Barbara Klein: If you are a man, you need to know about prostate cancer. It's a major cause of death among men -- the second most common cancer among men in the U.S. And nearly all men will develop it if they live long enough. The problem is that most men don't know about the disease, and many don't want to. The American Cancer Society is trying to change that with its new Complete Guide to Prostate Cancer. At 300 pages, it is designed to inform men about a cancer they are likely to develop with little or no warning. One of the signs men most frequently associate with prostate cancer is not cancer at all. David Bostwick is an expert in the field, and was the lead editor for the guide.
David Bostwick: Enlargement of the prostate, which causes men to get up in the middle of the night to go to the bathroom or have trouble beginning urination, that's usually benign enlargement of the prostate. Prostate cancer usually has few or no symptoms until it's greatly advanced. And we don't want to find it when it's advanced, because our ability to deal with it is greatly diminished.
BK: What exactly is prostate cancer?
DB: Prostate cancer is the prostatic counterpart of breast cancer in many ways. The prostate is an organ hidden inside the body, it's not visible, it's small, it's involved in sexual development and sexual function, it's hormonally responsive, just like the breast is, and it develops cancer with a great frequency, just as we see with breast cancer.
BK: Are there particular risk factors associated with it?
DB: There are two important risk factors. We know that African American men, as well as men with a family history of prostate cancer, are more likely to develop prostate cancer. The question is whether the African American linkage is truly a genetic linkage or could it be an environmental or biologic linkage. We think also that men who live in poorer areas with poorer hygiene or poorer diet are also at risk. So I think it's a problem for all men, but it's a particular problem for those men who have a particularly bad diet, high fat diet, or a sedentary lifestyle, a lifestyle without a lot of exercise.
BK: How do you test for prostate cancer?
DB: There are two tests that are available around the world. And they are very easy tests. One is a blood test called Prostate Specific Antigen, or PSA. Very simple, inexpensive, it's been available for more than fifteen years. The second test which has been available for a hundred years is the digital exam, or digital rectal examination. That's one of the reasons men don't get checked for prostate cancer because they don't want this examination. For cultural reasons, they're worried it's painful, or whatever, the reality is that a digital rectal examination takes fifteen seconds, it's painless, and in the hands of physicians, they do this all the time, it's not that big a deal and it can save your life.
BK: Because the prostate is involved in sexual function, is that part of the reason also that men really don't want to deal with this?
DB: The concern is that if we have prostate cancer, then we might have to get it treated. And the treatments do carry the risk of losing potency or sexual activitiy. The good news is that we're better at this than we were even five or ten years ago, and it's getting better all the time. So the reality is we can deal with this cancer. If it's caught early, we can cure men, and they can retain full sexual function and live a normal life after treatment, definitive treatment for cancer.
BK: What is the treatment, or are there a variety of alternatives?
DB: This raises another difficult problem in this particular area. Prostate cancer has multiple treatments. And those treatments are pretty much equally effective, at least in the short term. You can have surgery. There are different types of surgery. Radiation therapy - there are different types of radiation therapy. Some are advocating freezing the prostate - a procedure known as cryo-surgery. There's a new procedure, possibly, for heating the prostate, that will be available. And interestingly, some men, particularly older men, don't have any treatment at all. If you're 80 years old and you have heart disease and other issues, prostate cancer fortunately is a relatively slow-growing cancer. Which means that watchful waiting is a reasonable thing for some men. But unless you find out if you have it or not, you don't know what the proper treatment is.
BK: As for preventing prostate cancer -- in addition to reducing fat in the diet and increasing exercise, Dr. Bostwick says unconfirmed data suggests that (cancer-fighting) anti-oxidants such as Vitamin E, Selenium and soy protein might have some value. At this point, he says, getting checked is the best course to take.
David Bostwick is the lead editor for the American Cancer Society's new Complete Guide to Prostate Cancer.