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Health // Doctor in the House
Rasa Fournier

Minimize Invasive Prostate Care

DR. DAVID DERRIS, Prostate health advocate

What is your connection to prostate health?

I am a retired orthodontist, but I have studied prostate cancer health issues for more than 15 years. In 1996 at age 58, while practicing on Maui, I was diagnosed with prostate cancer. I immediately started educating myself about prostate cancer. I became a member of the Maui chapter of Us TOO! International Prostate Cancer Patient Support Group, and led the group for several years. I also received training with the Prostate Cancer Research Institute (PCRI) in 2004, and for 18 months was its Hawaii educational facilitator, answering helpline calls and email inquiries from prostate cancer patients and their loved ones. Recently, I completed a PCRI-sponsored mentoring program for prostate cancer support group leaders, and have rejoined the helpline staff of the PCRI. I am a member of the Kuakini Us TOO! Support Group and a director of the Hawaii Prostate Cancer Coalition. My goal is to provide information to prevent unnecessary pain and suffering caused by either the under-treatment or over-treatment of prostate cancer.

What are some of the recent findings regarding prostate health?

There are forms of prostate cancer ranging from very low aggressive to low aggressive to intermediate aggressive to high aggressive – aggressive, meaning the chance that form of prostate cancer will progress to cause health concerns and/or shorten survival. Helping men understand their type of prostate cancer is key to proper prostate care.

The issue of early detection of prostate cancer was placed on the front burner with a 2011 U.S. Preventive Services Task Force (USPSTF) report against the use of the PSA test. A rational understanding of the medical considerations involved – and not emotional beliefs of people who are for or against early detection – has to be brought to the public. The government issued the USPSTF because of concerns that more harm than benefit is happening to patients as a result of early detection. PSA (prostate-specific antigen) testing leads to prostate biopsies when a PSA reading is high.

Many prostate cancers detected because of an elevated PSA reading are of the very low aggressive or low aggressive forms. (Some PSA-detected cancers do reveal intermediate or high aggressive cancer.) These PSA-generated biopsies do not find cancer 75 percent of the time. Meanwhile, biopsies can cause infections, urinary problems and much anxiety for the patient. Also, there is the expense to the health care budget when so many men are being biopsied. Approximately 1 million biopsies are done yearly.

According to the American Cancer Society, in 2011, 240,000 American men were diagnosed with prostate cancer, and 33,700 died from prostate cancer. American Cancer Society data also finds one in six men will be diagnosed with prostate cancer some time during their life, and one of 36 men will die from prostate cancer. Using this data we can determine that one of those six diagnosed will die of prostate cancer, while the other five will die with prostate cancer, but not from prostate cancer.

Is it always best to take a minimally invasive stance?

Prostate cancer can be a serious disease. After lung cancer, prostate cancer is the second most lethal cancer in men. The intermediate aggressive and high aggressive forms have the potential to progress and spread in the body, and need to be treated. According to the National Comprehensive Cancer Network (NCCN), men diagnosed with very low aggressive and low aggressive forms should be counseled in the treatment option called active surveillance, and not immediately offered invasive treatments. The NCCN guidelines for intermediate and high aggressive give direction to evaluate which of the several invasive treatment options might be appropriate for an individual patient to use.

The report of the USPSTF emphasizes the harms done rather than benefits achieved from prostate screening, and recommends against PSA testing. The PSA blood test measures a protein made by prostate cells. Elevated PSA readings do not necessarily indicate cancer, they may be caused by a benign enlargement of the gland or prostate inflammation or infection. While prostate cancer can be the cause of death, many men are going through unnecessary pain and suffering caused by biopsies and then may experience over-treatment of a non-aggressive form of prostate cancer that might not have caused them health problems or shortened their life if never diagnosed.

Who should get a prostate exam?

With 33,700 men in 2011 having died from prostate cancer, there is concern about the under-treatment of aggressive prostate cancer. Therefore, men who have high-risk factors associated with having prostate cancer should be advised by their doctors to do PSA testing. High-risk factors include a hardness felt during a digital rectal examination (DRE), family medical history of prostate cancer, exposure to Agent Orange. As men age, their chance of having prostate cancer increases, but younger men do get prostate cancer. African-American men, airline pilots, male flight attendants, farmers and men exposed to toxic chemicals like pesticides and herbicides are all at a higher risk of prostate cancer. To minimize the over-treatment of non-aggressive prostate cancer, healthy men, without high-risk factors for prostate cancer, should discuss with their doctors the benefits and risks associated with testing, and only after being fully informed decide if PSA testing is right for them.

What recommendations do you have for men diagnosed with prostate cancer?

Join a support group before you make a final decision on having any treatment. Hear from the men in the group what actually happens when a man undergoes different types of treatments. There is a world of difference in understanding the treatment procedure as explained by your doctor, and hearing from patients what it is like living through the treatment and dealing with the changes caused by the treatment.

Patients who make the decision to become involved in their treatment process, who make changes in lifestyle, diet and reduce stress, do better and have less recurrence of disease than those who don’t. Free online resources include the Hawaii Prostate Cancer Coalition website, hawaiiprostatecancer.org, or call me at 922-3480. Another resource is the Prostate Cancer Research Institute, which also offers free, unbiased prostate health information at help@pcri.org, or call the helpline at 1-800-641-7274.

Become educated and be an active partner in restoring your health. While restoring health can mean eliminating cancer, it also can mean living a high-quality life while keeping cancer from progressing, and not causing you medical problems or shortening your life.

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