CORONAVIRUS (COVID-19) RESOURCE CENTER Read More
Add To Favorites

Boomer Health: For men, prostate cancer remains a lifelong concern

Palm Beach Post - 9/26/2021

As a retired health-care administrator who worked in the field for 45 years, Anthony Pollack knows well the value of regular health screenings — and how early detection is crucial for ensuring the best possible outcomes.

Regular wellness checkups, blood tests, EKGs, colonoscopies, etc. — the Royal Palm Beach resident believes in them all.

And during September's National Prostate Cancer Awareness Month, he's especially keen on encouraging men of all ages to be aware of their prostate health.

"I had a history of prostate cancer in my family," said Pollack, 74. "Both my father and brother were diagnosed in their 70s."

That's why the Royal Palm Beach resident and his urologist, Dr. Diego Rubinowicz of Palm Beach, did twice-annual PSA (prostate-specific antigen) blood tests to monitor Pollack's score. (The general rule of thumb is the lower the score, the better.)

Gradually, Pollack's score creeped higher and higher — reaching nearly 4.0, which is considered concerningly elevated — and in December 2019, he continued the family's unfortunate tradition: A biopsy revealed that he had prostate cancer.

"Honestly, I was resigned to the fact that I'd probably get it too," Pollack said.

He underwent an immediate bone scan to make sure the cancer hadn't spread — "we didn't waste time" — and then began discussing treatment options with Rubinowicz.

Pollack said he initially considered prostate removal surgery and radiation — that's what his brother had done — but after getting a second opinion, opted for intensity-modulated radiation therapy.

"I did 45 treatments in 45 days," he recalled.

Within just a couple of months, Pollack's prostate-specific antigens "dropped to almost nothing, an insignificant number."

"I still have my PSA level checked every six months," he said. "I feel very fortunate. I don't want to say that I've beaten it, but it is not something that I think about every day anymore."

Without question, early detection put Pollack in the best position to make sound, informed decisions about his treatment.

As men age, the likelihood of developing prostate cancer — whether one has a family history or not — increases.

According to the U.S. Centers for Disease Control, approximately 1 in 8 men will develop prostate cancer during their lifetimes.

That vast number of men who develop prostate cancer never have any warning signs.

"About 70% of prostate cancer patients don't show symptoms," said Rubinowicz. "Occasionally patients have urinary issues — frequency, pain, blood, etc. — but usually those are related to BPH (benign prostate hyperplasia), not cancer."

The most important first step men can take is to have their PSA tested annually so they and their doctors have a baseline score.

"PSA is an imperfect marker but it is one of the best, if not the only, one we have for screening for prostate cancer," explained Rubinowicz. "Screening for prostate cancer helps detect cancer early, so we strongly recommend every man have an annual PSA starting at age 50, or by age 40 if they have family history or are African American."

While the general rule of thumb used to be that a "normal" PSA was between 0 and 4 and that anything more than 4 was considered "elevated," Rubinowicz said in the last couple of decades doctors have recognized that patients can have cancer with PSA scores that are less than 4.

"What is more important than the PSA number or value is the rate of change," said Rubinowicz. "If your PSA doubles or triples in a year, that is a significant increase. We pay more attention to the rate of increase or change than the actual level."

If a combination of PSA scores and/or symptoms has your doctor suspecting you may have prostate cancer, the standard diagnostic order goes as follows: a magnetic-resonance imaging (MRI) scan followed by a prostate biopsy.

"The standard of care is if we suspect or are concerned about PSA level, we do an MRI first and then biopsy," explained Rubinowicz. "The MRI will tell us where the cancer is located and then we can do an MRI-guided biopsy. The biopsy with an MRI is more targeted and accurate."

The pathology of a patient's prostate cancer will help inform both the patient and his doctor about the best course(s) of treatment — or no treatment at all.

"Historically, the gold standard was surgery. Today that surgery can be done robotically," said Rubinowicz. "Number two is radiation therapy of the prostate. For advanced stages, sometimes hormone therapy is used."

Other newfangled — but less frequently used — treatments include cryoablation and high-intensity focused ultrasound (HIFU).

"There is also what we call 'active surveillance,' which is conservative management for those with low-grade cancer that is not likely to progress or spread," noted Rubinowicz.

Rubinowicz stressed that the three biggest misconceptions about prostate cancer are:

1. It's always slow-growing and thus won't prove fatal.

2. Treatment protocols always create urinary and/or erectile side effects.

3. A PSA of 4 or less means that you definitely don't have prostate cancer.

"Early detection is critical," said Rubinowicz. "If you catch prostate cancer early and it has not spread, you can have treatment and your chances of being cured are much higher. But if you delay and your cancer has spread, your chances will be significantly lower."

Pollack, Rubinowicz's patient, certainly concurs, advising men age 50 and older "to be informed and understand your situation. Don't waste time. Know your options and move forward."

Prostate cancer stats and facts

©2021 www.palmbeachpost.com. Visit palmbeachpost.com. Distributed by Tribune Content Agency, LLC.