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Prostate cancer-screening saves lives.

Whether it involves your father, son, brother, uncle, or best friend, prostate cancer at some point touches everyone's life. Fortunately, major advances in prostate cancer screening, treatments, and prevention over the last two decades have dramatically improved the overall survival rate and quality of life for all victims of prostate cancer.

The following are excerpts from our interview with a leading authority on prostate cancer, Dr. Patrick Walsh. A professor at Johns Hopkins Medical School, Dr. Walsh developed the nerve-sparing surgery that has significantly reduced incontinence and preserved potency in prostate cancer patients, and is author of the practical, highly readable Guide to Surviving Prostate Cancer. For the full interview, see the Sept./Oct. 2003 issue of The Saturday Evening Post.

On Screening for Prostate Cancer

"The current recommendation is to begin screening at age 50 or, if at high risk (African-American or with a strong family history, for example), age 40. Of course, along with the PSA, you need a rectal exam because 25 percent of men with prostate cancer will have a low PSA.

"For many men, the rectal exam is uncomfortable because doctors don't really position men correctly. In the right position, the musculature in the buttocks is relaxed, and the digital exam is not as painful. Also, when the patient is lying on his side, the physician can't feel the prostate very well. I describe the proper stance vividly in the book, with men bending at their hips and placing their abdomens on the examination table."

What If the PSA Is Elevated?

"Today, if a man has an elevated PSA, the test should be repeated, and a recent article in JAMA confirms this finding.

"When repeating the test, I have men refrain from sexual activity for several days, forego a rectal examination before the PSA test, and perhaps take antibiotics for two weeks to make sure that there is not a lingering infection. PSA of course refers to 'prostate' specific, not 'cancer' specific, so elevations in PSA can be caused by cancer, benign enlargement (BPH), or infection. But if the PSA level is elevated, you have some sort of prostate disease."

What Is the Difference Between a Total PSA and Free PSA Test?

"In the serum, PSA circulates in a bound form like scissors inside a case. When you measure total serum PSA, you are measuring bound PSA.

"If an arm of the scissors, for example, was broken, we can refer to that as 'free' PSA, which can't cut anything and circulates freely.

"For reasons that no one as yet understands, the higher the percentage of free PSA, the more likely you are free of cancer. Conversely, the lower the free PSA, the more likely you have cancer."

On Diet and Lifestyle

"Prostate cancer is probably caused by oxidative damage. Reducing oxidative damage can involve dietary measures, such as adding antioxidants--selenium, vitamin E, and lycopene--to your diet. It could also be something as simple as eating an apple. A study in Lancet showed that an apple contains more antioxidants than many vitamin supplements.

"Second, the effect of increased intake of calcium and fat from dairy products on increased risk of prostate cancer has been demonstrated in many studies. For example, men with high intake of calcium and/or dairy are more likely to develop advanced cancer.

"There is also new information about a new enzyme called racemase, which breaks down the fatty acids in red meat and dairy products. Racemase is up-regulated tenfold in cancerous, as opposed to normal, tissue. If someone with prostate cancer eats substances with the fatty acid called phytanic acid--found in meat and dairy products--cancer cells get ten times more energy from this acid than from any other source, which is another reason why reducing the amount of red meat and dairy products in your diet is a very wise thing to do. Reducing these foods is heart-healthy as well."

Choosing a Surgeon

"For the best outcome, find a urologist who does these operations frequently and who can answer the following questions: (1) How often do you do these? (2) What is the likelihood that I am going to need additional treatment afterwards--radiation or hormones?

"If either one of the answers to this last question is high, either your cancer may be too far advanced to cure (and maybe surgery isn't the answer), or maybe this person has not developed the technique well enough to take out all the cancer.

"The final question is, what is the chance that I will have problems with urinary continence and sexual dysfunction?

"Most urologists tell people the truth. If you don't like the answers, you need to find someone who does a lot of these procedures well and who is more specialized."

The Role of Genetics

"We have the largest registry of hereditary prostate cancer families in the world and have identified two genes that appear to explain the disease in some families. We are anxious to expand the number of families in our studies. Ideally, we are looking for families with three or more living affected members (father, son, brothers).

"To learn more, contact: Hereditary Prostate Cancer Study, The Brady Urological Institute, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Marburg 130, Baltimore, MD 21287-2101. You can also find out more at the Web site urology.jhu.edu/diseases/prostate/ hereditary.html or by calling 410-955-0355 or 410-614-4196."

Before the PSA Test ...

* Remind your doctor if you are taking Proscar for BPH, or Propecia for hair loss (Proscar lowers PSA; Propecia is a lower dose of Proscar).

* Don't ejaculate for at least two days before you have your blood drawn (this can raise your PSA level).

* Be sure to have the PSA test before your digital rectal exam (the trauma from the physical exam can raise PSA, too).

* If the PSA reading indicates a borderline elevation, or a significant increase since the last reading, repeat the test in the same laboratory. If there is a clear-cut elevation, ask your doctor about prescribing antibiotics to rule out a possible infection. (Often, men receive ciprofloxacin or levofloxacin for three to four weeks, and have the PSA measured again.) If it is elevated again, you should have a biopsy.
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Publication:Medical Update
Geographic Code:1USA
Date:Jul 1, 2003
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