health & wellness

Debate from page 75

(MIU) P.C., a Beaumont physician and
an assistant professor of urology at
Oakland University's William Beaumont
School of Medicine.
"However, in 2012, based on two
large research studies, the United States
Preventive Services Task Force recom-
mended against regular prostate cancer
screening concluding that the harm
resulting from this simple blood test
outweighs any potential benefit.
"In contrast, however, the recent
release of 15-year follow-up data from
one of the largest screening trials in
Europe revealed a 50 percent reduction
in prostate cancer disease-specific death
in the screened population," Lutz said.
One concern is that prostate cancer is
very common, especially among older
men, and many of those cancers found
through screening tests are so slow-
growing that they're unlikely to cause
the patient harm. The problem is that
there's no way to know for sure which
cancers detected through screening are
likely to kill a man and which could
be left untreated and go unnoticed for
decades.
The new guidelines were issued in
part because the recent studies reported
that efforts to reduce prostate cancer
deaths by screening and early detection
often resulted in over-diagnosis of the
disease. This lead to over-treatment that
left many men suffering from impo-
tence or incontinence as a result of a
biopsy and surgery. The data demon-
strated that the treatments caused harm
in greater numbers of men who have a
disease that would never be a problem
in their lifetime.
"Today, the subsequent develop-
ment and application of prostate cancer
tumor genetic markers allows us to dis-
tinguish a patient's candidacy for active
surveillance versus those who should
choose curative treatment options," Lutz
said.
"The guidelines of the task force
recommend the PSA blood test for
prostate cancer only if the patient has
symptoms," he said. "However, these
guidelines concern me because by the
time a patient has symptoms, the dis-
ease is often in its late stages, frequently
metastasized and can't be cured.
"I agree that PSA screening some-
times led to over-diagnosis, but it also
leads to an earlier diagnosis of the dis-
ease and the potential for cure," Lutz
said. "Prostate cancer is a silent disease,
often without symptoms, and with a
significant death rate. Early detection is
still needed:'

Risk Factors

Risk factors aren't the final answer to
detecting prostate cancer, but they can
help. Some risk factors can be changed
(quit smoking) and some can't be

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September 25 • 2014

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changed (your age). To complicate mat-
ters, there are people with multiple risk
factors who never get prostate cancer
and others with no risk factors who do
get prostate cancer.
Researchers have identified the fol-
lowing risk factors:

• Age: The chance of having prostate
cancer rises rapidly after age 50. About
60 percent of prostate cancer is found in
men over 65.
• Race/ethnicity: Prostate cancer
occurs more in African-American men
who are more likely to be diagnosed in
an advanced stage.
• Nationality: Prostate cancer is most
common in North America, northwest-
ern Europe, Central America and South
America.

• Family History:

"Prostate cancer seems
to run in some fami-
lies," says Dr. Marshall
B. Sack, D.O., family
physician and psychia-
trist practicing in Novi.
"Having a father
or brother with pros-
Dr. Marshall
tate cancer doubles a
Sack
man's risk of develop-
ing the disease. The risk for prostate
cancer also increases when there is a
family history of breast cancer, man or
woman," he said.
• Genes/Jewish Connection: "Some
inherited gene changes raise the risk
for more than one type of cancer," Sack
said. "For instance, inherited muta-
tions of the BRCA1 or BRCA2 genes are
the reason breast and ovarian cancers
are more common in some families. It
is now known that mutations in these
genes may also increase prostate cancer
risk in some men:'
Researchers found that men with
BRCA mutations are more likely to
develop prostate cancer at a younger
age. In addition, men with a mutation
on the BRCA2 gene are more likely to
develop a more aggressive form of the
disease. The rate of BRCA mutations
among Ashkenazi Jews is one in 40 and
one in 500 for the general population.
The task force did not specifically look
at men with BRCA mutations.
Other possible risk factors include
diet, obesity, smoking, inflammation of
the prostate and sexually transmitted
infections.
"The PSA screening is the best test
we have right now, and together with
a digital rectal examination it should
be offered until other prostate cancer
screening biomarkers are approved by
the FDA," Lutz said. "Although prostate
screening protocols have been updated,
the decision to undergo prostate cancer
screening should be made after a fully
informed discussion with the patient

regarding the risks, potential benefits
and current limitations of screening:'
Sack agrees with Lutz and includes
PSA screening as part of his male
patients' yearly physical, together with
a digital rectal exam, when they're over
50.
"I also include this screening for
younger patients, in their late 30s
and early 40s, if they show symp-
toms of a possible problem such as an
infected prostate, urinary frequency or
decreased streams," Sack said.
According to Sack, a high PSA level
does not necessarily indicate cancer, but
it does require a medical protocol for
investigating potential causes and cor-
recting them.

Personal Examples

The question of screening is a personal
and complex decision. Several years
ago, 63-year old Raymond Rose of Novi
was told by his physician that his PSA
count was high and referred Rose to
Lutz.
"I wanted my numbers tracked and
watched by a physician to at least rule
out other possibilities for my rising
PSA numbers," Rose said. "My numbers
kept rising and Lutz took a 3D-imaging
biopsy that indicated I had cancer on
one part of my prostate:'
"Last year, my numbers rose again
and for treatment I was given the choice
of a prostatectomy or radiation," Rose
said. "I chose focal cryotherapy because
the cancer was localized and there were
few side effects. Unfortunately, my PSA
numbers went up again and I was given
the choice of a prostatectomy, major
surgery or radiation. I chose radiation
treatment because there were less possi-
ble side effects. Five days a week for two
months I spent 15 minutes a day get-
ting treatment. That was last year. Since
then my PSA numbers are below one
and both my doctor and I are pleased:'
Cary Goldberg of Farmington Hills
was mildly concern when his internist
informed him that his PSA numbers
were up.
"I was referred to Dr. Lutz, who
checked my numbers again after six
months," he said. "My numbers went
up again and he performed a prostate
mapping, which involved MRI-imaging
techniques and a template-guided biop-
sy system producing a very accurate
diagnosis. The screening showed a small
spot on the prostate that was cancer.
"At this time, it wasn't necessary to
immediately use an aggressive treat-
ment:' said Goldberg. "I take a daily
medication, (Avodart) which may help
slow cancer growth and seems to be
managing my PSA levels. I realize that
if the numbers go up again, I'll need to
take a more aggressive treatment:'
Goldberg believes in asking his doc-

tor lots of questions about his condition
and talking about the risks and benefits
of different treatments with his family
before he makes a decision.
Seventy-two year-old Dan Burrows of
Livonia was diagnosed with an enlarged
prostate several years ago. A few years
ago, a PSA screening showed elevated
numbers.
Burrows had a biopsy of his prostate
and following lengthy discussions with
his urologist, decided to have radiation
therapy using radioactive seed implants.
"This was totally my decision,"
Burrows said. "I spoke with other men
who had their prostate removed and
decided on this method. Men tend to
keep everything to themselves, but I
think we should let others know what
happens when you have a treatment and
if it works or doesn't work. I still get
calls from people I worked with asking
my advice on a treatment they should
choose. I advise men to get a baseline
PSA screening, which gives them some-
thing to work with. I had no warning
signs, and if I hadn't been seeing an
urologist on a regular basis for my
enlarged prostate, I would have had no
warning about the cancer:'
Last year, the American Urological
Association, which originally disagreed
with the U.S. Preventative Task Force
recommendation against the use of PSA
screening for healthy men, changed and
updated its screening recommenda-
tions.
"Basically, they advise that the PSA
test remain an important tool in the
diagnostic process, but men over 40
should discuss PSA screening with their
physicians to determine if it's right for
them based on health and family his-
tory," Lutz said.
"At our last year's Men's Health
Event held at Ford Field sponsored
by the MIU Men's Health Foundation,
nearly 6,000 attendees were inundated
with information, lectures and videos
regarding the uncertainties, risks and
potential benefits of prostate screening.
Interestingly, 98 percent of those taking
the survey chose PSA screening:'
Lutz is a firm believer that testing for
and diagnosing prostate cancer doesn't
have to lead to over-treatment.
"Men with clinically insignificant
cancer or early stage disease can
select active surveillance, and those
with aggressive cancer can be assisted
through a local curative therapy," he
said.
According to Lutz, this discussion
should take place at age 50 for men who
are at average risk of prostate cancer,
at age 45 for populations at higher risk,
and at age 40 for men at even higher
risk such as those with more than one
first-degree relative who had prostate
cancer at an early age.

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