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Getting Ahead of Prostate Cancer

Getting Ahead of Prostate Cancer

Aside from skin cancer, prostate cancer is the most common cancer among men. The good news is, it can often be treated successfully.

Dr. Jacob Andrade, MD, Radiation Oncologist at Coastal Radiation Oncology and Salinas Valley Memorial Healthcare System (SVMHS), shares important information about prostate cancer—including risk factors, the screening process and treatment options.

To listen to an in-depth conversation on this topic with Dr. Jacob Andrade, MD, Radiation Oncologist at Coastal Radiation Oncology and Salinas Valley Memorial Healthcare System, click here.

Who Is Most at Risk for Prostate Cancer?

Prostate cancer primarily affects people of “older age,” as Dr. Andrade describes it. “Elderly men usually have prostate cancer. But, interestingly, patients with a family history or of African-American race usually end up having a higher incidence of cancer. Another interesting fact is not only is there more cancer in these subgroups, they also seem to have it at an earlier stage.”

Screening & Diagnosis

Prostate cancer is a very slow-growing cancer; so much so that many men don’t realize they have been living with it. Oftentimes, the first indication involves urinary issues—associated with enlarged prostate, or benign prostatic hypertrophy (BPH).

“Whenever you have urinary symptoms, it prompts a urology workup that usually starts with a PSA. This is a blood test looking at prostate specific antigen—a protein made by the prostate gland. When you have higher levels in your blood, it is an indication of possible cancer. Any PSA elevated above the normal level prompts a biopsy. That's generally where we identify early stage cancers,” explains Dr. Andrade.

PSA assessment is typically used in combination with a digital rectal examination, to identify any abnormalities such as nodules in the prostate gland.

Individualized Treatment Options

The standard treatment protocol after a prostate cancer diagnosis is “active surveillance,” which involves a PSA every six months and digital rectal exam and biopsy once a year. However, treatment is designed to fit each individual patient.

“When somebody is diagnosed with prostate cancer, if it's very early stage, we would recommend active surveillance as opposed to ‘wait and see,’ which is another option for somebody who is much older, is maybe a bit frail. Perhaps that person doesn’t have a long life expectancy. If a patient is 85, 90 years old and this cancer may not cause a problem for 10 years, then that makes sense. We’re not going to regularly do biopsies and blood tests to follow the cancer,” notes Dr. Andrade.

In the treatment of prostate cancer, an androgen blockade is used to block testosterone function—instead of chemotherapy. “Prostate cancer, like breast cancer, is very hormone dependent and we don't really need to use chemotherapy. We just need a block of the hormones present in the male body,” adds Dr. Andrade.

Chemotherapy might be required if the cancer has spread, also known as metastatic cancer. A highly sophisticated, specialized form of radiation may also be beneficial for these patients: stereotactic body radiotherapy (SBRT).

“The whole treatment can be completed in a shorter time, because we're giving so much more radiation. And, actually, prostate cancer patients with limited disease burden can potentially live longer without need of androgen blockade, if we target a few of these lesions with SBRT radiation. There's a lot of different options we can use depending on the circumstances, even if a patient has already been treated,” assures Dr. Andrade.

Advancing Treatment in Intermediate Risk Patients

Currently, SVMH is conducting a clinical trial surrounding confined prostate cancer—which means the cancer hasn’t spread outside the prostate gland. The trial is limited to patients with intermediate risk, which is a key point in the trial’s focus.

“Intermediate risk is important, because it suggests that maybe your cancer is going to be a bit more aggressive or it's going to be advancing a bit faster than a low-grade cancer. What this trial entails is using a short course radiation treatment as the standard arm, which is a five-and-a-half week course. And, we're going to compare that to a course that only takes five days.”

Men: Take Charge of Your Own Health

Because prostate cancer is slow to develop, and symptoms don’t always present in an alarming fashion, Dr. Andrade urges men to get regular screenings.

“I recommend all patients see their doctors regularly, especially if they have something weird going on. You want to get it checked out sooner rather than later, and trust your doctor. They may not have all the answers upfront, but if you ask, that will prompt them to look into it. And, they will help guide you in what you need to do for your specific situation.”

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