3 times more likely to die from the disease. I believe that this is due to the fact that the Gleason scores (the histological grade of the cancer) are, on average, much higher in newly diagnosed black men with prostate cancer than they are in white males of the same age when they are first found to have the disease.
The second important exception to the general rule that prostate cancer tends to be a relatively benign disease relates to the age of the patient when the cancer is first diagnosed. My experience suggests that prostate cancer is a much more virulent and aggressive tumor when it is diagnosed in young males irrespective of race. As a result, we tended to treat men in their 50s with newly diagnosed prostate cancer much more aggressively than those who were diagnosed in their late 70s. In my view, watchful waiting is a poor option for younger males because, even if their cancer is low grade when first diagnosed, it will certainly become more aggressive as time goes on and, as the aggressiveness of the tumor increases, the chances that it will metastasize and become incurable also increases. Therefore, younger males might as well bite the bullet and do everything in their power early on to eradicate the cancer while it is still confined to the prostate and is curable.
Now for a question that demands our attention. Despite our advances in early detection over the past 30 to 40 years, primarily due to the availability of PSA testing, the mortality rate for prostate cancer has actually increased over the past three decades. For example, in 1973 the mortality rate for prostate cancer in white males was 20/100,000; in 1995, 22 years later, the mortality rate from prostate cancer had increased to 22/100,000 in Caucasian males. During the same time period, the mortality rate for blacks with the disease increased from 40/100,000 in 1973 to 52/100,000 in 1995. The significance of these statistics is that approximately, 30,000 American males died of prostate cancer in 1990 while 32,000 died from the malignancy in 2010.
What in the world is going on here? Early diagnosis is much easier to achieve with the PSA blood test than it was when we had to rely on the rectal-digital examination and crude transrectal biopsies to diagnose the disease. Some would argue, although I would not, that the treatment for prostate cancer also has advanced considerably over the past 40 years. So, why are so many males still dying of prostate cancer?
I believe the answer is quite simple, the watchful waiting crowd which includes many of the primary care physicians and the internists who in today’s medicine are the gate keepers for all things surgical have not taken this malignancy seriously enough. In short, they tend to fiddle around while Rome is burning, or in this case, while the cancer is escaping the confines of the prostate and, in so doing, becoming incurable. I hope, after reading this eBook that you will agree with me. If so maybe it would be a good idea to give a copy of this book to your primary care physician for XMAS. After all, a little knowledge never hurt anyone.
3. How is prostate cancer diagnosed?
One of the most important things to realize about prostate cancer is that, with rare exception, the malignancy does not produce symptoms until it has metastasized (spread outside the prostate gland) to other organs. The exception is when it is associated with benign prostatic hypertrophy in which case it may contribute to difficult urination. In this case the diagnosis may be made when the pathologist examines the tissue removed when the urologist performs a turp (transurethral resection of the prostate) to relieve the obstruction.
Thus, in the majority of cases if prostate cancer is to be detected in its curable state it must be done during routine physical and hematological examinations of asymptomatic patients. These examinations include a rectal digital examination of the prostate wherein irregularities of the posterior surface of the prostate are detected by the examiners finger and, most importantly, by periodic determinations of the males PSA (the prostatic specific antigen blood test). Interestingly, a study performed many years ago at the Mayo clinic revealed that one of the most meaningful things, from a cost effectiveness standpoint, that came out of the yearly physical examinations they performed on business executives was the detection of curable prostate cancer.
At this point I must address a very significant misconception that is held by many in the medical profession, and even some Academic Urologists, I am sorry to say. These physicians rely on large body statistical evidence that at first glance would seem to suggest that, taken as a whole, men with prostate cancer would be better off if they were never diagnosed with the disease. The rational being that the complications of treatment and possible over treatment out weight any possible benefit the population as a whole might gain from efforts to cure the cancer. Along the same lines those who support this course, or rather, non course of action, also maintain that the diagnosis and treatment of prostate cancer for the nation as a whole is too expensive to be cost-effective. Interestingly, you never hear anything about the cost-effectiveness of treating lung cancer, colon cancer or, God forbid breast cancer.
I believe this line of reasoning is erroneous for at least two reasons! First, and possibly most importantly, death from prostate cancer is a prolonged extremely painful ordeal. It is one thing to keel over and die from a massive heart attack or stroke; It is quite another to die a prolonged death from incurable prostate cancer that has metastasized to the bone. If you don’t believe anything else I tell you in this eBook, believe that! If you are unfortunate enough to develop the malignancy, and are not likely to die from something else, you need to be diagnosed early so that the cancer can be cured, that’s the long and the short of it!
Second, you can make a case, from a statistical standpoint, for almost any supposition. In this case, don’t let the statistics confuse you; rather follow your instincts and common sense. In this respect, I know of no urologist under the age of 75 and in reasonably good health that does not get his yearly PSA test. Why do you think this is? By the way I think most primary care physicians and internists make sure that they are tested for prostate cancer on a yearly too.
WE will discuss who should get a PSA momentarily; however, if you have an elevated PSA what’s next? The diagnosis of prostate cancer is not based on the PSA test along. For a diagnosis of prostate cancer to be make the urologist must perform a prostate needle biopsy, usually under ultra sound, so that tissue specimens from suspicious and non-suspicious areas of the gland may be examined histologically for the presence or absence of malignant tissue. Cancerous tissue is graded on a Gleason score of 1 to 10. Low grade, score, tumors are less malignant and less likely to have metastasized, while high grade tumors carry a significantly more ominous prognosis because they are faster growing and are more likely to have metastasized before the diagnosis was made.
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