Knight Ridder/Tribune Business News, 06-14-06
Jun. 14--When Dr. Mike Price recommends prostate cancer screenings for men, he speaks from professional and personal experience.
The Franciscan Skemp urologist was a medical student at the University of Oregon when his father, Jim Price, died of prostate cancer at age 60 in 1974.
"My father's death got me into urology," Price said. "I started going with him to his appointments. I thought it was an area of medicine where I could make a difference."
He thinks his father might have had a baseline prostate examination, but probably didn't follow up with annual checkups. His father was diagnosed with prostate cancer at age 55.
Price said consumer groups and physicians didn't emphasize annual prostate exams at the time his father was diagnosed. And doctors didn't have much treatment back then.
He believes his father's life would have been saved with annual checkups and early detection.
Price's father was a professional musician who played with Nat King Cole.
"My dad's death was a great loss," Price said. "He didn't get a chance to meet my wife and kids.
"Today, if we can catch prostate cancer early enough, we have excellent treatment for it, and we have high success rates," he said. "On the other hand, when we catch it late, it's devastating."
Although men of any age can get prostate cancer, it is found most often in men older than 50. In fact, more than eight of 10 men with prostate cancer are older than 65.
Price, 58, said he has had annual exams since age 40 because of his family history. His three brothers -- ages 54, 62 and 64 -- also have regular checkups.
"We're all very aware of what prostate cancer screening can do," Price said. "It can save your life and keep you with your family."
Price said he likes to follow the American Cancer Society guidelines for prostate cancer screening even though research is still being done to determine whether screening is cost effective or makes a difference in most cases.
The cancer society recommends both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at higher risk, such as men with a family history, should begin testing at age 40 or 45.
In a digital rectal exam, a doctor feels the prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, a doctor may suspect cancer. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level also can be high because of other, less serious causes such as infection.
"There are guys whose cancers are picked up late because physicians didn't push the test," Price said. "I know family practice physicians who don't recommend a PSA."
Only slightly more than half of American men older than 50 get tested for the disease, according to the National Prostate Cancer Coalition.
The coalition points out that 99 percent of men with prostate cancer survive if the cancer is caught early, and deaths from the second-leading cancer killer of American men would drop dramatically.
That's one reason the coalition is launching a screening and awareness Father's Day campaign in June.
The coalition is sponsoring a national mobile screening program for prostate cancer in which 39-foot RVs designed specifically to test for prostate cancer will travel throughout major American cities offering free testing.
The campaign, Drive Against Prostate Cancer, will visit more than 50 cities by the end of 2006 and screen more than 14,000 men for free.
The coalition's Web site, www.fightprostatecancer.org, has spoofed the worst-case scenario survival hand guide by offering interesting statistical data, such as "a man living in the U.S. is 210,000 times more likely to die from prostate cancer than getting killed by an alligator" and off-the-wall tactics on encouraging men to get tested like locking him in a dog crate and dragging him to the urologist.
"A lot of men are afraid of the rectal exam," Price said. "But if done right, it shouldn't be that uncomfortable.
"But they're also afraid of cancer, and they fear what they may find," he said. "The fact is it's better to diagnose the cancer early when you improve your chances of living."
Price said he and other urologists are picking up more prostate cancer earlier because more men are being tested.
"There is more awareness than five years ago," Price said. "More and more men know their PSA."
But Price said it still isn't unusual that women drag their husbands to a prostate checkup.
"There are many times when men still have to be pushed, and there are many times they are glad they were," he said.
No one knows the exact causes of prostate cancer. Doctors often cannot explain why one man develops prostate cancer and another does not. Research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for prostate cancer:
--Age: Age is the main risk factor for prostate cancer. This disease is rare in men younger than 45. The chance of getting it goes up sharply as a man gets older. In the U.S., most men with prostate cancer are older than 65.
--Family history: A man's risk is higher if his father or brother had prostate cancer.
--Race: Prostate cancer is more common in African-American men than in white men, including Hispanic white men. It is less common in Asian and American Indian men.
--Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia may be at increased risk for prostate cancer. These prostate cells look abnormal under a microscope.
--Diet: Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk for prostate cancer. Men who eat a diet rich in fruits and vegetables may have a lower risk.
--Most men who have known risk factors do not get prostate cancer. On the other hand, men who do get the disease often have no known risk factors, except for growing older.
A man with prostate cancer may not have any symptoms. For men who have symptoms of prostate cancer, common symptoms include:
--Not being able to urinate; having a hard time starting or stopping the urine flow; needing to urinate often, especially at night; weak flow of urine; urine flow that starts and stops; and pain or burning during urination.
--Difficulty having an erection.
--Blood in the urine or semen.
--Frequent pain in the lower back, hips or upper thighs.
--Most often, these symptoms are not due to cancer.
Source: National Cancer Institute
BY THE NUMBERS
Prostate cancer is the most common form of cancer, other than skin cancer, among men in the U.S., and it is second only to lung cancer as a cause of cancer-related death among men.
--The American Cancer Society estimates that in 2006, about 220,900 new cases of prostate cancer will be diagnosed and 28,900 men will die of the disease.
--About 70 percent of all diagnosed prostate cancers are found in men aged 65 years or older.
--During the past 20 years, the survival rate for prostate cancer has increased from 67 percent to 97 percent.
--Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy.
--Men at high risk -- African-American men and those with a strong family history of one or more first-degree relatives diagnosed before age 65 -- should begin testing at age 45.
--Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.
SOURCES: American Cancer Society, Centers for Disease Control and Prevention, National Center for Health Statistics
Terry Rindfleisch can be reached at email@example.com or (608) 791-8227.
Copyright (c) 2006, La Crosse Tribune, Wis.
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