(These FAQs are for men who have received an elevated PSA or have a definitive diagnosis of prostate cancer. As medical oncologists who specialize in the treatment of prostate cancer exclusively, we know that prostate cancer can be managed, and that radical treatments aren’t always the best approach. As such we recommend that men keep their prostates and manage the cancer. Below are answers to some frequently asked questions about prostate cancer and why Keep Your Prostate is our battle cry.)
Prostate cancer is totally silent until it metastasizes. The first step in detecting prostate cancer is conducting a PSA (prostate antigen specific) blood test. This is a routine test for men over 50 and for men with a family history of prostate cancer. Does an elevated PSA always mean prostate cancer?
An elevated PSA may indicate prostate cancer and should never be ignored. PSA screenings greatly improve the chances of detecting prostate cancer at an early stage while it is still curable. But an elevated PSA does not always mean prostate cancer. A PSA screening can also lead to the detection of small “un-cancers” that are totally innocuous. Overtreatment of un-cancers is a big problem.
If a man’s PSA test is elevated, what are the next best steps?
Schedule a consultation with a medical oncologist who specializes in prostate cancer. While there are very few in the country, most will consult long distance via phone, Skype or email.
If a man is diagnosed with an elevated PSA, will he need a biopsy? What are the alternatives to biopsy?
When a man receives an elevated PSA that indicates the possibility of prostate cancer, doctors who are less sophisticated in treating prostate cancer routinely recommend doing a 12-core random biopsy, even for slightly elevated PSAs. This procedure is highly invasive, and often unnecessary. A better alternative is Multiparametic MRI imaging, the best screening tool for a man who has an elevated PSA. If the scan detects an abnormality, it can be further investigated with a targeted biopsy. Men with clear scans can avoid biopsy altogether.
Why is it better to keep your prostate after a cancer diagnosis than to remove it or radiate it?
Prostate cancer is slow growing. Prostate cancer’s low malignant potential means that survival is far more prolonged compared to other cancers, even if a man keeps his cancerous prostate. 91.5% of men living with prostate cancer live a normal life expectancy and die of natural causes, not the cancer. Radical treatments including surgery and radiation often lead to irreversible side effects such as incontinence and sexual dysfunction. Men living with their prostates have a much higher quality of life than men who have had their prostates removed.
What is the life expectancy prostate cancer in general when stage-appropriate treatment is selected?
— Mortality within the first year of diagnosis: 1%
— Mortality within the first 10 years of diagnosis: 2%
— Mortality within the first 15 years of diagnosis: 4%
When properly managed, there is no discernible difference in survival rates for men who have had radical treatments such as surgery or radiation, vs. men who keep their prostates and opt for less invasive treatments. Since prostate cancer is slow growing this begs the question, why rush into a treatment that is irreversible and can have unpleasant side effects?
What is the difference between a prostate oncologist, a medical oncologist and a urologist? Who is the best person to see after a prostate cancer diagnosis?
- A urologist is a medical doctor who focuses on diseases of the urinary tract and the male reproductive tract and sexual organs. Prostate cancer is only one of many diseases that a urologist manages.
- A medical oncologist manages multiple types of cancer. Medical oncology is a sub-specialty of internal medicine. Medical oncologists are trained to diagnose and treat all types of cancer.
- A prostate oncologist is a medical oncologist who specializes exclusively in the management of prostate cancer.
Typically, prostate cancer patients should have at least one consultation with doctors from several specialties, including a urologist, a radiation oncologist and a medical oncologist who specializes in prostate cancer.
Prostate cancer seems to be a single disease. Why does it call for a specialist?Prostate cancer isn’t one disease; it comes in hundreds of varieties. It can be slow or fast growing, responsive or unresponsive to treatment, metastatic or non-metastatic. Most cases lie somewhere in the middle. The best approach is to understand each patient’s particular cancer and treat it individually and specifically. Your decision about who will manage your prostate cancer is one of the most critically important decisions you will ever make.
How does a man know how bad his cancer is, and what the best treatment protocol is?
Prostate oncology specialist Dr. Mark Scholz developed a short, self-administered quiz that directs patients to targeted information about their prostate cancer, once it is diagnosed, that is stage-specific. Based on the stage, patients are provided with in-depth knowledge about treating and managing their cancer.
The quiz talks about the Five Stages of Blue. What are the stages and what does each represent?
The Five Stages are based on the most popular staging system used by doctors to determine the level of risk associated with a man’s prostate cancer. We use STAIR as an acronym:
- Stage 1 – Sky: low risk
- Stage 2 – Teal: intermediate risk
- Stage 3 – Azure: high risk
- Stage 4 – Indigo: relapsed disease
- Stage 5 – Royal: metastatic disease
What are the treatment options for each stage?
There are four broad categories of treatment:
- Observation (active surveillance) is the process of monitoring the cancer without any immediate medical intervention
- Local treatments focus on the prostate gland itself
- Systemic treatments circulate through the blood and treat cancer throughout the body
- Combination therapy is when a local therapy is combined with a systemic therapy, or if multiple systemic therapies are used at the same time.
The best treatment depends on the stage of cancer. Read The Key to Prostate Cancer for details about each stage and possible treatments, and consult a prostate cancer specialist.
What is Active Surveillance and when should it be used?
Active surveillance, or observation, is the process of monitoring the cancer without any immediate medical intervention. As we understand prostate cancer better and better, active surveillance is becomingly increasingly popular for men with Low-risk (Sky) prostate cancer.
Does surgery or radiation always lead to incontinence and/or impotence?
Due to the prostate gland’s location near the bladder, rectum and nerves that control erections, the risk of urinary and sexual problems is very high, even with the best of surgeons. Men can lead a very high quality of life with prostate cancer, if they take the time to assess their stage, seek out a specialist, and determine the best course of treatment that allows them to keep their prostate while managing their cancer.
But doesn’t surgery or radiation cure prostate cancer?
Each year, more than 60,000 men relapse after prostate cancer surgery or radiation. Unfortunately, some of these relapses could have been prevented by using combination therapy with radiation, seed implants and hormonal therapy.
What are the latest developments in Prostate Cancer and its treatment?
New PET scans can accurately reveal the cancer’s location when a relapse after surgery or radiation occurs. New medications that control the hormone-resistant type of prostate cancer have just been FDA approved.
What additional questions should a man with prostate cancer be asking?
The best approach to managing to prostate cancer is for a man and his loved ones and caregivers to educate themselves about the disease and the available treatments. Be your own advocate. Get a second opinion. Above all else, Keep Your Prostate while you are researching your options. Rushing into surgery or radiation can lead to a lifelong diminished quality of life and more often than not, does not lead to longer survival rates. A good working knowledge of prostate cancer is a man’s best protection against the cancer, especially knowing his Stage of Blue.
Additional resources:
Keep Your Prostate:
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Twitter: @keepprostate