Ask the Doctor at Saint John’s: Prostate Cancer -- Put the Odds on Your Side

Q: What are the advantages of early screening for prostate cancer?

A: By Leslie Kaplan, M.D., urologist at Saint John’s Health Center.

One in six American men are at lifetime risk of prostate cancer. If a close relative has prostate cancer, risk more than doubles. The good news? If cancer is detected early, you have a better chance of successful treatment with minimal or short-term side effects.

The American Cancer Society recommends that both the PSA (prostate specific antigen blood test) and DRE (digital rectal examination) be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy.

Men at high risk, such as African American men and men with a strong family history of one or two first degree relatives diagnosed at an early age, should begin testing at age 45. Men at even higher risk, due to three or more first-degree relatives affected at an early age, could begin testing at age 40.

Prostate cancer frequently doesn't produce symptoms. First indication of a problem may come during routine screening tests:

Digital rectal exam (DRE). Your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate. Abnormalities in texture, shape or size of gland may warrant more tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn and analyzed for PSA, a substance produced by the prostate. Small amounts of PSA normally enter the bloodstream. Higher than normal levels may indicate infection, inflammation, enlargement or cancer.

Urine test. Urine sample is analyzed for abnormalities. This test doesn't detect prostate cancer. It helps rule out other conditions.

Transrectal ultrasound. If other tests raise concern, transrectal ultrasound may be used for further evaluation. A small probe into the rectum generates pictures of the prostate.

If cancer is diagnosed, further tests help determine if or how far cancer has spread. When a biopsy confirms the presence of cancer, the treatment you choose may depend on: how fast your cancer is growing; how much it has spread; age and health; benefits and potential side effects of treatment.

Sometimes, watchful waiting is recommended if your cancer isn't causing symptoms, is expected to grow slowly, and is small and confined to one area of your prostate.

That said, prostate cancer treatment is advancing quickly. Surgical therapy for localized prostate cancer continues to evolve. Nerve sparing surgery can be performed using minimally invasive and robotic techniques in selected patients.

In prostate seed implantation, radioactive seeds are placed into the prostate. Both Low Dose Rate (LDR) and High Dose Rate (HDR) systems are used at Saint John’s. For early-stage, low-risk patients, radioactive implants are a convenient treatment. Saint John’s physicians are offering the full complement of available therapies for localized and advanced prostate cancer.

Dr. Kaplan is a Board Certified urologist on staff at Saint John’s Health Center.

For more information about Dr. Kaplan or other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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