Significant advancements in the detection and treatment of prostate cancer — the second-most common cause of cancer death in men behind lung cancer — means prostate cancer doesn’t have to be a death sentence or the end of your sex life.
Screenings of the prostate, a walnut-sized portion of a man’s reproductive system that wraps around the urethra, the tube that carries urine out of the body, have improved. More information on prevention is available as are considerably more options — from monitoring to surgery with robotics.
“We understand this cancer much better than we did 10 years ago. We now know that not every man diagnosed is going to die from it and a lot of these men have the very viable option of active surveillance,” said Dr. Dipen Parekh, professor and chairman of the department of urology and director of robotic surgery at the University of Miami Miller School of Medicine.
“Now, hope is a matter of choice, not chance,” Parekh said. “The focus on prostate cancer is not just the cure but, in addition, to get back the quality of life a man enjoyed before he got cancer.”
That point is important because prostate cancer comes with a host of psychological issues given that post-surgical side effects include incontinence, as well as sexual dysfunction or inability to achieve and maintain an erection.
“Good sexual function and continence control, we’re doing much better than we did 10 years back, but by no means are we at optimal level. There are still several layers of improvements where we can make quality of life even better,” Parekh said.
According to the Centers for Disease Control and Prevention, in the United States in 2009, the year with the most recent figures, about 200,000 men were diagnosed, and about 30,000 died from cancer of the prostate.
And while “one in six men may be diagnosed with prostate cancer” at some point in their lifetime, “only one in 35 will die from it,” said Dr. Sri Sundararaman, medical director of radiation oncology for Memorial Cancer Institute in Hollywood. “It doesn’t immediately bring up the connotation of having less than a year to live. Millions are living with prostate cancer under watchful waiting.”
In fact, most older men who have prostate cancer die from heart attacks, strokes or old age, rather than from the cancer.
Given that most men don’t die from prostate cancer and that blood tests, like the PSA, can result in unnecessary surgeries, which contain a host of risks, the U.S. Prevention Services Task Force recommended against routine screening for prostate cancer in 2012. That recommendation proved controversial among urologists.
“There have been conflicts in the media, even in medical literature, ‘Why do we care about prostate cancer, it doesn’t kill many people and most of the time it’s benign and most men die with prostate cancer?’ But we are still dealing with tens of thousands of men dealing with prostate cancer and annually die from it,” Sundararaman said. “What we want to do, from start to finish, we want to make sure a patient understands that they can empower themselves about their situation. Not knowing, not checking is not an appropriate way to deal with this.
“If you are talking about a man, 40 to 50, a rectal exam goes hand in hand with a blood test. Start checking by 50. Start earlier if you have younger family members affected by prostate cancer.”