Prostate Cancer - Prevention Has Made A Difference

Think of this. If a man lives long enough, there is virtually a 100 percent of developing prostate cancer.

Startling, but not frightening as such. Certainly, not all prostate cancer is life-threatening, especially the ones that are diagnosed in the older age group, above 70 year.

In general, prostate cancer is relatively slow growing taking at least six to ten years to be felt on rectal examination after the first cell becomes malignant, and another six to ten years before the tumor spreads outside the confines of the prostate gland making it noncurable.

Patient education, frequent annual prostate examinations by digital rectal exam, and the use of a specific blood study called PSA or Prostatic Specific Antigen has markedly improved the cure of prostate cancer.

Twenty-five years ago, when I started practicing urology, 95 percent of my patients had advanced cancer of the prostate on initial diagnosis and it already had spread outside the prostate. Many of them had tumor in their local lymph nodes and in their bones.

All we could do was make them comfortable, improve their quality of life, but we could not sustain their life and cure them of their disease. Today the exact opposite is true. Ninety-five percent of my patients have disease localized to the prostate gland with no evidence of spread outside the prostate, lymph nodes not involved, and bones having no disease.

The patients are potentially curable and most are curable by using local therapy to the prostate. These local therapies include total removal of the prostate, radiation therapy, radioactive needles within the prostate, or combinations of external beam radiation and radioactive needles.

Twenty-five years ago only 50 percent of my patients survived five years. Today more than 85 percent of my patients are surviving ten years and thereafter the survival rates are the same as the age correlated population. The difference is obvious to all of us who work in this field. The media, self help groups, and more intelligent patients are educating the public about cancer prevention and more specifically prostate cancer prevention. Patients are seeing their physicians on an annual basis if they are over 45 to 50 years of age and obtaining an annual prostate exam by digital rectal examination.

They are also obtaining a blood test, PSA, which further enhances the pick-up of prostate cancer before it can even be palpated within the prostate gland itself. The combination of both digital rectal exam and PSA on an annual basis will pick up 98 percent of all prostate cancer at a stage when the disease can be cured.

These two tests have the same results for males as Pap smears and pelvic exams have for females in terms of curing and picking up cancer of the cervix at an early stage. In the future, newer and better markers and diagnostic tests will be formed, but a simple digital rectal exam and a simple relatively cheap blood test at this time is doing a dramatic job of picking up prostate cancer long before it is symptomatic and long before it spreads outside the prostate gland where it can't be cured

In individuals who have a family history of prostate cancer digital rectal exam and PSA should be done from 40 years of age onward. In those patients who are older than 75 year, the examination probably need not be done since early diagnosis of cancer will not lead to treatment in most individuals. Only if the patients become symptomatic with bone pain, anemia, weakness, lethargy, or weight loss should the diagnosis be made and palliative therapy begun.

Patients are smarter by getting more frequent examinations of their prostate, and the remarkable PSA tests have really done a job in reversing the statistics.

Now 95 percent of patients can have cancer picked up before it spreads outside the prostate. Now 95 percent of patients can be cured by radiation or surgical therapy. Instead of a 50 percent five year survival, 85 percent of our patients are surviving 10 or more years.