Editor’s note: This is the second part of a two-part series about health issues men face and ways to get screened.

By Kristine Porter

kporter@tnonline.com

Some in the medical community question whether or not men should be screened for prostate cancer.

According to the Centers for Disease Control and Prevention, screening prevents about one death for every 1,000 men between the ages of 55 and 69 years old, and prevents three men from having the cancer spread throughout the body.

On the other hand, screening can result in unnecessary testing in men who never would have experienced symptoms from prostate cancer, never would have known they had it, and ultimately wouldn’t be the cause of death.

“There are risks and there are benefits to screening for prostate cancer,” said Dr. Shawn Mendonca, a urologist with Lehigh Valley Health Network. “Prostate cancer is a very complicated disease. It is something that requires expertise with a urologist to sift through the nuances in managing the disease. Every patient has an individualized care plan.”

An additional problem with screening is the prostate-specific antigen test. A high level of PSA in the blood can indicate a

problem in the prostate, but not always, Mendonca said.

“It just means you have an increased risk of prostate cancer,” he said. “None of these tests are perfect.”

PSA levels also can be high due to certain medications, medical procedures, an infection in the prostate, or an enlarged prostate. An enlarged prostate can cause voiding dysfunction, but voiding dysfunction does not indicate prostate cancer.

“Men with prostate cancer don’t have voiding dysfunction,” Mendonca said. “The part of the prostate that develops cancer is usually different than the part that gets enlarged and causes voiding dysfunction. If you have both, then the cancer is probably at a higher stage.”

The most common risk factor is age. The older a man gets, the greater the chance of developing the cancer, according to the CDC.

Mendonca screens all of his male patients between the ages of 55 and 75 for prostate cancer. And for those with several risk factors, he starts screening at 50.

African American men are more likely to develop prostate cancer than other men, and a family history can be a red flag.

If a man’s father, son or brother had prostate cancer, or if a relative within three generations on either his mother’s family or father’s family had prostate cancer, then he is at a greater risk of getting it, too. Likewise, if a relative within that same group had breast, ovarian or pancreatic cancer, then his risk of prostate cancer increases.

In all, 13 out of 100 men will get prostate cancer, and two or three will die from the disease, the CDC states on its website.

“Most of the time if you have prostate cancer, they won’t die for 10 to 20 years,” Mendonca said, and that’s if a person doesn’t do anything to treat it. It’s a slow progressing cancer.

Mendonca said the progress of prostate cancer is rated on a Gleason score between 2 and 10. Typically, the lowest is Gleason 6.

“If you have Gleason 6 prostate cancer, the chance of death from it in 10 years is very, very low,” he said.

So, what’s happens if the PSA test comes back high?

Mendonca said for some, the best next step is to recheck later or do genetic testing. For others, the next step is to biopsy the prostate.

“It’s not a comfortable procedure,” he said.

The biopsy procedure can cause blood in the semen and infection.

Once the biopsy results are back, treatment options are discussed. For some patients, the best course is to check them with routine PSA tests, and an MRI every 18 months to look for lesions. A biopsy will be done every few years to check the progression of the cancer, Mendonca said.

For others with an intermediary cancer or high-risk situation, radiation or surgery to remove the prostate and surrounding tissue are the treatment options.

The CDC said there are other therapies being investigated including cryotherapy to freeze the cancer cells, chemotherapy, biological therapy to work with the immune system, and hormone therapy to block the cancer cells from getting hormones.