see a doctor until it’s too late, until it hurts,” says Karpman.

The road seems especially tough for single men. In an interview with Men and Health: It’s a Guy Thing, Karpman believes female partners help men focus on health. “I think that’s really the reason why we see longer life spans in guys who are in relationships.” Many men see the doctor only after being told to do so by their partner.

Women can provide the careful nudge, convincing their hubbies, fathers or boyfriends to pay better attention to aches, pains, even subtle symptoms. Karpman says a survey of households in the Silicon Valley revealed that women (approximately 80 percent of the time) were the primary medical caretaker in the family. “I think it’s kind of an enigma as to why this happens. We can probably look at our society and culture and attribute some of this kind of behavior to the way we’re brought up,” says Karpman.

Foot dragging and a lack of knowledge can cause men to delay prostate screenings. “I think there is still a gap in knowledge about the prostate among the general population. Guys still refer to it as the prostrate,” says Karpman, adding that he’s surprised some guys still don’t know about PSA blood tests. “That tells me that our general knowledge about prostate health is not where it really should be.”

Men need to know that many diseases, in the early stages, show no symptoms. So it’s not a good idea to think you are free of illness, just because you feel healthy and strong. “The vast majority of medical problems only manifest themselves when it’s kind of at a critical point,” says Karpman, Medical Director of the Men’s Health Center at El Camino Hospital in Los Gatos, California. The idea behind cancer screening is to catch a cancer early, when there’s a much greater chance of cure.

Regardless of how good you feel, Karpman says “You’re not immune, you’re not invincible to disease. Get checked out.”

Visit Dr. Karpman at www.healthy-male.com

Doctors still rely on the PSA blood test — article by Scott Keith

Did you know that Prostate Specific Antigen, better known as PSA, is an enzyme produced by the prostate? If you’re a women not familiar with prostate issues, you may be thinking, “so what.” But if you’re a man approaching middle age, you need to get familiar with PSA. Get to know it like the back of your hand. Your PSA level can help determine your chance of developing prostate cancer.

Over the last year or so, you’ve probably read a series of articles about mammograms, pap smears and PSA tests. At what age do you need to be tested? You may be totally confused, based on conflicting opinions from experts. In the absence of any stunning breakthrough in prostate cancer research, the PSA blood test and digital rectal exam remain the best screening methods to catch an early-stage tumor, which is confined to the prostate.

While a prostate biopsy is the only certain way to diagnose prostate cancer, urologists still depend on the two screening tests. Dr. Barry Buffman, a board certified urologist with Boston Medical Group Los Angeles, says the PSA test has been used for many years. Before PSA, a lot of men would present with advanced disease. “If anything, PSA allowed us, as it evolved, to pick up earlier disease, that was more treatable,”says Buffman, Even so, PSA is not always specific to prostate cancer. A bump in the PSA, adds Buffman, can also come from prostate enlargement and prostate inflammation.

Patients may wonder what is a “normal” PSA reading. “It’s not cut and dry,” according to Buffman, in an interview with Men and Health: It’s a Guy Thing. Traditionally, that number has been 4 or lower. But some urologists prefer a reading closer to 3. “Everybody looks at these numbers a little differently, due to their own professional experiences and their own biases.” Buffman says what’s important is PSA velocity, or the change in the amount of PSA over a period of time.

What happens when a man approaches middle age? Buffman says if you’re between 40 and 45, and have no family history of prostate cancer, you may only need a digital rectal exam. For men 45 and over, a PSA test would be practical to establish a baseline count. For African-Americans, and those with a family history of the disease, the first PSA test, says Buffman, should be done at a younger age, closer to 40. And any change in urinary symptoms (including stream, difficulty, bleeding and pain) should prompt a visit to the doctor. While more men are becoming aware of the prostate, a walnut-sized gland between the bladder and rectum, Buffman says, “usually it takes a prompting from the doctor to ask a battery of questions…most men, unless they’re really having a lot of symptoms, don’t bring up the subject.”

Buffman is encouraged that more people are aware of screening. ” I think the public is much more educated today than they’ve previously been, and so they’re much more aware of screening tests and the ability to be proactive and to prevent later, or aggressive disease.”

Visit Dr. Buffman at http://losangeles.bostonmedicalgroup.com

Walnut-sized gland a major headache for older men — article by Scott Keith

 If you find yourself in an elevator with five older men, chances are good one of them is dealing with a disease or condition affecting his prostate, a tiny gland found below the bladder, surrounding the upper part of the urethra.

About the size of a walnut, the prostate gland aids in the production of seminal fluid. It is not vital; men can get along without one. As a man ages, his prostate can become enlarged, inflamed or cancerous. Prostate cancer generally attacks older men.

Prostate exams may be a key reason men avoid doctors. They fear the “gloved hand.” This is a digital rectal exam, one of two tests that help determine the likelihood of prostate cancer. The other diagnostic tool is the PSA blood test. Known as prostate-specific antigen, PSA is a protein made only by the prostate gland. According to UrologyHealth.org, “High levels of PSA in the blood may be a sign of prostate cancer.” As a man approaches middle age, he needs to discuss prostate issues with his doctor. African American men are at greater risk of prostate cancer as are men who have a family history of the disease. Cancer is a powerful incentive for men to stop procrastinating. Getting these prostate tests at regular intervals help men catch cancer in its early stages, when it’s confined to the prostate. This is when prostate cancer can be cured.

Dr. Sheldon Marks, author of “Prostate and Cancer,” says more men are becoming aware of prostate health thanks to public figures sharing their cancer stories and media exposure to medications such as Avodart and Flomax. Even so, Marks says, “there are still a lot of men who either don’t want to talk about it or don’t understand it, so they kind of just choose to avoid it.”

A man, according to Marks, should first approach his doctor if he has disturbing or alarming urinary symptoms, such as dribbling, urgency and frequency. If you are healthy and not experiencing symptoms, “it’s probably a good idea to get a baseline exam and PSA starting about age 40 to 45, absolutely at a minimum age 50, then annually thereafter.” Those at greater risk of prostate cancer need to start tests at 40.

Marks says the PSA test is “far and away the most sensitive test for detecting prostate cancer. It’s far more sensitive than a mammogram, than a pap smear, than almost any other screening test on the market.” The tricky part of the prostate puzzle is that the PSA blood test is not prostate cancer specific. Marks says if the PSA is elevated or going up, it raises a question that needs to be answered. “It may be, gee, it was the recent infection you had, or maybe it’s because you just had orthopedic surgery and you had a catheter in for three days…or something else.” An abnormal PSA, says Marks, is like the “idiot light” in your car. “It tells you something may be wrong and needs further evaluation.”

It’s important to have both a PSA test and a digital rectal exam. Marks says the exam is not as effective and sensitive as the PSA, but on occasion, “there’s a guy who will have a nodule or asymmetry, one side being fuller than the other, but the PSA is normal, and it turns out there is a cancer.”

While some prostate cancers are found at an advanced stage (typically spreading to the bones), the prognosis is much better with early stage disease. Marks says, “That’s one of the things that’s so exciting about this. If we catch it early, it’s totally curable.” Depending on the stage of the cancer, treatments include prostate removal, radiation and hormonal therapy.

Despite growing publicity about prostate health, men continue to drag their feet. Marks says it remains an issue, observing, “Men are stubborn about their own health. They’ll go and they’ll get their lawnmower fixed, they’ll take their car in every 3,000 miles for an oil change, but when you say you’re age 50, it’s time for your PSA and colonoscopy, they flatly refuse.”