More info on prostate cancer

Since September is National Prostate Cancer Awareness Month, I’m confident that many of your readers, including me, appreciate your publishing of Mary G. McKinley’s timely and informative op-ed Sept. 9. The purpose of this letter is to provide some additional information to assure readers do not arrive at wrong conclusions about what to do (or not do) about their personal prostate health condition. This writing is based on my personal experience with prostate cancer and my familiarity with the book “Guide to Surviving Prostate Cancer,” second edition, by world renowned cancer specialist Patrick C. Walsh, MD and Janet F. Worthington of Johns Hopkins University Hospital in Baltimore.

In an ideal situation a man should have a PSA test to establish his base, which varies appreciably from person to person. Thereafter, PSA screening should be done on a scheduled basis, i.e. once every year or two for older men, or those with a history of prostate cancer in their family. That second PSA result is then compared to the first to determine any significant increase in the PSA level. In my case, I was 82 years old and had 12 PSA results based on more than 20 years of prostate monitoring, during which time the PSA progressed from 0.9 to 4.2. The significance was the increase within the last three years, not that 4.2 was necessarily high. Meanwhile, a friend had a 12 PSA which remained at that level and during which time he had two biopsies, resulting in negative results, i.e., no action was needed. Quoting Dr. Walsh, “Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA results. Only a biopsy can diagnose prostate cancer for sure.”

Unfortunately, many men learn that they have prostate cancer when their physicians discovers it by a digital rectal examination. Because of that discovery, most likely a biopsy will be done in order to determine the severity of the patient’s cancer — stage 1, 2 or whatever. At that point a course of action will need to be determined: watchful waiting, chemotherapy, radiation, brachytherapy, surgery or some combination.

Many urologists employ the Gleason Score, which is a numerical evaluation of the shapes of the cancer cells observed in the biopsy process. This tool allows a clear understanding of the severity of the cancer and may be valuable in determining a course of action.

Unfortunately, there is no exact age range for when a man should commence or discontinue PSA screening and digital rectal examinations. That should be determined by the patient and primary care physician.

In summary, in the ideal world the routine would most likely follow this order of precaution: periodic PSA screening and/or digital rectal exams, followed by biopsy when indicated, biopsy evaluation and a course of action, which could include watchful waiting for patients having a low Gleason Score.

Harold D. Brown