JOHNSTOWN, Pa. – Although evidence is mixed and national recommendations vary, two experts say their experience shows screening for prostate cancer can save lives.
A blood test for prostate-specific antigen, or PSA, has been shown to identify men who may be developing prostate cancer – particularly those ages 55 to 70.
"Please get your PSA checked," radiation oncologist Dr. Ali Tunio said from Conemaugh Cancer Center in Johnstown. "That is the way they find it in the early stage.
"I don't want a guy coming to me with advanced prostate cancer; with it in the lymph nodes. I don't want it spreading."
The PSA test measures the antigen on a scale. Those with PSA under 4 usually don't have cancer. Scores between 4 and 10 indicate a one in four chance of having prostate cancer, the American Cancer Society says. Scores over 10 show a better-than-50% chance of prostate cancer.
Other factors can also affect PSA levels.
Another screening test is the digital rectal exam, in which the doctor or other medical professional feels the prostate for cancer.
The prostate is a walnut-sized gland between the bladder and the penis that helps in reproduction and bladder control. Prostate cancer is the second-leading cause of cancer deaths among men, after lung cancer, the Centers for Disease Control and Prevention reports. It is the second most common cancer in men after skin cancer.
Studies have not conclusively shown that screening for prostate cancer reduces mortality in the long run. In fact, the U.S. Preventive Services Task Force in 2012 recommended against the PSA test because of the lack of evidence.
Although the recommendation was reversed last year, Johnstown urologist Dr. Judd Chason said the damage was done.
'Need the screenings'
About 250,000 men a year were diagnosed with prostate cancer before the 2012 guidelines. Since then, it dropped to 175,000, Chason said from Conemaugh Physicians Group – Urology, 1111 Franklin St., Johnstown.
"It doesn't mean 75,000 fewer men are getting cancer, they just aren't getting diagnosed because they aren't getting screened," Chason said. “What we are seeing is more advanced stage cancer, in fact."
Last year the task force issued new guidelines that men age 55 to 69 should consider the PSA after discussing the risk and benefits with their physicians. Risks include anxiety from false positives and possible unnecessary biopsies.
The problem is, most men with prostate cancer don't know it, Chason said.
"Prostate cancer, at its earliest stage does not have any symptoms," he said. "That is why you really need the screenings. For the most part, we can cure it if we find it in early enough."
Because most prostate cancer is progresses slowly and treatment has significant side effects, early cancer is often not treated, but monitored with frequent screenings. The course is called "active surveillance," Chason said.
If cancer is confined to the prostate, most patients have two options: Surgery to remove the prostate, called prostatectomy, or radiation therapy. The radiation can be external beam radiation or internal radiation, known as brachytherapy, in which tiny radioactive pellets are surgically placed near the tumor.
Technology and treatment
Surgery and radiation have been shown to be equally effective in preventing prostate cancer deaths if the cancer is diagnosed early, Tunio said.
"The chances of the cancer coming back after surgery or radiation therapy is less than 5%," Tunio said.
Side effects from either treatment can be rough, the doctors admit.
"The things we talk about are erectile dysfunction and urinary incontinence or leakage," Chason said.
With surgery, the conditions may appear immediately, but lessen over time, Chason said. With radiation, the conditions may develop over time following treatment.
Advances in technology have reduced the side effects in recent years, Tunio said. Conemaugh's new linear accelerator and imaging system helps reduce damage to surrounding tissue.
"This is is pinpoint radiation," he said. "This is a top-of-the line radiation machine."
A normal regimen for radiation therapy requires five-day-a-week treatments for about eight weeks. Each visit takes about 15 minutes, but there is only about three to four minutes of radiation, Tunio said. It takes a few minutes to get the patient into position and double check the beam targeting.
Conemaugh tries to schedule radiation treatments to allow patients to continue with their lives, Tunio said, noting the treatments aren't as debilitating as early radiation therapy.
"The rest of the day, that person can do anything," he said. "It is not a change in life."