For men, the risk of prostate cancer is a fact of life.

Byline: Dr. David DiMarco For The Register-Guard

Prostate cancer is second only to lung as the leading cause of cancer-related death among men in the United States. Each year, roughly 219,000 American men are diagnosed with prostate cancer and 27,000 will die from the disease.

The risk of developing prostate cancer increases with age beginning at 40 years. For men, the probability of developing prostate cancer is 1 out of 1,000 for ages 40 to 50, 2 out of 100 for ages 50 to 60, and 7 out of 100 for ages 60 to 70.

The occurrence and death rate from prostate cancer varies among different racial and ethnic groups. African-American men have a 60 percent higher chance and are twice as likely to die from prostate cancer as white men. On the other hand, dying from prostate cancer is 35 percent lower in Hispanics and 40 percent lower in Asian-Americans and Pacific Islanders compared with white men.

Who should be screened?

In general, screening for prostate cancer begins at age 50 with a PSA (prostate specific antigen) blood test and a digital rectal exam. Men with a family history of prostate cancer and African-American men begin screening at age 40.

What is PSA and what does elevated PSA mean?

PSA is a protein produced by prostate cells used in reproduction. Prostate cancer can increase the PSA blood test, as well as, disrupt tissue barriers between the prostate and bloodstream causing an elevated PSA. Other conditions, such as infection, BPH (benign prostatic hypertrophy) can also raise the PSA, making it less than perfect as a cancer test. New markers that are more specific to prostate cancer are currently being studied.

Are there risk factors?

The most important are increased age, ethnicity, genetic factors, and probably a diet high in animal fat and low in vegetables.

How do I avoid cancer?

There are no definitively proven medications or supplements that decrease the chance of getting prostate cancer. However, research suggests that certain agents may help. This is another area that continues to be studied. The following are promising candidates: 5-alpha reductase inhibitors (Proscar), soy and phytoestrogens, retinoids, vitamins E and D, selenium, and nonsteroidal anti-inflammatories, or NSAIDS.

What diet should I have?

In general, a balanced diet low in saturated fat is best. A diet high in animal fat and low in vegetables may be an important factor in the development of prostate cancer.

What are the options?

More options are available today with the majority of prostate cancers being detected at an early stage due to careful screening. Decisions regarding treatment are always individualized with the goal of maximizing cancer treatment and minimizing the side effects.

Treatments include active surveillance where cancers are closely followed over time with exams and PSA values, hormonal treatment, various forms of radiation (external beam, seeds, high dose), cryosurgery (freezing) and surgical removal of the prostate (radical prostatectomy).

Ingreater Springfield, all of these options are available. In addition, we have advancements such as the latest technology in radiation therapy, as well as, the da Vinci Surgical System used for robotic prostatectomy at McKenzie-Willamette Medical Center.

What is on the horizon?

Most cutting-edge therapies are focused on patients with aggressive cancers that have come back after standard treatment or are at high risk for failure. These include various combinations of surgery, radiation and chemotherapy. Immunotherapy, such as tumor vaccines are also being investigated in patients with aggressive cancers.

For low-risk prostate cancer patients, high-intensity, focused ultrasound is a treatment currently being studied.

ON THE WEB

For more information on prostate surgery, go to www.patients.uptodate.com, www.cancer.gov or www.oregonurology.com.

Dr. David DiMarco is a local urologist with expertise in robotics and minimally invasive surgery.