Search for tag: "prostate cancer"

Kim: Prostate cancer is the second leading cause of cancer death in men, but how do you know if you are one of those men with a high risk of developing the disease? That story is up next on The Scope.

Announcer: With the latest news and research from Huntsman Cancer Institute this is the Cancer Care Update.

Kim: A new study finds that when it comes to prostate cancer, your family matters. You could be at higher risk not only if your father had it, but even if a relative you have never even met had it. Lisa Cannon-Albright at the Huntsman Cancer Institute is the senior author on the study published in The Journal Prostate.

Lisa: My goal was to try to use available information to estimate a particular man's risk of prostate cancer, and the data that I wanted to use was his own family history.

Kim: Instead of asking thousands of men their family history, Cannon-Albright and colleagues used a resource called The Utah Population Database. It contains a computerized genealogy linked to medical information for over 7.3 million Utahans including those that have cancer. She says what they found was that having a first degree relative such as a father, brother or son, doubles your risk for getting prostate cancer. But surprisingly risk also increases by having a second or third degree relative such as an uncle, grandfather, cousin, or even great-grandfather with the disease.

Lisa: Most people would agree that if you have a first degree relative affected with prostate cancer that your risk must be higher than it is for other men in the population. But we found that second degree relatives and even third degree relatives, if you have them in your family history constellation you are also at increased risk.

Woman: So even just one?

Lisa: Yes, even just one.

Kim: Cannon-Albright says Doctors should not only pay attention to the men on your father's side of the family, but also on your mother's.

Lisa: The relative risk was exactly the same whether the family history was on your mother's side or your father's side.

Kim: Knowing your family history and whether this increases your risk for prostate cancer will help your doctor develop a health monitoring plan specific for you. For Cancer Care Update, I'm Kim Schuske with Huntsman Cancer Institute.

Announcer: For more resources from the cancer care and research experts, Huntsman Cancer Institute, go to HuntsmanCancer.org. The Cancer Care Update is a co-production with TheScopeRadio.com University of Utah Health Sciences Radio.

Dr. Tom Miller: Screening for prostate cancer.

Dr. Blake Hamilton: Oh my.

Dr. Tom Miller: Why the oh my?

Dr. Blake Hamilton: This is a very controversial subject.

Dr. Tom Miller: This is Dr. Tom Miller. We are going to be talking about prostate cancer screening next on The Scope.

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Dr. Tom Miller: Hi, I'm here with Dr. Blake Hamilton. He's the medical director for the urology clinic, and he's also associate director for the division of urology. Let's talk about it. Is prostate cancer screening with P.S.A. testing something that's time has come and gone?

Dr. Blake Hamilton: No, I don't think so. It's a shifting environment to be sure, but I think it still has relevance.

Dr. Tom Miller: You know, the national guidelines, or a couple of the guidelines out there now say that you really don't need to screen men for prostate cancer using the blood test, the P.S.A., prostate specific antigen test. That's based on a couple of large studies, I believe. The outcomes of those studies, one in Europe, one in the United States, didn't back up the idea that using this test could save lives best that the studies showed.

Dr. Blake Hamilton: We have to go back and understand the history of P.S.A. P.S.A. is a protein that's produced by the prostate. It has a role. It has a function. We learned many years ago, three decades ago, that it goes up in prostate cancer, and when you treat prostate cancer it goes down. It became used as a marker for recurrence of treated prostate cancer. It continues to be very reliable. It's one of the best blood markers that we have for cancer.

Dr. Tom Miller: No question. I think we all know that we find more prostate cancer using this test. The question is does it save lives in the long run.

Dr. Blake Hamilton: The two studies that you refer to, depending on how you interpret them, show that there was not enough difference between the group that was screened and the group that was not screened. There are several problems with those studies. One is that they may not be mature enough. They had an average follow up of eight, nine, ten years, and the arms are separating. If we get to 15 years I think we'll see a difference. I think we'll see a clear separation between those two arms. The other problem is there are some methodological problems in how the patients were accrued. It's complicated. I think the real issue is that some people with prostate cancer will suffer immensely and die, and many will not. What we really need to do is do a better job of trying to predict who needs treatment and who doesn't. I think that what's happened over the last couple of decades is when men are diagnosed with prostate cancer based on P.S.A. screening they automatically have gotten treatment. So, in a sense as a community we've over-treated men with prostate cancer.

Dr. Tom Miller: I think part of the concern is also the potential complications of the surgery or the other treatments available for prostate cancer. I mean it's not a benign procedure, and there are outcomes that are difficult for the patient. I think that is coloring the judgment of some of the task force groups that are looking at screening guidelines currently.

Dr. Blake Hamilton: The problem is you still have some 250,000 men who will be diagnosed with prostate cancer this year in the United States. There will be some 35,000 of those who will die from prostate cancer. To say that prostate cancer screening with P.S.A. has come and gone would be throwing the baby out with the bathwater. What we need to do is keep the screening but make better decisions about when to biopsy and when to treat prostate cancer. Already we're seeing a significant decline in the number of men who are being treated, and that's appropriate. But, we've got to keep looking for the ones that are going to be lethal cancers, because they're real.

Dr. Tom Miller: Let's talk practicalities. Are you saying that we should continue to follow the past guidelines which say begin screening in men at the age of 50, and then continue screening every year with P.S.A. testing?

Dr. Blake Hamilton: There are now many alternatives to that.

Dr. Tom Miller: Right.

Dr. Blake Hamilton: One alternative, which comes from the U.S. preventive services task force, is to not screen at all. The American Urological Association has modified their guidelines to suggest that we screen maybe not every year but every two years in men between the ages of 55 and 70 where we think that we'll find the highest yield in the patients for whom it will really matter. Screening in 80 year olds, not important. Screening in the younger generation, not enough data to show evidence that it helps or makes a difference.

Dr. Tom Miller: Younger generation meaning 50 years old and above?

Dr. Blake Hamilton: Less than 55.

Dr. Tom Miller: Less than 55.

Dr. Blake Hamilton: Although there are many researchers who would argue that between 45 and 55 should be included. The guidelines as we have them now would be that those men in that 15 year window, and screening not as intensely as we have in the past, but not to give it up.

Dr. Tom Miller: Let's say that your P.S.A. is elevated. What should the patient do? Should they go then to a urologist who specializes in prostate cancer? A lot of this, as you say, is going to depend on the expertise of the specialist taking care of this type of problem.

Dr. Blake Hamilton: I think most urologists have the ability to evaluate an elevated P.S.A. and make a decision on a biopsy. There continue to be a variety of opinions out there. If you have a single elevation in the P.S.A. I think it's reasonable to wait some time and repeat it and think about what that means.

Dr. Tom Miller: So, screening is something that you believe we should continue. You think it's a good idea.

Dr. Blake Hamilton: Yes, I think we should continue screening but do it judiciously and appropriately, and then think carefully without automatic treatment of those who are diagnosed with prostate cancer.

Dr. Tom Miller: A final thought. What about that time honored rectal exam? Do we still have to do that on patients? It's the brunt of so many jokes.

Dr. Blake Hamilton: Yes, it is. Unfortunately, there are some bad prostate cancers that have low P.S.A.s and are only found on physical examination, so we're going to continue doing that exam, Tom.

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Interviewer: You've been diagnosed with prostate cancer. What next? We'll talk about that on The Scope.

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Interviewer: For men that have been diagnosed with prostate cancer, figuring out the right treatment option can be really overwhelming. Dr. Jonathan Tward specializes in prostate cancer at Huntsman Cancer Institute. Dr. Tward, what treatment option would you recommend for a man just diagnosed with prostate cancer?

Dr. Tward: It's really an equally important question in a cancer that often won't take someone's life, Should they be treated? Because the treatments themselves can just as easily impact someone's sexual health, urologic bother, or bowel bother. One of the problems with prostate cancer, which is sort of unique to prostate cancer and different from other cancers, is that unlike other cancers where there's a very defined treatment paradigm, this particular cancer has many treatment options, and it is overwhelming to a lot of men who are faced with a new diagnosis of a relatively early stage cancer. Should they choose a surgery? Should they choose one form of radiation therapy or another radiation therapy? It's a big struggle for a patient who is contemplating their mortality to also have to go through the various treatment options and side effects because, honestly, when you start parsing treatment options for prostate cancer, there are essentially 20 different little ways of skinning that cat. It can paralyze people with this anxiety over 'Am I choosing the right thing? Am I not choosing the right thing?' So one of the things that I advocate for to a patient who is diagnosed is if they have an early stage prostate cancer, which is 80 to 85 percent of new diagnoses, they should speak to a urologist because the urologist will specialize in the surgical management of that disease. However, they should also speak to a radiation oncologist who specializes in the curative treatment of that disease with radiation therapy because they have non-surgical treatment options that are just as curative as the surgical option. But you're starting to choose on subtleties of different side effects.
When you're talking about sexual function, especially, this can become very important. There are certain ways of doing the surgery that will guarantee that you have erectile dysfunction whereas there are other ways of doing the surgery that will improve the probability that you don't. Or you might decide that radiation therapy in the form of external beam treatment or seed implants may have a favorable sexual function preservation rate relative to surgery, maybe, at the expense of an increased risk of a bowel bother. So men struggling with these treatment decisions are trying to balance risks of side effects to their urinary functions, risks of side effects to their bowel, and risks of side effects to their sexual function. And that's what is very challenging in terms of making treatment decisions.

Interviewer: And it doesn't sound like there's any easy way to really pick one. It sounds like you just kind of got to go through the options and then decide what's important to you.

Dr. Tward: Right. There is no way, and the reason that I advocated speaking both to your urologist and radiation oncologist is that a urologist, and rightfully so, should be biased towards 'You should get surgery' and may kind of communicate that perspective to the patient whereas a radiation oncologist may be biased that you should get radiation. But ultimately, you want the patient to hear the experts in those fields kind of discussing the details with therapy. If they're fortunate and maybe have friends who have gone through the different kinds of treatments, they can ask one friend who's had one form of treatment and another friend who's had another if they have that luxury. Or they can join a men's group where they can easily talk to men who have had different perspective. They can even include their primary care doctor in that decision making to help them kind of go through this decision and make an informed decision.

Interviewer: So there are men's groups that actually help support this sort of thing?

Dr. Tward: There are men's groups. The men's groups are not as active as, let's say, breast cancer groups.

Interviewer: Sure.

Dr. Tward: Women are very motivated to have survivorship groups and support groups, and men historically have been a little less motivated, but they do exist.

Interviewer: And you think they're a good resource?

Dr. Tward: I think they're an excellent resource, especially because it's one thing to hear a doctor tell you what you think and what you might feel, but it's another thing to hear it from someone who's gone through it. As much as I think I know about prostate cancer and what it feels like to get radiation therapy or what it feels like to get surgery, it's never been done to me. So I think there's extreme value in talking to people who have endured our therapies and the possible side effects.

Interviewer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

Interviewer: If you're a man and you live long enough, prostate cancer is going to likely be part of your life. It can be really confusing. When do you get screened? What does a positive screening mean? What should you do then? We're going to talk about these things and more coming up next on The Scope.

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Interviewer: Prostate cancer is one of the most common men's cancers, and although it likely won't kill you if you're diagnosed it can have very negative impacts on your quality of life. That's why you should get screened. Learn about the facts now with Dr. Jonathan Tward from Huntsman Cancer Institute. He's a prostate cancer expert. Let's start out with how effective is prostate cancer screening?

Dr. Jonathan Tward: We think that we are usually picking up the diagnosis 10 to 15 years in advance of when someone might feel a problem.

Interviewer: Oh, really? So, it's a cancer that's easily detectable?

Dr. Jonathan Tward: Easily detectable, although even that is controversial. We do have a screening test that helps guide us on whether or not we should do additional testing like a biopsy to prove it, but we are in fact able very early on to detect prostate cancer.

Interviewer: Is there a certain age where I should start becoming more aware of it?

Dr. Jonathan Tward: Guidelines are kind of evolving right now in terms of what age people should really start concerning themselves with thinking more about it. As a general principle, we think that around age 50 men should start bringing it to the forefront of their thinking. Digital rectal examinations are one common way to screen for this cancer. The PSA test is another thing. We usually start advocating that at age 50. What is interesting is that if you look at autopsies on people, starting at age 30 10% of people will have prostate cancer in their prostate and won't know it. This is if you just happen to autopsy someone killed for another reason. The risk goes up by about 10% per decade of life, so by age 50 one would expect 30% of people to have cancer in their prostate, and it goes up by 10% each decade. Once you are in your 60s or 70s you almost have a greater than 50/50 chance that you harbor this cancer. Many of these cancers will not require treatment. Some of them can be safely observed. This is part of the problem with screening. We often detect cancers in men that can be safely observed and sometimes over-treat them, and on the opposite side of the coin we often pick up very aggressive cancers that absolutely need to be treated to preserve quality of life such as urologic bother.

Interviewer: It sounds like you could have prostate cancer and it's not a problem.

Dr. Jonathan Tward: That's true. In fact, the vast majority of people being diagnosed today have no physical symptoms of the cancer because it is being detected with this 10 to 15 year lead time from the PSA test.

Interviewer: So could I go my whole life having prostate cancer but never needing treatment because it just never turns into anything?

Dr. Jonathan Tward: Chances are you will do that.

Interviewer: Wow. Really? Should that concern me?

Dr. Jonathan Tward: Well, I do think it should concern you. It sort of goes back to this issue of one in six men are being diagnosed with cancer. But, if you want to talk about it from a different kind of number, we diagnose in the United States approximately 250,000 men with cancer each year. Maybe about 35,000 die of the disease. What that implies is that the majority of people are either cured or able to live well with their cancer although they might have to live with side effects of their treatments, and maybe only 10% or 15% actually die of the disease. But, part of the problem with prostate cancer, and I think the confusion especially when it talks to should we screen and should we treat it, is when you look at these statistics, death from prostate cancer, it's clear that we're very good at keeping men alive with prostate cancer. I argue that the reason we should try to screen it, and treat it, and cure it is to try to prevent men from living a lifetime of side effects from the cancer or from the treatment. To me that is really the utility in identifying this cancer.

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updated: June 12, 2019
originally published: December 6, 2013