Dr. Val Farmer
Rural Mental Health & Family Relationships

The PSA Era In Men's Health

April 20, 1998

It's been a year since I was in the throes of deciding what to do about my newly diagnosed prostate cancer. Looking back, those where trying times. I had a radical prostatectomy on May 15, 1997. I had good results. To date the Prostate Specific Antigen (PSA) test has revealed no new cancer.

I interviewed nurse David Knudson and Dr. Henri Lanctin of the Prostate Health Center at MedCenter One in Bismarck, North Dakota for background on prostate cancer.

Prostate cancer is a disease with a cure. Based on early detection, there is a 94-98 percent cure rate. Early detection means detecting the cancer before it gets outside of the prostate into the lymph nodes and bone marrow. This is important because prostate cancer develops without warning symptoms. The good news is that there have been a number of breakthroughs with prostate cancer.

The advent of the PSA test in 1990 has brought a new era to the diagnosis and early detection of prostate cancer. The test isn't foolproof and still must be used in conjunction with a physical examination. The test is even becoming more accurate by detecting "free" PSA as opposed to PSA that is combined with an ion.

What does this mean? Lives can be saved. There are more than 340,000 cases diagnosed annually in the United States with about 34,000 deaths per year. Historically, about one percent of new cases are diagnosed in men between 40 to 49, eight percent between 50 and 59, 33 percent between 60 and 69, 41 percent between 70 to 79 and 18 percent in men over 80.

It is recommended that an annual screening and physical exam should begin for men at age 50. Unfortunately, African-American men carry a greater risk for prostate cancer. If one or more family members - a father, paternal uncle, grandfather, or sibling - has prostate cancer the risk is ten times as great and screenings should begin at 39.

Death rates are starting to drop because of early detection and treatment. Insurance companies, depending on the state where you live, are mandated to cover PSA exams. Medicare will cover the screenings beginning in the year 2000.

In the past, one of the recommended courses of action was "watchful waiting." This was based on the fact that many prostate cancers were slow growing. By early identification of moderate and high grade cancer in an early stage, older men can be spared the ravages of this disease.

With biopsies, the stage and grade of the cancer are determined. The stage refers to the location of the cancer. The grade refers to how fast the cancer is growing. By knowing the stage and grade of cancer, family members can make good decisions about having or not having treatment. The PSA test has been especially good for picking up moderate grade cancers where treatment is curative. Older men with moderate grade and lower stage cancers can be spared the ravages of this disease.

With this technology on line, men need to be responsible and ask for this screening as a part of their medical care. Don't just go to the doctor when you are sick. Have your annual physical and ask about prostate cancer. This is not an optional. This is smart. I swear by it. I know it has been a life-saver for me.

There have been breakthroughs in treatments.
- First, nerve sparing techniques were developed to preserve sexual and bladder function. This was done by eliminating the blood flow to the affected area so the surgeon could have a clear view of the surgery.

- Second, a new radiation technique implanting radioactive seeds has shown promising results although a few more years of data are necessary to verify that this is a cure. The localized implants are a definite improvement over general radiation therapies of the past.

- Third, there are some powerful hormone therapies that can arrest or slow down the growth of prostate cancer.

Getting support and information. It is a time when family members need to "know their enemy." Women are very supportive. They are usually the ones who get educated on the disease, ask good questions and push for good decisions. The men eventually come out of their shock and get up to speed on learning and dealing with the disease.

A support group, "Us Too" has mushroomed so men and their families can learn about the disease and work through some of their problems after treatment. Many of the men and their families with higher stage cancers can also rely on the group for support as they fight their cancer.

The time between diagnosis and treatment is a delicate and stressful time. Many of these support groups have members available to counsel with newly diagnosed families on a one to one basis. "Us Too" plays a vital role in giving out information and resources to suddenly desperate people.

We are in the PSA era of prostate cancer. Thank goodness!