Prostate health addressed at informational meeting

Sept. 06--Subject yourself to the finger wave and know your treatment options if you've got it -- that is the advice of a urologist and a radiation oncologist who addressed a group of men and women at an informational meeting Thursday morning sponsored by the Prostate Cancer Support Group of Craven County.

Two doctors -- urologist Thomas Stewart and oncologist Seth Miller -- spoke on prostate cancer subjects relating to their particular fields at McCarthy Court. At the same meeting both New Bern Alderman Jeffrey Odham and County Commissioner Johnnie Sampson presented proclamations declaring September Prostate Cancer Awareness Month in the city and county.

Stewart addressed the issue of the digital rectal exam (DRE) for screening for cancer.

Stewart noted that, while the United States Prevention Services Task Force (USPSTF) ruled in 2012 that the digital exam was not accurate enough, giving it a D rating and suggesting doctors stop using it, relying instead on Prostate-Specific Antigen PSA screening -- a blood test.

The antigen test has a higher rate of finding cancers -- when both were in use, the PSA found 69 percent of cancers and the DRE found a lower 31 percent.

Still, Stewart argued, that is a significant number that should keep both tests in use. "This idea that we shouldn't be using our most important tool for prostate screening is ridiculous," he said.

Since the 2012 recommendation, he said, the number of prostate cancers found overall has gone down -- meaning not that fewer men have developed the cancer, but that more men with cancer have been missed, he argued. The rate of metastatic prostate cancer -- cancer that has advanced to the point that it has begun to spread -- is also on the increase, he said, showing that the cancers are not being found as early in their development.

While the survival rate of prostate cancer patients over five years has dramatically improved over the last several years -- from 68 percent in the '70s to 98 percent now -- he said that the survival rate of metastatic prostate cancer is significantly lower.

He said that a number of organizations, including the American Urologists Association (AUA) have taken new studies suggesting the decline in found cancers is a result of using the digital exam. "In 2017 NUSPSTF changed the DRE for men 55 to 69 to a C rating," he said -- meaning the organization is still not impressed with the test, but admitted that patients should have the option of submitting to it.

The AUA advocates that both tests ought to be used, and lists guidelines at what age men should submit to the DRE:

Men under 40 should not screen for the cancer, but men at high risk should consider it from ages 40 to 54.

The screening is most effective for men aged 55 to 69.

Once men turn 70, only those in excellent health should screen -- this, because prostate cancer is a slow-growing cancer and its treatment can be harmful for older, unhealthy men.

"High risk" would be defined as men with a family history of cancer and African Americans, who are at a 2/3 higher risk to develop the cancer than Caucasians and who have double the risk of dying from it.

The DRE exam consists of a doctor placing his finger into the rectum of the patient and pressing against the prostate. The organization's president, Victor Taylor, said that he had tested negative with the blood test, but that his own prostate cancer was found through the DRE exam. "It might be uncomfortable for a moment," he said, "But it works for a lifetime."

Miller then spoke of a new method of treatment in radiation.

He noted that a man's prostate is located in close proximity to a number of vital organs including the rectum and colon. "One of our greatest challenges," he said, "is limiting doses to other structures while delivering maximum doses to the prostate."

A new treatment called SpaceOAR has been introduced, he said, as a means of protecting the rectum and colon from radiation. "Treatment is all about location, location, location," he said.

SpaceOAR is a gel that is injected between the prostate and rectum, creating additional space between them. After about three months the gel is absorbed by the body and disappears.

"It's really got a great reduction in dose to the rectum and the penile bulb," he said. "It also improves rectal toxicity" -- some men, during radiation, suffer bouts of diarrhea, for instance, but SpaceOAR has been shown to reduce this side effect 66 percent. It also increased urinary quality of life 65 percent and sexual function 78 percent.

Taylor told the gathering that a free prostate cancer screening has been set for all men 40 or older on September 15 from 9 a.m. to noon at the CarolinaEast Urology Center at 705 Newman Road, New Bern.

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