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Three key questions about prostate cancer

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September is national prostate cancer awareness month, a time to sort through what has become one of the most confusing areas for men to navigate in health care.

With controversial screening guidelines, uncertainty about whether to undergo treatment and multiple medical procedures from which to choose, there are more questions than ever about how to approach prostate cancer.

This year in the United States, approximately 233,000 men will be diagnosed with prostate cancer and about 29,000 will die of the disease, according to the American Cancer Society.

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Q: Is prostate-specific antigen (PSA) screening worthwhile?

A: “The U.S. Preventive Services Task Force has recommended to end routine prostate-specific antigen (PSA) screening for all men. But regular PSA testing has led to earlier and more sensitive detection of the disease. And the cure rate for prostate cancer has increased significantly since widespread use of PSA testing began in the early 1990s. Despite conflicting interpretations on the benefits of PSA screening, these tests should not be abandoned. PSA screenings save lives. Men with a strong family history of the disease (father and one other first-degree male relative) and African-American men should get PSA screenings annually starting at age 40. Men with significant urinary symptoms should also undergo screenings as appropriate. Men without symptoms should talk with their doctor about getting regular PSA screening starting at age 50.”

Q: What is the better choice, treatment or surveillance?

A: “We know that overall, a significant percentage of men diagnosed with prostate cancer may never physically suffer from it, and as a result don’t need treatment. We also know that in some cases, some treatments can cause unwanted side effects, and that overtreatment is a problem in this disease. But that doesn’t mean surveillance is the right solution for everyone. The predictability of prostate cancer progression becomes much fuzzier on an individual patient level. Patients who choose surveillance over intervention need to know that their cancer can change during their period of “watchful waiting” and that their “cure window” can possibly close without their knowing about it.”

Q: Which prostate cancer treatment is really best?

A: “There are many treatment choices for prostate cancer – open surgery, robotic surgery, X-ray radiation, proton beam radiation and others. Patients should take two to three months to explore all of their options, unless they have a high-grade tumor that requires immediate treatment. Men should explore the pros and cons of each treatment, and confer with family and physicians to arrive at an informed decision.

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