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Prostate cancer: It's not one size fits all

The Indianapolis Recorder - 11/30/2017

One in 10 men will be diagnosed with prostate cancer, but not all will require the same type of treatment. Along with healthy diet and exercise, regular screening is a way to commit to your overall long-term health. Here are some more things you should know about prostate cancer:

What is the PSA test and what are the current recommendations surrounding it?

PSA stands for prostate-specific antigen, which is a protein produced by the prostate. A simple blood test is required to measure PSA levels. This test can help detect prostate cancer.

It's important to know that your PSA number can bounce around, so don't be alarmed after one test. PSA can be elevated due to several factors including a large prostate or prostate infection. Even cycling and other activities can put pressure on the prostate and temporarily raise the PSA level. If the first test shows an elevated PSA level, it's recommended to have a second test done.

We recommend that men of average risk receive annual testing from age 50 to age 70, if their life expectancy is more than 10 years. Men who are high-risk for prostate cancer (father or brother with prostate cancer or African-American) should talk with their doctor about beginning screening earlier.

Is the PSA test the most effective way to screen for prostate cancer? What other options are there?

PSA tests catch prostate cancer very early - we are talking seven to 10 years before symptoms show. Since PSA screening started in the 1980s, the death rate from prostate cancer has been cut nearly in half. The difference today is we know a lot of prostate cancers are low risk and can be monitored instead of requiring surgery or radiation. This allows us to focus on treating the more aggressive cancers.

In addition to PSA tests, newer technologies like the 4K score blood test helps us determine which men do or do not need biopsy. A digital rectal exam can also improve the detection of prostate cancer and is a 30-second exam done by your doctor.

In the last couple of years, MRI has become much better at finding prostate cancers, which makes for more accurate biopsy. At IU Health, we are doing hundreds of MRI fusion biopsies each year, which is an MRI-guided biopsy.

Who is more likely to develop prostate cancer?

African-American men have an increased risk of developing prostate cancer, simply because of their genetic makeup. In addition to this, they are also more likely to develop more aggressive forms of the disease.

Men who have a family history of prostate cancer, do not maintain a healthy diet or are overweight or obese also have an increased risk.

Men who are at increased risk should talk with their doctor to come up with a screening regime that is best for them. This may include an early PSA at 45 years.

What can be done to lower one's risk of prostate cancer?

I always tell my patients that what's healthy for their heart is healthy for their prostate and for their sexual function. Maintaining a healthy diet and limiting sugar, processed foods, carbohydrates and saturated fats can lower risk. Particularly, red meats and dairy are associated with more aggressive prostate cancers.

Regular exercise is good for our overall health as well as prostate health. Exercise combined with a healthy diet and healthy weight will improve overall health and reduce risk of prostate cancer and other diseases.

How does IU Health typically treat prostate cancer?

Prostate cancer is typically slow growing and does not always require treatment. If we screened 100 men, 10 would be diagnosed with prostate cancer. Of those 10, half of them would be considered low risk and could go on active surveillance. Three of them would be considered intermediate risk and may qualify for less aggressive treatments. Two of them would be considered high risk and require more aggressive treatments like radiation and prostatectomy.

Exciting things are happening for those in the intermediate risk category. We are doing less and less aggressive treatments on these patients. We know surgery and radiation have side effects such as incontinence and decreased sexual function. To help prevent those side effects, we are using focal therapy, or HIFU (high-intensity focused ultrasound). This is an outpatient procedure that uses heat to treat just the cancer, leaving healthy prostate tissue intact. HIFU was invented at Indiana University and recently approved by the FDA for prostate treatment. However, it will take some time before insurance companies cover it.

Dr. Clint Bahler is a urologist at IU Health.

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