Monitor prostate antigen levels over time, callers told

Prostate-specific antigen test results are not a diagnosis of prostate cancer but may indicate the need for biopsy. And even if the biopsy is normal, the PSA level should be monitored over time because the tissue for the biopsy might have been taken from a cancer-free area.

"You can miss it. That's why follow-up is important," Dr. George Middleton, a urologist at Cottonwood Hospital, told one of the more than 40 people who called the Deseret Morning News/Intermountain Health Care Hotline on Saturday seeking information on prostate cancer detection and treatment.

Middleton and Dr. Richard Labasky, a urologist at Alta View Hospital, advised callers to be cautious but also offered reassurance, noting that prostate cancer is a typically slow-growing, very treatable disease if caught early and that antigen levels might be elevated because the prostate is enlarged, a common condition in older men.

One caller had surgery to remove his prostate but still required additional treatment. That's not uncommon, Middleton said. Each year, about 70,000 American men "fail" initial therapy and require additional treatment, such as radiation.

For some people, treatment is less about saving the life than it is about preserving quality of life, said Labasky.

Whether someone dies of prostate cancer depends in large part on how early it is detected, if it has spread and the "grade" — how aggressive the cancer cells are.

Middleton recommends a PSA test and digital rectal exam every six months, even after surgery, for 10 years. If that checks out normal, the patient may move to an annual exam.

Labasky and Middleton agree that there is a strong genetic link in prostate cancer, but other risk factors may act as the "trigger," including diet and exercise. Even how long someone has been overweight can indicate the gravity of the disease. "Someone who was fat all their life is at greater risk than someone who put on weight because he couldn't exercise as hard at age 55," Middleton said.

Not all prostate cancer has an elevated PSA result, Middleton noted.

Several callers wanted to know how aggressively their prostate cancer should be treated. The doctors said that a patient would need to have at least a 10-year or longer life expectancy for major interventions. Because the cancer tends to grow slowly, radical treatment is not recommended for people in their 80s, for instance.