Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer.
While treatments are improving, the American Cancer Society (ACS) estimates for prostate cancer are 191,930 new cases and 33,330 deaths in the United States this year. And Long Island men are not immune. The New York State Department of Health estimates that from 2012-2016, Nassau County presented with average annual cases of 1,118.8 and 107.8 deaths per year; Suffolk County reported 1,093 average annual cases and 113 deaths per year.
“It is certainly an important medical problem on Long Island, similar to the way breast cancer is in this region,” states Dr. Manish A. Vira, system chief of urology at the Northwell Cancer Institute. With greater awareness, screening, and improved treatment, the majority of men who are diagnosed typically have positive outcomes, he adds.
Diagnostics for prostate cancer include a physical examination to ascertain if there is unusual firmness or a nodule on the prostate, and prostate-specific antigen (PSA) screening. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate. The PSA test measures the amount of PSA in the blood.
The American Urological Association recommends “shared decision-making” between doctor and patient for men ages 55 to 69 years who are considering PSA screening. Men in their 40s or 50s who are at risk may consider getting screened earlier.
At-risk males include those with a family history of prostate, breast, ovarian, and colorectal cancer and specific genetic factors.
“We know that men who carry the BRCA mutation [gene mutations associated with increased breast cancer risk] also carry increased risk of not just prostate cancer but aggressive prostate cancer,” Dr. Vira says.
An elevated PSA does not necessarily equate to a definitive prostate cancer diagnosis or necessitate a biopsy, says Dr. Michael P. Herman, chief of the division of urology at South Nassau Communities Hospital. There are two additional blood tests — the 4Kscore® and the Prostate Health Index (PHI) — that can aid in determining whether or not a patient needs a biopsy.
“If needed, MRI-guided biopsies could increase accuracy of the biopsy,” Dr. Herman says. “We’re biopsying fewer people because we’re able to figure out which men don’t actually need it, but the ones we’re biopsying are the ones that are truly at risk, not just because of the high PSA.”
Surgery has improved by using robotics, says Dr. Herman.
“We’re able to construct everything very precisely and give people the best outcomes when it comes to urinary control and sexual function,” he says.
Recovery from surgery tends to be very fast, too, he adds. Treatment time for radiation for prostate cancer is also much different than it is for other cancers.
“Radiation [treatment] can be as short as a week or up to two months, but once you’re done with radiation, that’s typically it,” Dr. Herman says.
Treatments for men diagnosed with Stage 4 prostate cancer especially have dramatically improved over the years, notes Dr. Vira.
“Traditional stage 4 prostate cancer was treated with hormonal therapy to eliminate testosterone from the body and that treatment would be successful for a period of time, but eventually the cancer would start to grow again,” he explains.
Several drugs or treatments have been developed for patients who have failed hormonal therapy. A drug called olaparib has shown positive results in clinical trials in men who have the BRCA mutation, Dr. Vira says. A big avenue of treatment is actually no treatment at all, he adds.
The idea behind “active surveillance” is that “many men who have no risk of prostate cancer at diagnosis may not need treatment right away, because their cancer is going to have a very slow and somewhat indolent course.”
Surveillance, monitoring, and routine PSA testing would be recommended. If the cancer becomes more aggressive, treatment such as surgery or radiation could follow.
“Treatment recommendations should always be tailored to the individual and their personal approach,” says Dr. Herman, “and with a physician that is willing to take that personal approach, work with the individual, and understand where they are coming from.”
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