When patients ask me, ‘What can I do?’ I say: get plenty of rest, eat well and maintain a healthy weight, get some exercise, cut your stress level and just take care of yourself.Alan Hartford, MD, PhD
September is Prostate Cancer Awareness month. About one out of every nine men will be diagnosed with prostate cancer in his lifetime. “The prostate gland is part of the male reproductive system and located below the bladder and in front of the rectum,” explains Alan Hartford, MD, PhD, radiation oncologist at Dartmouth-Hitchcock's Norris Cotton Cancer Center (NCCC) who specializes in prostate cancer treatment. Advancements in research have offered new screening tools, tests and treatments for prostate cancer. Here are 10 things you may not know about this type of cancer.
- Prostate cancer is the most common cancer in American men (excluding superficial, non-melanoma skin cancers). The American Cancer Society estimates that in 2019 there will be more than 174,000 new cases of prostate cancer diagnosed in men (8,610 in New Hampshire), and more than 31,000 deaths from prostate cancer (2,820 in New Hampshire)
- Prostate cancer is the second leading cause of cancer death in American men (behind lung cancer). However, most men diagnosed with prostate cancer do not die from it; they may not even know they have it. “Many will have few related symptoms, if any at all,” adds Hartford.
- Common screening tests for prostate cancer include:
- Prostate-specific antigen (PSA) test: PSA is a protein uniquely made by the prostate. Levels may be elevated in the blood of men who have prostate cancer. However, the PSA may also be elevated for reasons that are not cancer-related. “If you look at the incidence of prostate cancer in men in the United States in 1970s and 1980s it was fairly flat from year-to-year, but in the mid 1990s the incidence went way up. Those are all the extra early-stage cancers in the population that were diagnosed as a result of the PSA test,” says Hartford.
- A digital rectal exam to assess for firmness or irregularity of the prostate. A bump or irregularity on the prostate found during a digital rectal exam may warrant additional testing.
- Most prostate cancers grow very slowly. In fact, autopsy studies show that many older men (and even some younger men) who died of other causes also had prostate cancer that never affected them during their lives. “You can monitor some prostate cancers using a PSA test without any further treatment. That’s a common approach for low-risk disease. But if it progresses or changes, we need to treat it. It’s very much a patient-specific decision.”
- Since 1991, the U.S. mortality rate for prostate cancer has been steadily declining. It has been cut in half from its peak in 1991 at 39.5 deaths per 100,000 population down to 19.2 per 100,000 in 2016. “Before the PSA test was introduced in the 1990s, prostate cancers were much more advanced at the time of diagnosis, and typically problematic symptoms were what brought men to the doctor,” explains Hartford. “The PSA test provides a method for diagnosis at an earlier stage, which means the cancer can then be treated earlier and the risk of mortality is lower.”
- Risk factors that may be involved in the development of prostate cancer include:
- Age - Prostate cancer is rare in men younger than 40. The chance of developing prostate cancer increases after age 50. About 6 in 10 cases of prostate cancer are found in men older than 65.
- Race/ethnicity - Incidences of prostate cancer diagnosis and death are more common in African-American men than in men of other races. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in white men.
- Geography - Prostate cancer is most common in North America, northwestern Europe, Australia and on Caribbean islands.
- Family history - Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found. Despite these statistics, most prostate cancers occur in men without a family history of the disease.
- Gene changes - Several inherited gene changes such as mutations in the BRCA1 and BRCA2 gene seem to raise prostate cancer risk in some men. Inherited gene changes cause about five to ten percent of prostate cancers.
- Other factors - Modifiable factors such as diet, obesity, smoking, chemical and environmental exposures, sexually transmitted infections or vasectomy are currently being studied to determine if they have any effect on prostate cancer risk.
- New therapies used to treat and manage prostate cancer are continuously being studied in clinical trials including:
- Cryosurgery - uses an instrument to freeze and destroy prostate cancer cells.
- High-intensity - focused ultrasound therapy - uses ultrasound (high-energy sound waves) to destroy cancer cells.
- Proton beam radiation therapy - external radiation therapy that targets tumors with streams small, positively charged particles called protons.
- Photodynamic therapy - uses a drug and a certain type of laser light to kill cancer cells.
Although to date, none of these have been shown to improve results over current state-of-the-art approaches,” notes Hartford.
- There is no surefire way to prevent prostate cancer other than removing the prostate. However, measures can be taken that may lower risk. “There are some studies that show that diets high in ‘green and leafies’ may be tied to lower risk,” says Hartford. “When patients ask me, ‘What can I do?’ I say: get plenty of rest, eat well and maintain a healthy weight, get some exercise, cut your stress level and just take care of yourself.” Studies are underway looking at the effects of vitamins, minerals, supplements and medicinal drugs on prostate cancer risk.
- Pathologists grade prostate cancers using The Gleason Score. The Gleason Score is based on how abnormal the cancer cells look under a microscope, which predicts how quickly the cancer is likely to grow and spread. The higher the Gleason score, the more likely the cancer will grow and spread quickly. Gleason scores and PSA levels are used to stage prostate cancer. “The stage of the cancer predicts the risk of disease spread and potential for worsening symptoms and mortality,” explains Hartford.
- Here at NCCC, the newest advancements in treatments and therapies for prostate cancer include:
- MRIdian – An MRI-guided linear accelerator that allows for precisely imaging the prostate and targeting high-dose treatment (coming in 2020).
- Space()OAR® hydrogel technology – a gelatin-like pad that serves as rectal protection for prostate cancer patients who are undergoing radiation therapy.
- Axumin PET scan – imaging for early detection of metastatic cancer.
- Drug therapies – “Chemotherapy is not always used to treat prostate cancer. Several other systemic agents exist that are highly effective both for limited disease and for metastatic disease. Also, right now there are new anti-androgen and anti-hormone systemic therapies under exploration that target prostate cancers in different ways,” says Hartford.
Each man’s genetic makeup, family and medical history, environment, habits and behaviors are different. Your providers can discuss your individual prostate cancer risk factors and make recommendations that are appropriate for you.