this year alone nearly 300,000 American men are expected to be diagnosed with prostate
cancer though most of those diagnosed with it don't die from it on this final day of prostate
cancer awareness month Ali Rogan takes a look at screening diagnosis and treatment of the
disease and what it means to live with it prostate cancer is the most common cancer among men in the
US and the second most common cause of cancer related deaths and glaring racial disparities
exist within the disease one and eight men will be diagnosed with prostate cancer during their
lifetime but that rate increases to 1 in six for African-American men but a diagnosis doesn't have
to be life-changing in fact many men with certain types of slow growing prostate cancer are able to
foro surgery and treatment altogether Dr Charles Ryan is a genito urinary oncologist and he heads
the Prostate Cancer Foundation Dr Ryan thank you so much for joining us let's start with
the absolute Basics what is prostate cancer and where does it originate in the body sure well
thank you for having me and uh and to explain this important issue the prostate is a gland
that is very important in male reproduction it essentially produces the fluid that allows the
sperm to uh to fertilize an egg so without it we are not able to reproduce it it it exists at the
base of the bladder uh and it is really part of the male urinary tract but also the male genital
tract allowing sperm to to be released from the body and I know the options for prostate cancer
screening uh it and whether or not someone is a good candidate for it is a complicated issue
there are lots of factors that go into that but let's start with what sort of screening
is available for prostate cancer right so the prostate cancer screening has long involved a
test of blood test called a PSA test and for many years involved a digital rectal exam which is also
called the finger test so a doctor inserting his finger into the rectum of the patient to
see if there's a tumor uh that one can feel U we also now incorporate MRI scanning and over
time the MRI scan is really replacing the digital rectal exam because it's less uncomfortable and
it's actually more accurate the US preventative Services Task Force which is an independent body
that makes recommendations on disease prevention recommends currently that men aged 55 to 69 uh not
get automatically screened but rather discuss the pros and cons of screening with their provider the
US PTF doesn't recommend screening at all for men over the age of 70 but my question is if prostate
cancer is as we said so widespread why shouldn't all men get tested well it's important to remember
that when regard with regards to screening that there are three distinct groups of individuals
who can who can get prostate cancer the first is a group that have such low-risk disease that they
may not require any treatment and our current estimates are that that may constitute 20 to
25% of all of the men diagnosed with prostate cancer in the United States there's a second
group which is patients who are curable with uh with treatment options as long as the disease is
confined to the prostate so those are the ones who really benefit the most from screening and
early detection there's a third group for whom the treatment options are not optimal
and they are not guaranteed a cure with current current treatment options and for those we need
to do we need to do more research and develop better treatment options it's important to
remember also that screening does not necessarily automatically lead to a certain type of treatment
and that's been some of the misunderstanding that's created the problems that we're seeing
now with a rising incidence of prostate cancer in its Advanced stages and what are the current
treatment options for people that are in those cohorts for whom treatment would work so for the
low-risk group we have a program called active surveillance which is monitoring and it's not
that they never receive treatment some of them and many of them actually do but it's delayed
until later uh those involve repeat biopsies MRI scan SC and close surveillance from a treating
physician but for men who are in the curable group the main treatments remain surgical removal of
the prostate radiation therapy uh to the prostate which has really evolved a lot over recent years
and then combinations with other approaches such as hormonal approaches that may help radiation
um do a better job in advanced disease we've seen a tremendous growth of a number of therapies for
with a whole variety of of different mechanisms of action uh that extend life and improve its quality
for men even with Advanced stage metastatic prostate cancer we mentioned in the introduction
this persistent racial disparity um in terms of diagnosis and outcomes why does it seem that black
men continue to be disproportionately affected by prostate cancer the cause of that disparity
are complex and probably include a combination of both biological factors genetic factors uh
as well as societal factors one key observation is that prostate cancer occurring in a black man
is likely to occur earlier in life and such that a screening when performed earlier uh May detect
curable cancer earlier uh than it would be for for example a a non-black man so starting screening at
the age of 50 may not be adequate for example for a population where the disease is likely to begin
even as early as age 40 I want to return to the issue of active surveillance that you mentioned um
some Studies have shown that some people on active surveillance when they're not receiving treatment
they eventually do have to undergo some sort of treatment does that indicate that testing needs
to advance in terms of being able to determine the potential seriousness of slow growing prostate
cancer well it's a wonderful question because we in fact are learning a lot more about the
biological heterogeneity of this disease and so when we're making a decision about whether
a patient would be uh an ideal candidate for active surveillance we incorporate genetic studies
now uh and genetic factors that look at the the interplay of a number of genes and that can help
us uh further stratify a potential uh patient for immediate treatment or deferred treatment
the treatments and the surgeries that currently exist for men dealing with prostate cancer tend
to be very serious and potentially life-altering what are the prospects that you see for the future
of that discipline is it getting better is it allowing men to continue to have happy and healthy
lives because of the location of the pr at the base of the bladder and as a as a key component
to the male sexual function um the worries around treatment side effects do include urinary function
and sexual function uh over the course of the past couple of decades uh the surgical
field has made tremendous strides in preserving sexual function and improving and preserving good
urinary function so one of the problems we have when we're thinking about the treatment related
side effects is where are we getting our data from if we're talking to patients who had their
treatment 15 20 years ago it was a very different setting back then than what we see now of course
there are cases where the the cancer is more advanced and it's more difficult to preserve
those uh functions but uh but today many men are quite optimistic about their treatment and there
are many men out there living happy normal lives after undergoing Curative treatment for prostate
cancer Dr Charles Ryan head of the Prostate Cancer Foundation thank you so much for joining us
my pleasure