Every year about 185,000 new cases of prostate cancer will be diagnosed in the United States. However, while one in eight men will be diagnosed with prostate cancer in his lifetime, only one in 35 will die from the disease, thanks in part to early detection and advanced treatments.
Dr. R. Carrington Mason, a urologist with Cleveland Clinic Indian River Hospital in Vero Beach, knows first-hand the toll a prostate cancer diagnosis can take on a patient. He was diagnosed with the disease 17 years ago when he was only 41, and he recalls vividly the range of emotions he felt when his doctor delivered the news.
“If it had not been for a routine PSA screening, I wouldn’t be here today to help others,” he said candidly. “I got my first screening at age 40 because my father had prostate cancer, which automatically put me at a higher risk. My PSA was 2.3.
“According to the lab sheet that should be nothing to worry about, even though young people should have a PSA less than 2.
“The next year my PSA had elevated to 2.6 and my doctor decided to take a biopsy, and sure enough I had prostate cancer. Having been through it myself has changed my approach to treatment. The National Cancer Care Network guidelines have helped with stratification and development of active surveillance and there are so many modalities that can be offered. It depends entirely on the individual and the progression of the disease.”
Prostate cancer is a slow growing malignant tumor that begins in the outer part of the prostate. Most men will never even know they have it and the majority will live for years with no problems. Because there are no symptoms, it’s imperative to get yearly checkups with PSA (a protein excreted by the prostate gland) screenings and digital rectal examinations to find localized prostate cancers in the early stages.
Men with no family history of the cancer should start yearly screenings between the ages of 50 to 55. African Americans and men with a family history of prostate cancer are at higher risk, so they should start screening between the ages of 40 to 45. The screening is carried on until about age 70 to 75 – or even later for active men who have a life expectancy of 10 years or more ahead of them.
Fortunately, most prostate cancers are confined to the prostate gland and have not spread at the time they are diagnosed. To help predict the aggressiveness the cancer, your physician will calculate a Gleason score, which is a scoring system that assigns a number from 2 to 10 to describe how abnormal the cells appear under the microscope. The more altered the cells look, the more dangerous the cancer.
“When the pathologist looks at a biopsy slide there are five architectural forms they see,” Dr. Mason explained. “The largest area of the tumor will be given a number from 1-5. The second largest will also be given a number of 1-5. We add them together and get the Gleason score. The lowest it could be being 1 plus 1 equaling 2, and the highest would be 5 plus 5 equaling 10. We know that Gleason scores 2-6 are moderately slow growing and a less aggressive type of cancer. Gleason scores of 8-10 are more aggressive and will spread quickly. Based on the Gleason score we’ll formulate treatment options and therapy.
“Not everyone with prostate cancer needs treatment,” Dr. Mason continued. “Those with a Gleason 6 tumor and a favorable PSA can be put on active surveillance. We’ll check the PSA every three months and check imaging once a year. Then every couple of years we’ll get another biopsy. We’ll follow them along and monitor their progression. We have a lot of young, active 60-year-olds that are living great lives with no treatment.”
For those with more aggressive prostate cancer there are many options. If it appears that the cancer has not spread beyond the prostate, a urologist or surgeon may first try non-surgical options like radiation therapy, cryotherapy or hormone therapy.
“Hormonal therapy is utilized alongside radiation as an adjunctive measure for curative therapy, but by itself it is not curative,” Dr. Mason said. “It really just delays the growth of the tumor until it becomes resistant to the treatment. I think it’s better to do definitive therapy and get rid of the tumor. It’s kind of like having a fire on the stove and waiting for it to spread throughout the kitchen prior to calling the fire department.”
Or your surgeon may suggest a complete removal of the prostate through a procedure called radical prostatectomy. Whether a patient has open, laparoscopic or robotic prostatectomy, the pain and recovery time are similar. Most of the surgical procedures for prostate cancer are done in ways that attempt to spare the nerves that control erections and the muscles that control urine flow, yet they can potentially cause erectile dysfunction and incontinence.
“Most men ask what will happen to their sex life, and I answer quite bluntly that any treatment they have will change their sexual function,” Dr. Mason confided. “I encourage patients to make their decision on survival and not on sexual function. The time spent in intimacy is a fraction of the time spent in living. I also remind them that there are medical procedures and medicines that can restore sexual function, so that intimacy can remain in their life. Urinary control is a bigger issue. Many have to relearn how to control their bladder but there are interventions that help them dry up after surgery.
“Being diagnosed with prostate cancer is a tough pill to swallow, especially when you feel fine,” Dr. Mason said. “I spend time with my patients and take them to the point of understanding. I want them to have realistic expectations of the treatments and what the healing process will look like. One of the toughest parts of my job is taking them psychologically to the other side. Prostate cancer is very treatable if detected early, and I’m living proof that life is great after treatment.”
Dr. R. Carrington Mason received his medical degree from Texas College of Osteopathic Medicine and has practiced medicine for more than 20 years. He can be reached at 772-794-9771.
