By Matt Hickman
It’s a well-worn stereotype and even more documented fact that men do not like to go to the doctor. When it comes to their prostates, men might be moved to go if they’re getting up seven times a night to relieve themselves, or if it’s affecting their erectile function.
The problem with that is that those symptoms are caused by BPH (Benign Prostatic Hyperplasia), which has nothing whatsoever to do with what should be their biggest concern — prostate cancer.
“The major challenge with prostate cancer is that very rarely does a patient have symptoms until it’s too late,” said Dr. William Magnuson, radiation oncologist at Providence Medical Center. “If you have stage 4 cancer that has metastisized into your bones, you may wake up with horrible back pain, but it’s actually very rare to have urinary symptoms… It’s not like a female who can feel a mass in her breast.”
The only way for a man to ensure he’s doing all he can to protect himself against the threat of prostate cancer is to get screened, and with September being National Prostate Cancer Awareness Month, the Providence Cancer Center will be holding free screenings Sept. 16-18 from 5 to 8 p.m. each night.
Magnuson said any man over 50 (or over 45 for African-Americans and over 40 for those with family history of cancer), should get tested.
If the thought of a doctor’s finger going up one’s rectum in search of the walnut-sized prostate gland sounds forbidding, fret not. Routine tests for prostate cancer now begin with a simple blood test known as a PSA (Prostate-Specific Antigen) which can gauge one’s likelihood of having or developing prostate cancer.
Even if those numbers do come in high, it does not mean a patient has prostate cancer, and, Magnuson says, even if a biopsy does show the presence of cancer, treatment isn’t always necessary.
“There’s been some seminal studies in this known as ‘active surveillance’ at Johns Hopkins that found that with patients who were very unlikely to die as a result of prostate cancer — these patients with a low risk criteria — they didn’t treat any of them and followed them for a number of years. They found that 40 percent of these patients never needed treatment and the other 60 percent, over time, gradually the cancer became more aggressive and they needed treatment, but a large portion never did,” Magnuson said. “Even among those 60 percent, 97 percent showed a high change of being cured, so we identify which patients do and do not need to be treated because even the best treatments in the world involve some risk of side effects. So if you’re low risk, we’ll say, ‘let’s just follow this for a while; you may not need treatment, or you may need treatment 10 years down the road.’”
For those who do require treatment, the cancer center at Providence features a state-of-the-art device in the Cyberknife, a $6 million machine, which takes the formerly shotgun approach of radiation therapy, and refines the spray to as little as 2 millimeters.
“It offers the highest degree of precision for radiation therapy and it allows us to deliver treatment at a very high dose per treatment. Historically we did intensity modulated radiation therapy wherein small amounts each day over the course of 9 weeks. The precision of Cyberknife allows me to deliver much larger doses in five treatments. There’s only so much radiation that gets to adjacent tissues so the outcomes are better and there’s a lower risk of side effects.”
Ron Houston is a 64-year-old man who has never been shy about getting his PSA levels checked and he may owe his life to that consistency. Three years ago, the medical dosimetrist at Providence received his highest PSA reading in his 15 years of doing them. It turned out, he did, in fact have prostate cancer, and given his family history he willingly became a ‘victim of the Cyberknife.’ Five days of treatment later, he was done and the cancer has not returned.
“My dad was diagnosed with prostate cancer and I was already working in radiation therapy at the time. Since his diagnosis, I started getting my PSAs and they would titrate up a little more and a little more. When it got a hair above normal I talked to three radiation oncologists and got a couple different opinions. Waiting and watching wasn’t an option so I elected to get Cyberknifed,” Houston said. “It’s pretty benign. It’s like 20 to 30 minutes of your day on the table, the machine does its thing and you go back to work.”
Houston said all six members of his immediate family have had cancer and two brothers died from the diesease.
“I knew at some point in time the shoe was going to fall for me, too,” Houston said. “The sad thing about it is you don’t have any symptoms. When it got advanced in my dad’s case, what he presented with was chest pain. When they worked up all his heart issues, his cardiac stuff came back stone cold normal. Then they looked at his bone scan and the cat was out of the bag at that point.”
In his capacity at Providence, Houston finds himself interacting with men who resisted getting tested longer than they should have.
“Being here with a lot of the guys over the years, they come because they feel they have to,” Houston said. “We’re our own worst enemies when it comes to going to the doctor for various things and I, thankfully, had an early diagnosis, which was a lifesaver for me.”
Magnuson said the free, after-hours screenings have seen increases in the number of men who’ve shown up to get tested, but he knows many more out there need to take advantage.
“The main thing is to get your PSA checked out because knowledge is power,” he said. “Some may not need treatment now, but what you don’t want is to wake up in stage 4 when it’s too late… Maybe you need treatment, maybe you don’t but at least you’ll have the knowledge.”