Rohnda Smith-Simmons - Prostate Cancer

Autopsy studies reveal that 80% of 80 year old men are found to have prostate cancer. In Bermuda because of the known increased risk of the disease for Black men, our centre recommends that men have a baseline test by the age of 40 years. If there is a strong family history, this screening may be recommended even earlier. Black men have a 60% higher incidence of prostate cancer as well as a higher death rate than white males - 64% vs. 26% according to the latest statistics from the American Cancer Society. According to the CDC, the lifetime risk for Black men in the U.S. being diagnosed with prostate cancer is 1 in 5. Many prostate cancers particularly in the elderly male, are slow-growing and the likelihood is that the person will die of another chronic illness before he can succumb to prostate disease.

 Your next question might well be- can prostate cancer be prevented? To date, medical experts do not know how to prevent prostate cancer. Researchers are currently working on a prostate cancer vaccine; however, none produced thus far has been approved by the FDA. This vaccine is currently available only to men participating in clinical trials and is considered therapeutic as opposed to preventative. In addition, researchers are studying many factors including culture, environment, and differences in the biology of the disease in African-American men. They do know that not smoking, eating a healthy diet, staying physically active, and seeing your doctor regularly contribute to overall good health. A study by Prezioso et al 2004 showed that with the migration of Chinese and Japanese men to North America the incidence of Prostate Cancer rose from 1.8 and 5.1 respectively to 14.9 and 16.5. This quote was taken from the article - "Until recently the concept that dietary variables could influence the pathogenesis of cancer was considered with scepticism, but now interest centers on whether worldwide variability is caused by dietary factors such as the high intake of fat in the West, or prevented by particular constituents of the Asian diet".

The next big question will likely be - who should get treatment for Prostate Cancer?

The answer is, certainly all men who have been diagnosed with an aggressive form of the disease and those who are symptomatic.  The treatments however will vary from one person to another. There is no one treatment paradigm to follow.

Treatments will depend on many factors:  Age at diagnosis, Stage of disease, General health of patient, Patient choice on advice of physician.

Treatment choices include: Active Surveillance (aka "Watchful Waiting"), Surgery, Radiation, and Hormone Therapy. Chemotherapy

Active Surveillance

If the risks and possible side effects of treatment outweigh the possible benefits, your doctor may suggest active surveillance

This is more likely if you are older or have serious health issues

May involve more frequent DRE and PSA exams

Surgery

Most used for early stage disease and may involve removal of the entire gland or only a portion

May be used in advanced prostate cancer to relieve symptoms:  Open surgery, Laparoscopy prostatectomy, Robotic laparoscopic prostatectomy, Cryosurgery

Radiation therapy

Is an option for men with any stage of prostate cancer, External radiation, Internal radiation

Hormone Therapy

Essentially two types:  LH-RH agonists: prevent the testicles from making testosterone, Anti-androgens: block the effect of male hormones thereby slowing the growth and spread of the cancer

Chemotherapy

May be used for prostate cancer that has spread and no longer responds to hormone therapy, The side effects depend mainly on which drugs are given and how much.