There has been a great deal of controversy in the media about prostate cancer screening. With all the confusion over the need for PSA testing and the need to treat prostate cancer, my biggest concern as an urologist is that men will throw up their hands and take the scariest approach of all – doing nothing. In an effort to prevent this from happening, I'm going straight to the source of most men’s health care decisions – women. You are often the most influential advocates and the catalyst for men’s health and well being. My hope is that by arming you with accurate information you can help your loved ones make informed decisions about their prostate health.
1. PSA Tests are Important in the Evaluation of a Man's Overall Prostate Health
Let's clear this one up right away. According to the American Urological Association (AUA): http://www.auanet.org/content/health-policy/government-relations-and-advocacy/in-the-news/uspstf-psa-recommendations.cfm?WT.mc_id=EML6621MKT, PSA testing remains an important indicator of a man's risk for having prostate cancer. One misperception that many people have is that a PSA test diagnoses prostate cancer. It does not. A PSA test simply helps the qualified urologist assess a patient's overall risk for having prostate cancer. The test that actually diagnoses prostate cancer is a prostate biopsy. A prostate biopsy is done if the urologist has a high suspicion of prostate cancer in a patient, based on a rectal examination and PSA test. While a single PSA test may not be very accurate, PSA testing over time (every six to twelve months) can be highly accurate for predicting prostate cancer. Furthermore, other aspects of PSA testing such as the correlation of the PSA to a person’s age, and determination of the “free PSA ratio” can increase the accuracy of PSA testing. Upon taking such factors into consideration, the urologist will determine which patient really needs a prostate biopsy.
2. Treating Prostate Cancer Early Can Be Life-Saving for Some Men
Beyond testing, screening, and diagnosis, is the issue of prostate cancer treatment. At first glance, it seems elementary that anyone with any kind of cancer should undergo treatment. However, numerous media articles have indicated that prostate cancer does not need treatment. It is assumed by some that because prostate cancer grows slowly, men will not die from it. They further speculate that it is not necessary to diagnose or treat prostate cancer. However, such arguments are seriously flawed. Here are some facts. More than 40,000 men die of prostate cancer every year in the U.S. Research shows that the treatment of early prostate cancer does reduce the risk of dying from the disease. PSA screening has lead to lower death rates from prostate cancer. Treatment of early prostate cancer prevents potential development of prostate cancer spreading, which can cause kidney failure, urinary tract hemorrhage, intestinal obstruction, paralysis, leg swelling, anemia, brain and spinal strokes.
It is true that certain types of prostate cancer grow slowly and rarely spread and cause death. It is equally true that certain types of prostate cancer grow aggressively, spread to other organs, lead to significant destruction of a man’s quality of life, and cause death. Currently the only test that can determine the degree of aggressiveness of prostate cancer is a prostate biopsy. Therefore, it is absolutely necessary to perform PSA testing and determine whether a biopsy is required. Once the diagnosis and degree of aggressiveness is established, then a careful discussion between the patient, his family, and his urologist will need to take place. The proper course of action will then be determined. Unfortunately, blanket statements made in the media such as 'PSA testing is not required because patients do not die of prostate cancer' are a disservice to all men and can create a false sense of security.
Many factors play a role in the decision to treat prostate cancer versus the decision to wait. These include but are not limited to degrees of aggressiveness, amount of cancer in the prostate, the age of the patient, and the patient’s own desires. I have had plenty of patients in their 50s who tell me that they wanted the cancer removed before it ever had the chance to spread. These are very personal decisions and they need to be made with much discussion between patients, their family members and their trusted urology health care providers.
3. Prostate Cancer Surgery has Advanced Significantly Throughout the Years
Among the chief reasons men shy away from prostate cancer treatment are the potential side effects. When most men hear that they might experience incontinence or impotence after prostate cancer surgery or radiation, it's no wonder they want to look the other way. But with today's surgical advancements, specifically Robotic Laparoscopic Prostatectomy, performed by highly-skilled urological surgeons these side effects are greatly diminished. In addition, some experts have developed other tools to minimize these risks. Having performed over 1,000 robotic prostate cancer procedures, I have also developed the “Ramin Sling” which can help reduce incontinence after prostate surgery. This technique involves the use of the patient's own healthy tissues to create a support under the urethra and the bladder, much like the one used in women for incontinence. However the advantage of this sling is that it does not use any foreign material or mesh. Finding a qualified urologist who is an expert in the treatment of prostate cancer and robotic surgery is an absolute must. The AUA (American Urological Association) has some great resources to help you find the right urologist: http://www.urologyhealth.org/_media/_pdf/whatisaurologist.pdf
I hope you've found these tips useful in helping the man or men in your life make the most informed decisions about their prostate health. Though it may not be immediate, I'm certain that one day, they'll tell you how much they appreciate your efforts. I've seen it happen more often than not.