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Prostate cancer often a disregarded concern by men

Prostate cancer is the second most-common form of cancer (after skin cancer) and the second leading cause of cancer-related deaths (after lung cancer) in American men, according to the American Cancer Society — and every year, more than 200,000 new cases are diagnosed. But while one is six American men are expected to have this disease during their lifetime, men are much less likely than women to worry about preventive screening.

“The most common killer for men is cardiac disease, so if you’re watching your diet and exercise and are not smoking, the next thing to watch is prostate cancer. Unfortunately in the Northwest, we’re active outdoors and enjoy recreation (and healthy activities), and we don’t think we need to be checked,” said Marc Mitchell, a urologist with The Doctors Clinic. “Men in the Pacific Northwest don’t think they need to watch their cardiac health or urinary tract health, there tends to be less awareness. As a man, that concerns me.”

He said in terms of public awareness, the issue of prostate cancer is where breast cancer was about 20 years ago, and one reason is because women in general are more open to talk to other women about their health.

“Men generally bring up the subject of what’s going on in their lives only when asked directly,” Mitchell said.

As with many other cancers, if detected early, prostate cancer is very treatable. Surgery and radiation are the most common treatment options but there are many others, including cryotherapy.

“If you’re treated, your chances are very good you will be a cancer survivor but the percentage is based on your risk category,” said Dr. R. Alex Hsi with Peninsula Cancer Center, who founded the Peninsula Prostate Institute, a consortium of Kitsap Peninsula specialists including urologists, radiation and medical oncologists from different practices. “The risk categories (low, medium and high) tell us how aggressively and quickly it grows.”

He said some patients may not need treatment other than “active surveillance” but the key is that they still need to be screened and diagnosed. The only way to diagnose prostate cancer is through a medical exam and a PSA (prostate-specific antigen) test. The PSA is a substance produced by the prostate, and if the blood has an elevated level of PSA, cancer may be suspected — but there may be other reasons for an elevated result.

Mitchell said traditionally, it has been recommended for men to be screened starting at age 50. “The problem is, a lot of men develop an enlarged prostate or cancer at a younger age so it’s hard to have a baseline,” he said.

He said recent recommendations from the American Society of Clinical Oncology is for men to get their first PSA test at age 40, before the onset of cancer, so that a baseline is available. If that test shows a low level (i.e. 1.5), then the risk is low but if it’s higher (i.e. 2.5), then the person has to be monitored more closely.

Locally, Mitchell is one of two surgeons currently who can perform robotic surgery for prostate cancer, a less invasive procedure that requires only small incisions and has shorter recovery time. He said while surgery is prevalent, it’s important for a patient to be educated about all his options, including the benefits and drawbacks of each.

“It’s a very detailed discussion and has to be tailored to every individual,” he said.

The Peninsula Prostate Institute model has allowed for those discussions to take place among the various specialists during case review meetings, Hsi said, and the idea has been well-received. Patients who choose to be involved with the institute get their cases reviewed by the group together and can then see each needed specialist during one visit to the clinic and talk about treatment.

“It gives them a comprehensive overview of their care and different options,” he said. “…They get their opinion and treatment plan much more quickly and make a more informed decision.”

One of the new treatments for cancer, a vaccine called PROVENGE (manufactured by Seattle-based Dendreon), will soon be among the options for Kitsap patients. In partnership with Harrison Medical Center, the Peninsula Prostate Institute will offer the vaccine, recently approved by the Federal Drug Administration for advanced prostate cancer, in the next month or two.

Mitchell said the most important thing about prostate cancer is to not procrastinate — the later it is diagnosed, the chances of treating it decrease. “If screened early, it works so much better,” he said. “We need to be as proactive with our health as we are proactive with other areas of our lives.”

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