ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, August 20, 1996 TAG: 9608200025
SECTION: EXTRA PAGE: 1 EDITION: METRO
COLUMN: health notes
SOURCE: SANDRA BROWN KELLY
MEMO: ***CORRECTION***
Published correction ran on August 21, 1996.
The telephone number for ordering a copy of the booklet, "Prostate
Cancer Therapy," is (800) 458-4372. The number was incorrect in
Tuesday's Extra section.
Asked to guess what a group of men sitting around a lunch table might be discussing, most people probably would answer: "Something about sports."
But they might be wrong. These days, the topic at a gathering of men is just as likely to be PSA scores as football scores, especially if there's a man over 40 in the crowd.
As men get older, many suffer from an enlarged prostate, which can cause difficulty in urination, and increase the frequency and urgency of urination. This is a benign condition. However, some of the symptoms present with an enlarged prostate (hyperplasia) also are indicators for prostate cancer, the second-leading cause of cancer death in men. (Lung cancer is the leading cause of cancer deaths in men and women.)
In 1995, the Food and Drug Administration gave approval to a Prostate-Specific Antigen screening test that can help in the diagnosis of cancer. The test, done on blood drawn from the arm, measures the level of a protein that circulates in the bloodstream. An elevation of that protein can signal prostate cancer.
The test is recommended as a standard screening for all men 50 and older and for certain groups of men younger than that. The PSA test result is in the form of a number.
Men are right to be concerned about their numbers: In addition to being a killer, prostate cancer is unsettling for another reason. Treatment for it can result in incontinence, or inability to control release of urine, and in loss of sexual function.
The prostate gland opens into the urethra just below the bladder. During ejaculation, the prostate secretes an alkaline fluid that forms part of the semen.
It is expected that 7,400 new cases of prostate cancer will be diagnosed in Virginia this year.
Largely because of better methods of detecting prostate cancer, its rate increased 50 percent between 1980 and 1990. So did awareness of it. Regularly, prominent men go public about their battles against the disease.
Within a month's time last year, retired Army Gen. H. Norman Schwarzkopf and NASCAR legend Richard Petty announced that they had prostate cancer. Republican presidential candidate Bob Dole also openly discusses his bout with the illness.
The problem is a man can't depend totally on the PSA numbers. Researchers still are trying to "fine-tune what the numbers mean," said Dr. Robert Wisman, a Roanoke urologist.
Researchers first looked at all men and decided 0 to 4.0 was normal. Then, age studies indicated that younger men should have a PSA less than 3 and men over 70 could have a PSA over 4 and not have evidence of malignancy, Wisman said.
A low number also is no guarantee that there is no cancer. Schwarzkopf had a PSA of 1.8. It had increased within a year, however, from 1.2 to 1.8, enough to make his doctor suspicious.
Wisman said that generally if a PSA goes up more than .75 in a year's time, it can indicate a problem.
Some men are trying to lower their PSA by taking the over-the-counter saw palmetto, which Wisman describes as a kind of plant estrogen.
"Far as we know it doesn't do any harm and maybe no good," he said. The lowered PSA just becomes a new baseline to watch, he said.
Elevated PSA levels are a possible - the key word here is "possible" - indicator of cancer, he said. A follow-up ultrasound and biopsy are needed to make a definitive diagnosis of cancer. One reason everyone is working to understand the numbers better is because they want to better determine who needs a biopsy, Wisman said.
Some studies now also are looking at PSA density, the PSA value compared to the volume of the prostate, Wisman said.
No matter what the PSA result, the test should always be used in conjunction with a digital rectal exam, experts advise.
A digital rectal exam can be unpleasant, but what can be learned from it is worth the discomfort. Two of the main cancers in men, colon and prostate, can be detected through a rectal exam, Wisman said. The exam is recommended for all men from age 40 on.
The American Cancer Society recommends a PSA test for all men 50 and older. Men in families with a history of prostate cancer should begin being tested at age 40, Wisman said. African-Americans, who have the highest rate of prostate cancer, should start testing earlier, Wisman said.
More than 80 percent of prostate cancers found, however, are in men over 80 years of age. Interestingly, it is more common in northwestern Europe and North America and rare in the Near East, Africa, Central and South America. Some studies have suggested that fat in the diet might be a factor in prostate cancer.
"The big controversy with PSA is: Are we making a difference?" Wisman said.
PSA screening is controversial because it has drastically increased the number of surgical prostate removals. Surgery not only often makes men impotent or incontinent, it may not help them live longer, especially if they are elderly and the cancers are slow-growing.
To attempt to learn if screening will increase survival rates, a large clinical trial, 37,000 men, was begun in 1994 by the National Cancer Institute. It will be 10 years before the results are known.
Fifty-eight percent of all prostate cancers are discovered while are still localized, according to the American Cancer Society. The five-year survival rate for patients with tumors found at that stage is 94 percent. The outlook is different for the 42 percent of the men who are diagnosed with prostate cancer that has already spread, or metastasized.
Treatments for prostate cancer include surgery, radiation, hormones and anticancer drugs, and by just watching the cancer, what the British refer to as "watchful waiting."
The important thing to keep in mind about treatment options is to ask the doctor to explain them. A national survey conducted last year by Louis Harris Associates found that 30 percent of men treated for prostate cancer never asked their doctors how treatment might affect them.
In reaction to the survey, Theragenics Corp., which makes the drug Proscar used in treating enlarged prostate, has produced a booklet, "Prostate Cancer Therapy." It can be obtained free by calling (800) 458-4373.
General information about prostate cancer and its treatments can be gotten from the National Cancer Institute Cancer Information Service at (800) 422-6237, Monday through Friday between 9 a.m. and 4:30 p.m.
For men 50 and over and with no known problems, Carilion Health System is sponsoring a free PSA screening and digital exam Sept. 28, from 8-11 a.m. Contact Physician Referral, 981-7641 or (800) 422-8482 to register. Appointments are limited.
Men diagnosed with prostate cancer might also want to check out the support group, Us Too. You can learn about it from the Carilion referral office.
A good book on the subject is "My Prostate and Me," written by William Martin, the author of "A Prophet With Honor: The Billy Graham Story."
The last section of the book was written by Dr. Peter Scardino, chairman of the Scott Department of Urology at Baylor College of Medicine in Houston and in 1994, chairman of the Prostate Health Council of the American Foundation of Urologic Disease. He discusses treatment options, especially the alternative method of "watchful waiting," leaving the cancer alone on the theory that prostate cancer in some men grows so slowly that something else will kill them before it does.
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