Back in the Dark Ages, the prostate was one of those mysterious parts of the male anatomy that most people didn’t know much about and certainly never talked about. That’s all changed, thankfully, and none too soon. According to the latest figures, more than 30 million U.S. men have a prostate condition that negatively affects their quality of life. More than 50% of men over the age of 50 have an enlarged prostate, and prostate cancer is expected to take 28,000 lives this year.
But there’s good news, too. Keeping weight under control and exercisingg regularly—things we all know—are two important factors that have an impact on prostate health. Other things we’ve heard about—ranging from the antioxidants in tomatoes to the polyphenols in red wine—also play a role. But the really big news has to do with the progress that’s being made on a number of fronts to detect prostate cancer, diminish the percentage of lives being lost, and improve the treatment and longevity of its victims.
The big guns of medicine—pharmacy, technology, and philanthropy—are being trained on prostate cancer as never before. “In 1975, only one out of the top 20 pharmaceutical companies had a research program on prostate cancer,” says Dr. Jonathan Simons, president and CEO of the Prostate Cancer Foundation.
“Now there are 14.” As recently as 1993 there were only two new clinical trials per year; now there are more than 60. And the number of dedicated research laboratories has grown from three to 200 over that 15-year period.
Even so, American men still face the prospect that one in every six will eventually be diagnosed with prostate cancer. Most men are not aware that prostate cancer is the second-largest cancer killer among men, exceeded only by lung cancer. Experts grimly joke that many adult males don’t even know they have a prostate gland, much less the havoc it can play when cancer strikes.
One problem is that prostate cancer can develop without any noticeable symptoms. Dr. J. Brantley Thrasher, professor of urology and co-director of operative services at the University of Kansas Medical Center in Kansas City, says that the first thing many new patients ask him is: What does the prostate do, anyway? Actually, the walnut-sized gland—located just below the bladder and in front of the rectum—contains cells that make some of the seminal fluid that protects and nourishes male sperm.
Because drugs that treat the common male condition of an enlarged prostate are so widely advertised, many men believe that since they don’t need to make frequent night trips to the bathroom, they are free of prostate cancer. Not necessarily so, says Thrasher, who also serves as a spokesman for the American Urological Association (AUA) and the AUA Foundation. When prostate cancer creates real distress, such as bleeding or pain in the bones, it may have already entered a life-threatening phase. “This is why it is important for men to be aware of the risk factors for prostate cancer and get screened for the disease so they can catch it early,” said Sandra Vassos, executive director of the AUA Foundation.
Surgery and radiation are the two most commonly utilized treatments for localized prostate cancer. If employed early enough, they can produce a 90% cure rate. Another approach involves active surveillance (also known as “watchful waiting”) of tumors determined to be very early or slow-growing. On the other hand, some cancers can be very aggressive and require a quick response. Since tumors can be scattered throughout the prostate, surgery usually removes the entire gland, while taking care not to damage the surrounding nerves that control erectile and urinary functions.
When prostate cancer develops, more and more PSA is released, and its level can serve as a warning sign of the disease. Anything under four ng/ml is considered normal; a higher reading can be cause for alarm and require further testing, usually including a biopsy of the prostate.
Many physicians—including Dr. David Samadi, chief of the Division of Robotics and Minimally Invasive Surgery in the department of urology at Mount Sinai Medical Center in New York City—contend that a jump in PSA velocity is an even more important warning sign. Says Samadi: “An increase in the PSA from 0.8 one year to 1.6 the following year may be a red flag requiring a biopsy.”
Nearly 35 million American men have a PSA test each year and more than one million of them then undergo a biopsy of their prostate tissue. “Yet only 250,000 of these men are found to have prostate cancer,” says Dr. Alan W. Partin, director of the James Buchanan Brady Urological Institute at Johns Hopkins Medicine in Baltimore. He cites the institute’s work in developing other cancer predictors, particularly one called EPCA-2 (early prostate cancer antigen- 2), that, the Hopkins researchers say, can detect the presence of prostate cancer in men with normal PSA levels and can also determine if the disease has spread beyond the prostate. The PSA test, Partin notes, can indicate that a man has cancer, but it doesn’t tell much about what kind of cancer it is—whether it’s aggressive or a milder, slow-growing type. EPCA-2 is about to be studied in a large trial, and the institute hopes to obtain FDA approval for its use.
Experts in the field agree that detection at an early age is crucial. “The earlier we catch it, the faster we’ll reduce the total number of deaths,” says Simons, whose foundation—created in 1993 by financier and prostate cancer survivor Michael Milken—is the largest private funder of prostate cancer research.
There are also dramatic developments in the types of prostate cancer surgery being done around the country. Mount Sinai’s Samadi is a leading robotic laparoscopic surgeon, having performed more than 1,400 such operations over the last seven years. He contends that this minimally invasive procedure has substantial advantages over traditional “open” surgery. “In open surgery,” says Samadi, “you’re working in a pool of blood. Not so with robotic surgery. And with the robot, my eyes compensate for the lack of tactile feeling. I’m working with two cameras in a bloodless field. The robot is an extension of my hands, and my eyes are more sensitive than the tips of my fingers.”
Robotic surgery, says Samadi, results in less trauma to surrounding tissue, minimal blood loss, much faster recuperation, and the lowest possible risk of incontinence and sexual dysfunction, which sometimes are side effects of prostate cancer surgery. “Our goal,” he says, “is not just survival. It’s to make the quality of life better for the patient.”
David B. Samadi M.D., Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at Mount Sinai Medical Center, is one of the nation’s leading urologic oncologists specializing in robotics and minimally invasive surgery for prostate cancer. Dr. Samadi is one of very few urologic oncologic surgeons in the United States trained in all three primary areas of surgery – open, laparoscopic, and robotic.
The Mount Sinai Hospital is one of the country’s oldest and largest teaching hospitals. Mount Sinai is internationally acclaimed for excellence in clinical care, education and scientific research.In the news