SALT LAKE CITY — The advice surrounding prostate cancer screening's a bit confusing. On one hand stand folks who believe that false positives and the slow progression of most forms of the disease would argue that it's a waste of time and resources.
But Dr. Michael Mangelson has had the discussions with men when their cancer has spread. He knows the statistics showing it's the most common malignancy in men. In Utah, it's the top cancer killer of men, while nationally, it's always in the top three, he says.
"It's not a uniformly lethal disease. But it's always potentially lethal.... And I believe screening is important."
Mangelson, a urologist at LDS Hospital and the Salt Lake Clinic, and Dr. Richard Matern, a urologist and surgeon at LDS Hospital, will be featured on Saturday's Deseret News/Intermountain Healthcare Hotline, where they will take questions about prostate cancer. From 10 a.m., people can call 1-800-925-8177 or post questions on the Deseret News Facebook page, www.facebook.com/desnews.
Screening consists of a blood test, called a PSA (prostate-specific antigen) test, and a digital rectal exam. Neither is foolproof. But even critics agree it's a tool that helps find the cancers at an early stage, when they're most treatable, Mangelson says, and results are confirmed with a biopsy.
Diagnosis leads to a long discussion of options, says Matern, that includes everything from watching but not doing anything to surgery and/or radiation in one form or another. There are also some experimental things to discuss, like freezing or heating the cancer.
A patient's age, overall health, life expectancy and the nature of the prostate cancer itself are all considerations, Mangelson says. He likens prostate cancer to five brothers — the last name's the same, but the resemblance may end there. There are five different "Gleason" patterns to the tumor that describe the cellular architecture. And that, in turn, tells experts what kind of potential it has to grow fast or spread quickly. Typically, prostate cancer is a slow-growing thing. But there are aggressive cases and those are typically found in younger patients who are less likely to be screened because of their age.
Still, most people with prostate cancer will die with it, not of it. That's why aggressive treatment is not usually recommended for elderly men who are much more likely to die within a decade or so from something else.
Screening, the two note, should consist of a baseline at about age 40, then at intervals determined in part by what that first PSA shows.
Matern and Mangelson both say some people avoid screenings because they fear possible complications, including impotence and incontinence, if cancer is found.
"I personally think screening is important. Deaths from prostate cancer that was metastatic are declining," Matern said. "We're finding them earlier. Nowadays, there are more with prostate cancer who die from something else than from it. It's a good idea. It's easy."
Tomorrow: A look at treatment options
The Deseret News/Intermountain Healthcare Hotline focuses on prostate cancer. From 10 a.m. to noon Saturday, Dr. Michael Mangelson, division chief of urology at LDS Hospital and the Salt Lake Clinic, and Dr. Richard Matern, urologist and surgeon at LDS Hospital, will answer questions. Call 1-800-925-8177 toll-free. You can also post questions during that time on the Deseret News Facebook page, www.facebook.com/desnews, and they will answer them.
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