Prostate cancer risk factors, part 2: Controversial screening debate and cancer/non-cancer treatments

In April, 2017, the Wall Street Journal, AARP Bulletin, and Northwest Herald reported on the latest positive recommendation from the U.S. Preventative Services Task Force concerning the use of P.S.A. (prostate specific antigen) testing for men 55 to 69 years of age of average risk and higher risk for developing cancer. One physician, Dr. Eric Klein, of the Cleveland Clinic, even recommends a baseline PSA test for all men at age 50 and for higher-risk patients at age 45. 

The PSA, according to Northwest Herald, is “a simple blood test for a specific protein. Elevated levels may be a sign of cancer but can be caused by less serious conditions such as an enlarged prostate or an infection. The goal is to find cancer at an early, treatable stage.”  

As in other cancers, biopsies confirm suspicious results. The U.S. Food and Drug Administration approved the screening test in 1994.

The controversy stems today from the fact that both in 2008 and in 2012, the panel of doctors decided that not all men need to get tested. Now, however, there is evidence that screening can save certain men’s lives, despite the fact that, according to the Northwest Herald, “Prostate cancer usually grows too slowly to be lethal; most affected men will die of other causes and never experience symptoms.” 

The local paper continues “Positive tests may lead to treatment for something that isn’t dangerous. Treatment often involves radiation or surgery, which can cause incontinence and impotence.” With their recent drafted decision, the panel of professionals suggest that only men below the age of 70 talk with their doctors to discuss pros and cons of the PSA test. These same males can then make their own educated decision on being tested. 

Besides the PSA test, three newer tests to develop better predictability of prostate cancer include:

1. A urine analysis called PCA3

2. The OPKO 4Kscore blood test, and finally

3. The mpMRI scan that accurately diagnoses aggressive tumors in 93 percent of suspected cases according to AARP Bulletin. Active surveillance seems to also work for slow-growing cancers with scores of 6 or less. This includes periodic PSA tests, biopsies, and rectal exams (where if there is cancer, it is confined to one lobe of the prostate), and MRIs to check for changes.

Mayo Clinic informs us that prostate cancer treatment today relies on how fast the cancer is growing, how much it has spread, and the patient’s overall health. Treatments include:

1. External radiation therapy

2. Internal radioactive seeding of the prostate

3. Hormone therapy (using drugs) to block testosterone hormone production or removal of the testicles which make the hormone

4. Surgery to remove the prostate (four different procedures)

5. Chemotherapy or use of varying drugs,

6. Cryosurgery or cryoablation using freezing to kill the cancer cells

7. Biological therapy using the patient’s own immune cells, genetically engineered in a lab, to fight the cancer.     

But what about the 50% of men over the age of 50 who have developed enlarged prostates and already exhibit symptoms mentioned in my last article? In the past, these male sufferers have had to choose between surgery or medication, both of which have many side effects. 

Now the Wall Street Journal, April 24, 2017, reports that two minimally invasive procedures have become available to replace older treatments. The first therapy, Uro-Lift, developed by Neo-Tract Inc., is an implanted device (limited in use to certain prostate anatomy sizes). The second therapy, Rezum, developed by NxThera, Inc. uses thermal energy in the form of steam applied to the prostate with a needle which has shown success in shrinking the gland.

---