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In the News

Prostate Cancer: On The Rise!

By Dr. Victor Gong, Medical Director of 75th St. & 126th St. Medical, Ocean Pines Medical & Doctors Weight Control & Wellness centers, Ocean City, MD.

Prostate cancer is by far the most common malignant disease diagnosed in the United States and is the second leading cause of cancer death in this country, exceeded only by lung cancer. Autopsy studies have established the fact that prostate cancer, either occult or overt, is present in about 30 percent of men over the age of 50 years, but only about 20%-25% of these cancers become clinically evident. It has been estimated that 350,000 U.S. men will be diagnosed with this disease and that over 40,000 men will succumb to prostate cancer. The introduction of the PSA (prostate-specific antigen) assay, the blood sample for screening for prostate malignancy, affords much hope that morbidity and mortality attributed to this disease will be substantially reduced.

Unfortunately there are no early symptoms of prostate cancer. Since the majority of prostate tumors occur in the periphery of the gland, encroachment on the urethra and accompanying urinary obstructive symptoms are late manifestations of the disease; it is only in advanced disease that lower urinary tract symptoms occur.

Until recently, the diagnosis of prostate cancer was largely based on the suspicion of the physician. Every man over the age of 50 years should undergo digital rectal examination on a regular basis (the arbitrary age of 40 is selected for those at increased risk, i.e., family history in first-degree relatives, blacks). The diagnostic yield from digital rectal exam varies considerably with the skill and experience of the examiner. The findings of areas of stony hard induration and nodular irregularity should suggest the diagnosis, which is verified only by means of biopsy.

The PSA assay determination affords the patient a greater likelihood of success through means of effective screening and earlier diagnosis to a point where therapy would more likely be effective. In years before, when PSA assay was unavailable, prostate cancer was diagnosed by clinical signs and symptoms, the stage at diagnosis was relatively advanced, and overall survival was suboptimal. Many of these patients presented with advanced disease which obviates cure with current systemic therapies.

The accepted normal cutoff value for most available PSA assays is 4 ng/ml. Older men and men with a larger prostate due to benign hypertrophy may have slightly elevated levels. Cancer patients with a PSA level of 10 ng/ml or less and small-sized tumors are in a distinctly favorable subgroup where long-term survival and superior outcomes have been observed with a variety of therapeutic approaches. In contrast, studies in patients with a PSA level greater than 10 ng/ml (usually associated with larger tumors) have demonstrated much poorer results.

About one-third of patients with a PSA determination above 4 ng/ml later have a diagnosis of prostate cancer and this fraction increases as the PSA level rises; about two-thirds of patients with PSA levels above 10 ng/ml have prostate cancer. In conclusion, it can be shown that PSA has the highest specificity of any circulating cancer screening marker. Clearly, cancer of the prostate is a major health concern; however, the possibility exists that routine screening of PSA levels in conjunction with diligent rectal examination will lower the morbidity and mortality associated with this disease.

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