Q&A WITH SEAN DOYLE, MD OF UROLOGIC SPECIALISTS
The prostate is a walnut sized organ that sits right outside the bladder. It has several functions but the main one is the secretion of fluid to help the sperm survive the female reproductive tract. I tell my patients to think about it as a complex piece of plumbing important for urination and fertility. Unfortunately, in about one in seven men, the cells in the prostate stop responding to our normal control systems. This results in uncontrolled cell growth, also known as cancer. This loss of control varies between men, so the cancer can behave very differently among different men. Some men will never be affected by cancer cells in their prostate even if they don’t receive treatment, whereas others will die of their disease despite aggressive therapies.
Most men who have early prostate cancer don’t have any symptoms at all. It is detected with an elevation in a protein in the blood called prostate specific antigen (PSA) or through a prostate exam. Later symptoms can include a change in the frequency or strength of urination, blood in the urine or ejaculate, weight loss, and pain.
There has been a lot of debate about prostate cancer screening.
While there has been much discussion about when prostate screening is indicated, the American Urologic Association currently recommends PSA screening be discussed with patients between the ages of 55-69 as these patients tend to benefit most from screening. Screening is not recommended in low risk men ages 40-54 or over 70. However, risk factors like family history of prostate cancer and African American race should be considered when deciding the age to start screening. An important distinction should be made between a screening test and a diagnostic test. If there are symptoms suggesting there may be issues with the prostate gland, a PSA may be an important part in the diagnostic workup regardless of age.
I’d also add that when it comes to screening, there are a couple of things I ask patients to consider. If prostate cancer is detected early, when the disease is confined to the organ, nearly 100% of patients will survive their cancer at five years and 98% will survive their cancer at ten years. When the cancer has spread, however, the 5-year survival rate is less than 30%. That’s a pretty strong incentive to identify cancer early, and currently the PSA is the most widely available test for early detection.
One of the biggest changes is in the treatment of men with low risk early stage prostate cancer. These are the patients for which we believe the risks of cancer treatment outweigh the benefits. In other words, you are more likely to suffer if your cancer is treated than if you do nothing for now. We closely monitor the cancer in these patients. This is called “active surveillance” and it should be discussed with every patient with low risk prostate cancer.
There have been incredible advances in the treatment of both early and late stage prostate cancer. Robotic assisted surgery to remove the prostate gland offers many benefits including less blood loss, less pain, and faster recovery. This surgery has all but replaced open surgery for prostatectomy. Many different medications to treat late stage prostate cancer have been approved in the last 10 years as well. Eventually, we hope to turn prostate cancer into a disease that men live with and manage for years instead of it being one they die from.
When asked that question, I tend to refocus patients from prostate health to overall health. I tell people what is good for their heart is also good for their prostate. Do what you know you should be doing. Get to your ideal body weight. Eat right. Exercise. Don’t smoke. And please, stay away from “prostate supplements”. Neither their ingredients nor their claims have been fully evaluated.
About Sean Doyle, MD Dr. Doyle is a board-certified urologist with extensive training in the laparoscopic and robotic treatment of urologic cancers including prostate, bladder, kidney, adrenal and testis.