New ways to detect, treat prostate cancer New ways to detect, treat prostate cancer (September 16, 2005)

By Dr. Arnold Aigen

Q: What is the prostate and what causes cancer in it? A: The prostate is a walnut-sized gland located behind the pubic bones in the male pelvis. The prostate produces seminal fluid, which, when mixed with the sperm from the testicles, is semen. As men age, it can also produce a lot of mischief.

The cause of prostate cancer is unknown, though we know that the risk of getting it increases with age and the risk is markedly higher in those with a family member with the disease. More than 70 percent of prostate cancers are diagnosed in men over 65. It's the most common non-skin cancer among men in the U.S. and the No. 2 cancer killer in men.

Although the number of men who get this disease is great, the number who die from it is relatively small. Many men can live with prostate cancer for many years.
Q: Can prostate cancer be prevented? A: There are known risk factors associated with prostate cancer, though not all of them can be avoided. Age is primary, so men over 50 should get a prostate cancer screening. Another known risk factor is race. Incidences of prostate cancer are significantly higher among blacks; they should contemplate getting screenings beginning around the age of 45.

The effect of diet is unverified, although diets high in animal fat may contribute to an increased risk. More studies are needed to determine if a low-fat diet with more fruits and vegetables helps prevent prostate cancer. Maintaining a healthy lifestyle is essential to helping prevent prostate and other cancers.
Q: Can prostate cancer be detected before symptoms occur? A: Yes. There are currently two tests used to detect prostate cancer. A physician can perform a digital rectal exam (DRE) to seek out firm areas. Another is a blood test that detects a substance produced by the prostate, called prostate specific antigen (PSA). Used together, these tests can detect prostate cancers that have not yet caused symptoms.

Early PSA screening may reduce men's risk of aggressive, metastatic prostate cancer by as much as 35 percent. None of the screening tests for prostate cancer is perfect. About 15 percent of cancers may be found in men with normal PSA levels, but these deficiencies don't negate the value of PSA in early detection.
Q: What are the symptoms of prostate cancer? A: Early stages of prostate cancer usually don't trigger symptoms, but some men with prostate cancer may experience urination difficulties.
Q: Are there any new options for treating prostate cancer? A: Traditionally, prostate cancer is treated surgically, but technological advancements are speeding the progress of less invasive treatment. One noteworthy innovation is cesium brachytherapy. It's is a minimally invasive procedure performed with needles rather than incisions, using computer modeling to accurately place the cesium "seeds" in the prostate. The seeds are actually tiny capsules that slowly release radiation into an area about the size of a quarter. Because needles are used to implant the cesium seeds, no incision or stitches are needed, so the out-patient procedure is completed in about one hour. Patients are typically back to normal activities in a few days.
Arnold Aigen, M.D., is a urologist at Camino Medical Group in Sunnyvale. Dr. Aigen is one of the few urologists in the Bay Area offering the cesium brachytherapy prostate treatment.

Have a medical question? E-mail it to Cynthia Greaves at greavec@caminomedical.org.

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