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Out of the shadows:Prostate screenings save lives

By Staff | Feb 4, 2012

One in six men will be diagnosed with prostate cancer during his lifetime.

Other than skin cancer, prostate cancer is the most common cancer among American men. The American Cancer Society estimated that about 240,890 new cases would be diagnosed last year, and about 33,720 would die from it.

The National Cancer Institute predicts that in 2012, approximately 241,740 new cases will be diagnosed, and the disease will claim another 28,170 lives.

With numbers like this, doctors stress the importance of screenings.

“We strongly believe the best way to keep people healthy is to do all the screening tests,” Dr. Salvatore Lacagnina, vice president of Health and Wellness for the Lee Memorial Health System, said.

Prostate cancer screenings are typically recommended for men 50 and older. Those with a higher risk of developing the disease, however, should consider starting the screenings at an earlier age – 40 is recommended.

Factors that can raise one’s risk of developing prostate cancer are being African-American or having a brother, son or father who had the disease.

“Those things would give you more risk,” Lacagnina said.

Eating a diet high in fat and drinking alcoholic beverages also are risk factors, according to the Centers for Disease Control and Prevention.

Lacagnina suggested eating more fruits and vegetables and avoiding red meat and processed foods as one possible preventative measure.

“A plant-based diet may lower the risk for cancers in general,” he said.

As to how often to screen, it again depends on age and risk factors.

“We generally recommend individuals with a higher risk screen once a year,” Lacagnina said, adding that men can incorporate the screening for prostate cancer into their annual health checkup or their yearly physical examination.

“You want to make sure you’re getting a complete exam,” he said. “You want to make sure you’re getting examined completely from head to toe.”

Dr. Paul Bretton, of Southwest Florida Urologic Associates, noted that low-risk men can be screened every couple of years when younger. At about age 60, they should be screened for prostate cancer on a yearly basis, he said.

“Early detection really is the key to it all – picking it up early when it is treatable and curable,” Bretton said. “When you have a small amount of the disease, you have treatment options. When it is advanced, you are limited.”

According to the American Cancer Society, more than 2 million men in the United States who have been diagnosed at some point are still alive today.

Dr. Constantine Mantz, of 21st Century Oncology, said his youngest patient to be diagnosed was 18, which was “strange and extremely uncommon.” He added, however, he has had some 30-year-olds and “plenty” of 40-year-olds.

“You have to trust to a large extent your physician,” he of when to screen. “They will probably be the most informed to make a recommendation.”

According to the CDC, some symptoms of prostate cancer are:

n Difficulty starting urination

n Weak or interrupted flow of urine

n Frequent urination, especially at night

n Difficulty emptying the bladder completely

n Pain or burning during urination

n Blood in the urine or semen

n Pain in the back, hips or pelvis that does not go away

n Painful ejaculation

“With so many cancers, in the early stages, there may not be any symptoms,” Lacagnina said.

During a prostate cancer screening, the tests conducted are a digital rectal examination and prostate specific antigen, or PSA, test. The exam allows for a check of the size of the prostate, as well as for lumps and abnormalities.

PSA is a substance made by the prostate. The blood test measures it.

Lacagnina said the normal range on a PSA test is zero to four.

If the PSA number if higher than normal or if something abnormal is felt during the rectal exam, the patient is sent for an ultrasound and possible biopsy.

“To see if any lumps in the prostate itself can be cancer,” he said.

Bretton, who has most of his patients referred to him for further review because of an elevated PSA level, acknowledged that there has been some controversy tied to PSA tests. A benign enlargement of the prostate or a urinary tract infection can raise one’s PSA level above the normal range.

“But, it’s the best test that we have,” he said.

According to Bretton, back before doctors started using the PSA test, he saw the disease more advanced in one-half to two-thirds of his patients.

Mantz explained that a government task force has recommended that PSA screenings not be done. When he speaks at seminars on prostate cancer, an audience member always raises that point and concerns of health coverage.

“There is a difference between what their doctor is saying and the government task force,” he said.

Mantz, however, pointed to the number of prostate cancer survivors.

“It is not coincidence we have seen the cure rates go up,” he said.

He attributed the success to primary doctors recognizing the importance of the PSA tests and preventive maintenance – men having their screenings.

“Whenever I go out and give talks to the community, I’m always impressed by how well the general public is aware of cancer screenings,” Mantz said.

If a patient is diagnosed with prostate cancer, the next step is taking into consideration things like how much cancer is there and how aggressive is the tumor, Bretton said. Doctors also take into account age and medical history.

“Most of the time, the treatments are to watch it – active surveillance – and then surgery or radiation therapy,” he said.

According to Lacagnina, prostate cancer can involve the bones and lower back if left untreated, but it tends to be one of the “slower cancers.”

“It’s usually a more treatable cancer when caught early,” he said.

Mantz echoed that.

“Cancer is no different than any other problem,” he said. “If you identify it early enough you can solve it. You can spot the problem and offer treatment that would be useful, that can indeed cure it.”

For more information on prostate cancer and screenings, visit:

* American Cancer Society, www.cancer.org

* Centers for Disease Control and Prevention, cdc.gov

* National Cancer Institute, www.cancer.gov

* U.S. Department of Health and Human Services, healthfinder.gov