Sunday, July 1, 2007

Prostate Cancer

Real Men Get It Checked!

Spring of 2004 was a busy time for me as I was preparing for the United States Medical Licensing Exam, Part I and completing my 2nd year of medical school. The phone call came from my mother and was of no surprise. She often called to check on me to see if I needed anything; I always needed something. But this phone call was unique and I could hear in her voice concern, worry, and a touch of fear: “Your dad has been diagnosed with cancer!” Huh? Say what? The man, who helped her to raise four kids, joined the military, graduated with honors from both undergraduate school and graduate school earning a doctorate in education, and turned down an opportunity to play pro football to teach; this could not be. But it was a reality, however, and at the age of 59, my father took on the battle of the most common non-skin cancer in America: Prostate Cancer!

In 2007 it is estimated that more than 218,000 men will be diagnosed with prostate cancer and more than 27,000 will actually die from the disease. There are approximately 2 million American men living with prostate cancer, unfortunately African American men are affected disproportionately. African American men are 56% more likely to develop prostate cancer compared to Caucasian men, and are 2.5 times as likely to die from the disease. The reasons for this disparity is unknown, but one thing we do know is that prostate cancer is the “male disease” and there is no reason why a man with risk factors or a family history of prostate cancer should not get his prostate checked. Real Men Get It Checked!

Fear of needles is a common problem encountered in physician offices, but when the idea of a digital rectal exam (DRE) is suggested to some men they break out running! The DRE combined with a simple blood test called a prostate-specific antigen (PSA) test are what we doctors use to detect prostate cancer. If the PSA is elevated and/or the prostate exam is abnormal, a biopsy of the prostate is usually performed to determine if cancer is actually present. Once the diagnosis is made, the different treatment options are then discussed.

The question is who should be tested? The American Cancer Society recommends that men begin testing (DRE and PSA) annually at age 45 for high risk populations which include African American men and men with strong family history of prostate cancer. Men at even higher risk, which would include those with more than one first-degree relative affected at an early age, could begin testing at age 40.

Primary risk factors for prostate cancer include being African American, family history of the disease, and older age. As men get older, the prostate, which is a reproductive organ increases in size and may cause symptoms of an enlarged prostate called benign prostatic-hypertrophy (BPH). Signs of BPH include waking up frequently at night to urinate; sudden or strong urge to urinate; straining to urinate; a weak urinary stream; dribbling after finishing urinating; feeling like the bladder has not completely emptied; pain or burning while urinating. These can also be symptoms of prostate cancer, but in most cases, there are no symptoms at all and that’s why early detection and screening is so important.

Some studies have shown that diets higher in fat intake are associated with an increased risk of prostate cancer. Thirty to 40 percent of the calories in American diets are made up of fat compared to Japanese diets that consist of only 15% fat. The incidence of prostate cancer and the death rates are significantly lower in Japan than those in the United States. Diets high in vegetables may lower the risk of this disease and there is also evidence that lycopene (an antioxidant found in tomatoes and tomato-based products), selenium (a trace element), and vitamin E may also reduce the risk.

Once the diagnosis if confirmed by, which is a grading scale used to determine how aggressive the cancer might be, is assigned, the different treatment options are discussed with the patient and the urologist (one who specializes in diseases of the urinary system and prostate). An in-depth discussion on treatment options is beyond the scope of this article, but there are multiple options including surgical, radiation therapy, hormone therapy, chemotherapy, and even observation (active surveillance). An intimate discussion between the patient and the surgeon must take place to decide what option would be best.

My father has done well and not only survived his bout with prostate cancer, but has remained cancer free since undergoing surgery almost 11 years ago. Since that time he has two brothers who have been diagnosed with the disease; and yes I got it checked. My daughter depends on her father and I have to do whatever necessary to prevent illness to watch her grow old. So I say to all those brothers who are too busy to see the doctor, feel as if it can not happen to them, or who are afraid of the digital rectal exam: your life and that of your family depends upon you and your decisions…REAL MEN GET IT CHECKED!

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