U.S. Senator John Kerry.  Former U.S. Senator Bob Dole.  Former U.S. Secretary of State Colin Powell.  Former New York City Mayor Rudolph Giuliani.  Former President of South Africa Nelson Mandela.  Nobel Peace Prize-winning South African Episcopal Archbishop Desmond Tutu.  "Junk-Bond King" Michael Milken. Golf legend Arnold Palmer.  Actor Charlton Heston.  Singer Harry Belafonte.

What do all of these men have in common?  Prostate cancer.

Prostate cancer does not discriminate.  According to the American Cancer Society, nearly one out of every five American men will develop prostate cancer during his lifetime.  Prostate cancer is the second-most common cancer in American men, trailing only skin cancer.

While these statistics are cause for concern, there is a brighter side to the story, according to St. Luke's Hospital oncologist Dr. Richard Bohannon. "Except for skin cancer, prostate cancer is the most easily diagnosed and treated cancer among men," he says.

Bohannon should know.  He is another prostate cancer survivor.  "I was surgically treated for prostate cancer five years ago, and today I'm still cancer-free."

Noting that September is National Prostate Cancer Awareness Month, Bohannon encourages men to seek regular prostate cancer screenings.  "In general, men should have a prostate evaluation every year from the age of 50 on," he explains.  "For some men who are at greater risk for developing prostate cancer – such as African Americans and men who have a family history of prostate cancer – we recommend annual screenings beginning at age 40."
The prostate, a gland found only in men, is normally about the size of a walnut.  Located under the bladder, the prostate surrounds the upper part of the urethra.  Prostate cancer is a malignant tumor that develops from cells at that site. 

"Most prostate cancers grow slowly, but others can spread quickly to other parts of the body, especially the lymphatic system and the bones," Bohannon notes. "Prostate cancer in men under age 65 tends to be more aggressive than tumors in older men."

Early prostate cancer frequently causes no symptoms.  Some may cause more frequent urination or difficulty urinating, but that can also be a symptom of non-cancerous enlargement of the prostate.  Symptoms of advanced prostate cancer can include impotence, blood in the urine, and bone pain in the pelvis, spin, hips or ribs.

"Most cases of early prostate cancer can be detected by a screening that includes a blood test to measure the level of PSA – prostate specific antigen, a protein made by prostate cells – and a digital rectal exam or DRE," says Bohannon.  "The higher the level of PSA, the more likely it is there is cancer present.  With the DRE, the physician can feel whether or not there is any swelling or nodules in the prostate.  A transrectal ultrasound study may also reveal the presence of nodules."

If either the PSA or DRE is abnormal, a biopsy should be performed to determine whether or not cancer is present.  "A biopsy is really the only true way to diagnose prostate cancer," Bohannon explains.  "We usually take 8-10 surveys of cells from the precise location of abnormalities or the areas of the prostate where cancer most commonly occurs."

When a diagnosis of prostate cancer is confirmed, the question becomes how to treat it.  Surgery, radiation and hormone therapy are the most common treatment options.  Chemotherapy may be used in some cases.  "Watchful waiting," which involves closely monitoring the cancer without using any treatment, may be an option for some men – particularly those over age 75 or who have other major health problems.

"It is critical for men with prostate cancer, especially those under age 65, to be treated with a 'curative intent,' seeking a cure, not just a slowing of the disease," Bohannon says.  "In most cases, surgery to remove the prostate is the most effective.  Between 90-95 percent of patients treated surgically can expect a 10-year survival rate following treatment.  Radiation – either the implantation of radioactive 'seeds,' known as brachytherapy, or external beam radiation therapy – may be more appropriate in some cases, such as when the cancer has spread to the lymph system or bones. Between 80-85 percent of patients treated with radiation can expect a 10-year survival rate."

Bohannon adds that hormone therapy to medically or physically block the production of testosterone also can be highly effective.  "Hormone therapy would be a possible recommendation for men who are not good candidates for surgery or radiation, especially the elderly over age 80," he says.  "Prostate surgery is very hard on older patients, and physicians tend to treat prostate cancer in older patients more conservatively."

Each of the treatment options has potential side effects, Bohannon notes.  "Surgery can result in incontinence or impotence, although surgeons often attempt a nerve-sparing approach that doesn't impede erectile function and the use of Viagra-like drugs can improve blood flow," he says.  "Radiation therapy may cause scarring of the rectum or bladder.  Hormone therapy doesn't really cure the cancer, it can simply make the tumor shrink or grow more slowly."

The important thing to remember is that prostate cancer usually grows slowly, sometimes over decades.  Plus it is easy to detect and treat.   "A diagnosis of prostate cancer is not an automatic death sentence," Bohannon says.  "Early diagnosis and appropriate treatment can effectively cure prostate cancers.  I'm living proof of that."

If you need help finding a pediatrician, please call (415) 821-DOCS, or visit our website at www.stlukes-sf.org and click on the link for "Find a Physician."
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