Unclear if screening saves lives

By JORDAN WILSON

VIEW ON HEALTH

Maybe if men weren't so thick-headed when it comes to going to the doctor, prostate cancer wouldn't be such a widespread problem.

However, that's the routine scenario when it comes to prostate cancer. Many men diagnosed with this disease aren't aware of it until it is in advanced stages. Still, there are differences of opinion when it comes to screening for prostate cancer.

Djenaba Joseph, who is a physician who specializes in prostate cancer and a works as a medical officer for the Centers for Disease Control and Prevention, said getting screened is one of the biggest obstacles to overcome.

Screening can be the difference between dying from prostate cancer and getting it taken care of before it even gains momentum. The early stages of prostate cancer aren't painful, which is why it often goes undetected. By the time men can physically feel prostate cancer, it is likely in its advanced stages.

That's why getting an exam is so important.

"The problem is that men aren't so great about going to see their doctor," Joseph said. "You have to see your physician and discuss whether prostate cancer is a possibility."

Well, maybe men have an excuse. Prostate cancer, after all, is a quiet disease. The symptoms are scarce, as are the side effects.

Prostate cancer in many cases is a silent killer. There are few symptoms and prostate cancer grows at a very slow rate. Unlike the majority of cancers and infectious diseases, prostate cancer can easily slide under the radar because there are very few -- if any -- symptoms. Sometimes, symptoms may include urination problems, such trouble starting or stopping the flow of urine.

"There's really nothing too specific as far as symptoms," Joseph said. "Men can have difficulty starting their urination. They can have a weak flow or it can shut off in the middle. They may go to the bathroom more often and there may be a pain or burning during urination."

Other than that, here isn't much on the symptom front. The cancer can go undetected for years, or even until it becomes deadly.

And to make prostate cancer even more of a crap-shoot, there are no real risk factors. Being old or being African-American is about the only thing that puts you at a higher risk.

"The only risk factor we're sure of is age," Joseph said. "And we don't have any control over there. There is also family history and race. African-American men have a much higher incidence. There's been all sorts of research into obesity, diet and vitamins. We're not for sure if any is associated."

According to the Mayo Clinic, about one in six men in the United States will be affected at some point in their life. Prostate cancer is regarded as one of the most prominent cancers in the United States. With such a high percentage of men at risk, it's important to know the facts behind prostate cancer.

Prostate cancer forms in the prostate, a gland that produces a component of semen, and can actually spread to other parts of the body such as lymph nodes and bones. Aside from the presence of the cancer itself, prostate cancer can create many difficulties in everyday life. Men with prostate cancer can have trouble urinating, can develop erectile dysfunction and might not be able to perform during sexual intercourse.

Not all men have to worry about prostate cancer. At least not now. Men 50 and older are most at risk for prostate cancer and it is rarely seen in younger men. So why does prostate cancer seem to only affect those in their 50s and beyond? Joseph said that as men get older, their prostates enlarge. When the prostate enlarges, it presses on the urethra or bladder, causing urinary problems. However, only about five percent of prostate cancer cases are originally prompted by urinary problems, which is why screening is so important.

Prostate cancer can be detected in a number of ways. The most common is to test PSA levels, or prostate specific antigen levels. If men have an elevated PSA, then a biopsy will be performed, Joseph said. This biopsy will confirm if the cancer exists or if it was just a fluke reading. A physical examination can also help in diagnoses.

One of the most important parts of treating prostate cancer is finding out what stage the cancer is in and how aggressive it may be. Knowing these things can help doctors and those with prostate cancer better decide what method of treatment is best. Also, finding out the stage is important because that will tell if the cancer has spread to other parts of the body.

The stages of prostate cancer range from Stage I, a very mild form that often doesn't need treatment, to stage IV, which means the cancer has spread to many other parts of your body and is an immediate threat.

Even though the word cancer carries such a powerful meaning, some minor forms of prostate cancer aren't powerful enough to put you in a panic. Sometimes, the best thing to do for a very minor case of prostate cancer is to just let it go, as the side effects of treatment may be worse than the actual cancer.

"If it's a low-grade cancer, they may just watch it," Joseph said. "If it gets worse, they'll come back and get a PSA test or maybe repeat a biopsy every so often."

If the cancer is more aggressive and quickly spreading, more forceful measures are taken. Radiation therapy can be used to treat prostate cancer or you can even treat it through, "surgery. You can take out the entire prostate," Joseph said.

Naturally, it is best to detect the cancer early. In doing so, it allows more time for treatment and drastic measures such as removing the prostate and radiation therapy might not be needed.

A PSA test is the standard way to determine the severity - or existence - of prostate cancer. For this, doctors will analyze your blood test for levels of prostate-specific antigen, which is produced by your prostate. High PSA levels can be indicative of prostate cancer, as well as a number of other prostate problems. A physical examination is probably the second most common way to screen for prostate cancer. While not as convenient as a PSA test, it can still be effective.

A physical examination is often referred to as a digital rectal exam. For a DRE, a doctor will insert a finger into your rectum to feel the size shape and texture of the prostate. A biopsy is usually called for after abnormalities in the PSA test or the digital rectal exam. A biopsy for prostate cancer basically consists of your doctor sticking a small probe into your rectum to collect tissue samples from the prostate. Once collected, the tissues can be analyzed to determine if prostate cancer is indeed present and how far along it is.

According to fact sheets on the Web site of the National Cancer Institute, the benefits of screening and for local therapy of early prostate cancer remain unclear, and it is not known for certain whether screening for prostate cancer saves lives. Studies are under way to determine whether screenings with PSA tests or DREs reduce the death rates for prostate cancer.

Even though no solid risk factors for prostate cancer have been identified, it doesn't mean they don't exist, Joseph said. With that in mind, the CDC still encourages people to live a healthy lifestyle incase unhealthy habits and conditions ever are tied to prostate cancer.

"We still do recommend a healthy lifestyle even though we have no hard and fast evidence against it (for prostate cancer)," Joseph said. "For now, we're still recommending the things that you ought to be doing anyway."

She said even though prostate cancer often goes undetected, it is still the most commonly diagnosed cancer in men. And it is the second deadliest cancer a man can have except for lung cancer.

Joseph said some 200,000 men are diagnosed with prostate cancer every year, and just over 10 percent of those men will die from the disease.