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Monthly Health Topics

Protect Your Prostate for Men's Health Month

By Susan Beane, M.D., Vice President and Medical Director, Healthfirst
This month, I want to help spread awareness for Men’s Health Month. Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States, according to the Centers for Disease Control. It is also the second-leading cause of cancer death among men of all races. I spoke with my colleague Joseph P. Silletti, M.D., the Chief of Urology at Bronx-Lebanon Hospital Center, so he could share some important background on this disease.
Susan Beane, M.D.: What are the risk factors of prostate cancer?
Joseph P. Silletti, M.D.: Right now, we do know that high-risk groups are African American men and folks who either have a father, brother, or uncle with prostate cancer. There aren’t any real, known environmental factors outside of rare ones like Agent Orange exposure.
Dr. Beane: What are the symptoms of prostate cancer?
Dr. Silletti: Currently, because of screenings, people have no symptoms at all. Usually, we see symptoms only when the cancer is at an advanced stage. So we hope to find no symptoms of prostate cancer and only find the cancer during screenings.
Dr. Beane: How can men reduce their risk of prostate cancer?
Dr. Silletti: The most important thing to do to reduce your overall risk is to be screened. The American Urological Association recommends that men begin screening at age 40 if they are either African American or have a relative [who has prostate cancer]. If you are a high-risk person, the guidelines don’t really say how often you should be screened; that more or less depends on a discussion with your doctor. If you don’t have a high-risk factor, then start screening at age 55 and get screened every other year.
Dr. Beane: What is the screening test for prostate cancer and what’s involved?
Dr. Silletti: Screening for prostate cancer involves two things. One is an examination of the prostate gland: feeling the prostate with the finger. The other is the Prostate Specific Antigen (PSA) blood test. The prostate naturally lets out protein that enters the blood. In patients with prostate cancer, more of that protein is released into the blood. When we see the PSA elevate, we know that there is a risk of prostate cancer.
Most centers, and we here at Bronx-Lebanon Hospital Center, consider anything over a 4 [on the PSA test] to be abnormal. There are a lot of things that could make the blood test elevated, such as the size of the prostate, inflammation of the prostate, any urinary tract infections, or a recent catheter, so we don’t recommend getting an exam if any of those things are going on. It gives you a bad result.
If [the PSA] is elevated, then we recommend a biopsy of the prostate. It’s an office-based procedure we do under local anesthesia. Basically, we take a needle and take about 12 little pieces of the prostate and send them to the lab to be looked at under the microscope.
Dr. Beane: What questions do you get most frequently from your patients about prostate cancer?
Dr. Silletti: There’s a lot of confusion with prostate cancer, since there are a lot of new guidelines. I think the no. 1 question is, “If I have an elevated PSA, does that mean I have cancer?” The answer to that is “no.” The PSA test is just a test that prompts us to do the cancer test, which is the biopsy. The blood test alone does not tell you if you have cancer or not.
Also, there is some confusion about who should be screened. We don’t recommend screening for patients who are sickly, meaning that they don’t have a life expectancy beyond 10 to 15 years. The official cut-off is 70 years old, but we say if you’re a healthy 70-year-old, then you’re a reasonable candidate for a screening. That being said, a sickly 60-year-old shouldn’t be screened. Prostate cancer is such a slow-growing cancer that the likelihood of other problems catching up to people is much higher.
Dr. Beane: What are treatment options for prostate cancer?
Dr. Silletti: Treatment options come in three flavors. One is surgery—taking out the prostate using either traditional surgery or a robot. Number two is radiation, either externally or putting seeds in. And number three—for low-grade, slower-growing cancer—is active surveillance, which is just watching it and following the PSA blood test and exam and making sure it doesn’t become more aggressive.
Dr. Beane: What advice do you have for men who have prostate cancer?
Dr. Silletti: I think no one treatment option is better than any other in terms of cancer survival. Patients’ decisions are mostly based on what the side effects of the treatment are, and that’s a conversation to have with your urologist about what’s best for you.
The most important thing to happen in prostate cancer surgery is the robot. This has really changed the way the surgery is being done, and in some places it’s only a day surgery, or in other places, just an overnight stay, with a small incision. It has really revolutionized what was a difficult surgery and has gotten rid of some of the complication risks associated with it in the past.
Dr. Beane is Vice President and Medical Director at Healthfirst®. For more tips on leading a healthier lifestyle, visit the Healthfirst website at www.healthfirst.org

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