Columns for The Lufkin News

Prostate Cancer: How Should We Treat It?

Posted Jul 01, 2014 by Sidney C. Roberts, MD, FACR

Prostate cancer screening and treatment may be the most divisive issue in oncology today. Oh, we argue about breast cancer, and whether or not women in their 40s should get a mammogram (they should), and how often they should get one (every year). But prostate cancer is even more controversial. That's because prostate cancer is not a single disease with just one way to treat it.

We divide prostate cancer patients into three risk categories: low, intermediate, and high risk. Risk of what? Risk of spreading and killing you, basically.

We place patients in these risk categories based primarily on how high the prostate specific antigen (PSA) blood test is, and how aggressive the prostate cancer biopsy specimen looks under the microscope (the so-called Gleason score). Low risk patients (PSA less than 10, Gleason score 6 or less) have a 90% survival rate at 10 years, which is fantastic. High risk patients on the other hand (mainly those with PSAs greater than 20 or Gleason 8-10) have aggressive cancers and only a 50% survival rate. Finding a prostate cancer when the PSA is lower and the cancer is less aggressive is better. But...

The problem is, we are now finding some cancers so early that they don't even act like a cancer; they will never spread or cause a problem. The conundrum is determining which cancers those are, because we still live with fear of the word "cancer" and assume that something must be done whenever it is diagnosed. Even more problematic, we too often assume that we must have surgery and "cut it out", when that may not be what is best, much less what is needed at all.

Yes, we over-diagnose and over-treat prostate cancer. Now, I am not a hardliner who says we shouldn't be screening for prostate cancer. Far from it. The American Cancer Society recommends that "men make an informed decision with their doctor about whether to be tested for prostate cancer." How old are you? What health problems do you have?

"Starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 45."

Remember, however, that even if you learn you have prostate cancer, you do not necessarily need treatment! Certainly, don't jump in and have major surgery without checking out all your options, including that of observation. On of the oldest statements in medicine is primum non nocere - first, do no harm. That holds true today as much as it did when that ethical concept was included in Hippocratic Oath in the 5th century BC.

If treatment is recommended, we are fortunate at CHI Memorial to offer a very precise form of radiation treatment called Intensity Modulated Radiation Treatment (IMRT) for prostate cancer. This pinpoint, outpatient treatment is every bit as effective as surgery with few side effects. It also does not have the risk of long-term incontinence that comes with surgery.If you or a loved one you know gets diagnosed with prostate cancer, or even just has an elevated PSA, please do not rush to surgery. Certainly, we have skilled surgeons in East Texas, but take your time and get a second opinion to determine 1) whether treatment is the best option, and 2) whether surgery or radiation is a better option for you.

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Meet Our Team

Sidney C. Roberts, MD, FACR

Sidney C. Roberts, MD, FACR

Radiation Oncologist

Madelene Collier, RN, OCN

Madelene Collier, RN, OCN

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Jewel Randle, RT (R)(T)

Jewel Randle, RT (R)(T)

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Aimee Salas, RT (T)

Aimee Salas, RT (T)

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Josh Yarbrough, RT (R)(CT)(T)

Josh Yarbrough, RT (R)(CT)(T)

Radiation Therapist

Julie McClain, RT (R)(T)

Julie McClain, RT (R)(T)

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Linda Miller, MS

Linda Miller, MS

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Evelyn Leach

Evelyn Leach

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