Prostate cancer patient Carl is the volunteer lookout for the other men in his large extended family. He knows what most of the men do not: that there has been a run of prostate malignancy in the clan.
"I am trying to create a family support group because there are enough men in my family to exchange information and educate each other," said the 62-year-old. "And they are young enough to benefit from my knowledge."
Carl is the third male on his father’s side to develop cancer of the prostate. One uncle died from the disease; a second uncle is living with it, and Carl is recovering from it.
"He’s had a nice outcome, and his quality of life is high," said Matthew Spellman, MD, urologist on staff at Missouri Baptist Medical Center.
"He’s doing well," agreed Humberto Fagundes, MD, radiation oncologist, who also treated Carl.
"I’m lucky," Carl said.
A Risky Profile.
As an African-American, Carl realizes that he is more prone to prostate cancer than any other racial group, and he knows that prostate cancer in black men is more likely to be aggressive. He also knows that two uncles on his father’s side of his family have had prostate cancer, and Carl is aware that he is at the age to develop the disease. And he’s known all of this for some time because he had a prostate cancer scare in 2007.
"I really understand the need for screening," said the St. Louis County resident and retired supervisor.
Because Carl is diabetic and has long had regular blood draws to monitor that disorder, lab technicians have routinely checked Carl for his level of prostate-specific antigen, or PSA. He knew he might be in trouble last year when his PSA level spiked to 12.6 nanograms per milliliter (ng/mL). A reading of 4.0 ng/mL or lower is generally considered normal although some physicians may order a prostate biopsy with a PSA level higher than 2.5 ng/mL.
When it comes to screening for prostate cancer, forget what you might have heard or read elsewhere. Dr. Spellman says that men over age 40 should have regular PSA tests in combination with digital rectal exams (DRE).
"More than 30,000 men die of prostate cancer each year," Dr. Spellman said. "It’s the second leading cause of cancer deaths in men in this country. To me, it’s self-evident that you regularly screen for prostate cancer."
Dr. Fagundes, who specializes in treatment of prostate cancer, agreed. He added that he rates the severity of a prostate cancer by tracking what he calls "PSA velocity" − the rate of rise of a PSA score over time.
"And you can’t track the PSA velocity unless you have captured PSA scores, and that means you order PSA tests," Dr. Fagundes said.
While Drs. Spellman and Fagundes leave it up to the primary care physician to determine the start and frequency of rectal exams and PSA screenings for each patient, they agree that screening saves lives. The data, they said, are unshakable. The most recently updated study found that screenings resulted in a 44 percent drop in prostate cancer deaths.
When your physician performs a rectal exam, he or she is feeling for a lump or lumps on your prostate. When a PSA is ordered, your physician looks for a sharply elevated PSA score or a trend of rising PSA readings over time.
Grading the Cancer.
If an exam or PSA test shows an abnormality, a variety of evaluations can be ordered to determine whether cancer is present. Ultrasound and prostate tissue biopsy are two common tests.
With a cancer diagnosis comes a determination of the cancer’s level of aggressiveness, typically employing a scale called a Gleason score, and assigning a stage to the cancer from Stage I to Stage IV.
Treatment options for prostate cancer may include anything from active surveillance, to medications and hormone therapy, to chemotherapy or radiation, to surgery to remove the prostate. Sometimes, treatment may include combinations of techniques. A number of factors provide physicians with a roadmap for treatment most likely to be successful.
For Carl, Drs. Spellman and Fagundes collaborated on a treatment plan that focused on the application of external and internal radiation. Carl received a series of external beam radiation sessions last July and August, and then implantation of radioactive "seeds" in September.
"Overall, I feel the treatment was really fast and responsive," Carl said. "It’s almost like having no issue at all. While it is normal to have some side effects, such as erectile dysfunction, I am not having side effects that I feared. I don’t see any limitations on myself."
Advances in Technology.
The effectiveness of treatment and limited side effects are largely due to recent improvements in technology, according to Drs. Spellman and Fagundes.
Advances in radiation therapy, in particular, have been leapfrogging each other, Dr. Fagundes said. Two-dimensional radiotherapy has been supplemented with three-dimensional conformal radiation therapy, intensity modulated radiation therapy and image guided radiation therapy.
"With each advance, we can target cancer cells more precisely with an increased dose of radiation," Dr. Fagundes said. "We achieve better results more quickly and with fewer side effects."
Dr. Spellman, too, treats patients using advanced medical technology, including the daVinci® Surgical System for minimally invasive prostate surgery. He performs as many as 100 robotic-assisted prostate surgeries each year and rarely finds the need for the more invasive open surgery to remove the prostate.
Matthew Spellman, MD, is board-certified in urologic surgery and on staff at Missouri Baptist Medical Center. He earned his medical degree from the University of Iowa and completed an internship and residency in general and urologic surgery at University of Nebraska Medical Center.
Humberto Fagundes, MD, is board-certified in radiology and on staff at Missouri Baptist Medical Center. He earned his medical degree from the Federal University of RGS in Brazil and an internship in medicine at Jackson Memorial Hospital in Miami. He completed a residency and fellowship in radiation oncology at Mallinckrodt Institute of Radiology, Washington University School of Medicine.