Prostate cancer is the leading cause of cancer death in Utah, but if found early, it's very treatable. Options range from "watchful waiting" to surgery or radiation therapy, both of which can be curative.
The incidence of the disease also has increased, according to Dr. Jay T. Bishoff, director of Intermountain Urological Institute at Intermountain Medical Center in Murray. For years, experts said one in eight men at some point developed the disease; that number is now "probably close to one in six," he said.
Prostate cancer and treatment is the topic of Saturday's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Bishoff and urologist Dr. Scott Chidester will take phoned-in questions. All calls are confidential. The number is 800-925-8177.
This month, the Deseret News and Intermountain are expanding the hotline to include a feature through which questions also can be submitted by e-mail. Deadline for those questions, sent to Hotline@desnews.com, is 5 p.m. Saturday. Answers will be posted online at www.deseretnews.com at 12:01 a.m. Wednesday.
Despite the fact that the vast majority of men are alive at five years if the cancer is detected early, Bishoff says he still sees tragedies. Recently he diagnosed cancer in a man in his mid-50s who had never had the simple prostate specific antigen (PSA) blood test that's recommended as an annual screening for men over 50 (40-45 for those with family history of the disease). The PSA is paired with a digital rectal exam to detect prostate cancer.
Failure to be screened early may have robbed the man of many years, Bishoff said.
Typically, it's a slow-growing cancer, and doctors routinely choose watchful waiting as the best treatment option in elderly patients, who are much more likely to die with prostate cancer than of it. With early detection and no treatment, patients live an average of 10 years, so doctors are unlikely to treat 80- and 90-year-olds who have early-stage cancer. Younger patients and more aggressive cancers prompt active treatment, Bishoff and Chidester agree. Untreated in younger patients, it's a killer.
When a man no longer reasonably has a 10-year life expectancy, the annual screening is no longer needed, Chidester said.
The PSA is not the final word, because other things besides cancer, such as inflammation or infection, can elevate it. If the PSA or rectal exam is abnormal, the next step is an ultrasound-guided biopsy, said Chidester. If that, too, is positive, physician and patient begin to discuss options.
Chidester calls surgery and radiation therapy the "big-gun" treatments. There are different options for each that must be weighed.
But complications that previously deterred treatment, including possible loss of erectile function or bladder control, are not the problems they once were. There are nerve-sparing approaches to both radiation and surgery, the two say.Prostate cancer that progresses can be very painful at the end, although in the early stages there are no symptoms. That's why it's so important to get the annual screening, Bishoff and Chidester said.
Tomorrow: A look at the treatments.