Affinity Health Plan

  • Advances Have Improved Prostate Cancer Screening

    September 29, 2015

    Prostate_Cancer_LargeMen are notorious for not getting check-ups. Most think, why go when nothing is wrong?

    But here's the thing.  Prostate cancer has no symptoms, and when symptoms do start it means that the cancer is advanced.  That is why seeing a doctor every year is important.

    This year, in America, approximately 220,800 new cases of prostate cancer expected and about 27,540 men will die from it.  Except for skin cancer, prostate cancer is the most common form of cancer.  What's more, it's the second leading cause of death among men, after lung cancer, statistics from the Centers for Disease Control and Prevention in Atlanta show.  The incidence of prostate cancer is highest among African-American men, followed by whites and Hispanics.  African-American men are more likely to die from the disease than white men, according to the National Institutes of Health Cancer Institute.

    The latest government guidelines, released in 2012, coupled with long-standing advances in detection methods have vastly improved screening methods and a man's chances of living with or defeating prostate cancer.  

    Age is the greatest risk factor for prostate cancer. The older a man is the greater his chances are for contracting the disease. The guidelines recommend these ages for screening:

    • Age 50 for men at average to small risk
    • Age 45 for men at high risk - that includes African Americans and men with a father, brother or son diagnosed with cancer before the age 65
    • Age 40 for men at highest risk - that includes men with who had more than one immediate family member with prostate cancer at an early age

    Dr. Pedro Maria, a urologist with Montefiore Medical Center, goes further. "The Guidelines do not apply to every ethnic group outside the United States," he said, adding, "For example Jamaica is one of the countries with the highest incidence of prostate cancer, and it is in the Caribbean," he said. "Therefore, when having a discussion about PSA screening and prostate cancer it is important for the physician to take into consideration the patient's ethnic background."

    The prostate is a small gland, below the bladder and in front of the rectum, which makes fluid to carry sperm.   As men age this gland grows, and it can interfere with the urinary tract.  The problems include difficulty urinating and having to urinate often, especially at night. While these are among the signs of prostate cancer, it also can signal other problems such as benign prostatic hyperplasia, a condition in which the prostate grows so large that interferes with the urinary tract. "It is common after age 50," said Dr. Maria. "In fact, I have seen patients with it at age 40."  While it mimics cancer symptoms, "benign prostatic hyperplasia has nothing to do with cancer," he said, noting, "Before the PSA-era, which is in the '80s, these were symptoms that men with prostate cancer would present."  Back then, by the time a doctor was seen it was too late. The cancer would have taken hold and even spread. Better testing has changed that.

     Prostate-Specific Antigen (PSA) test, approved for use by the FDA in 1984 to track prostate cancer in men already diagnosed with the disease, turned into a major diagnostic advancement.  PSA is a protein made by the prostate. It can be measured in the blood as part of a screening for prostate cancer. "Now after the PSA, we rarely see a patient with prostate cancer so severe that it causes any symptoms," he said.

    The guidelines are against using the PSA alone to screen for cancer.  "Sometimes you can have a normal PSA, but that doesn't mean that you don't have a nodule," the doctor explained.  "That is why we have the PSA and the digital rectal examination. These tests complement each other."  While the digital rectal exam may be unpleasant, Dr. Maria said it is necessary.

    Prostate cancer can sometimes develop very slowly. The doctor explained that as a consequence, the guidelines allow some patients to take part in what medical professionals call active surveillance. "If it is a low-grade prostate cancer and meets the specific criteria, then that person doesn't need to undergo any treatment," he said. "We can follow up with a PSA every six months and do a biopsy every year."  This type of treatment does have its risks. "It is absolutely essential that a patient have knowledge of the disease, and is prepared to live with cancer." The patient must be compliant. That means showing up without fail to appointments and tests. Patient's involvement is key in this method of treatment. To help him, the doctor said that sometimes he will involve the family.  But for some patients this active surveillance doesn't work. "Sometimes, you have to make a decision on behalf of the patient just to prevent the patient from disappearing and the disease from getting worse," he said. In those cases, he still works to get and keep the patient involved.  "Getting a patient involved in the decision making is the ideal," he said.

    Contact the organization below for more information:

    1. The American Cancer Society
    2. The Centers For Disease Control and Prevention
    3. The National Cancer Institute

    Dr. Pedro Maria is Director, Caribbean and Latin American Programs, Urology, Montefiore and Einstein. Dr. Maria obtained his medical degree from the Philadelphia College of Osteopathic Medicine. He completed his residency training in urology at the Albert Einstein Medical Center in Philadelphia, and he obtained fellowship training in minimally invasive and robotic surgery at Montefiore and Einstein. He is the Director of Minimally Invasive and Robotic Surgery, North Campus. Dr. Maria's practice includes the treatment of patients with all forms of urologic disease. Dr. Maria provides services to members oftheAffinity Health Plan.

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