Prostate cancer is the second leading cause of cancer
death in American men, behind only lung cancer
BRONX TIMES R 16 EPORTER, SEPT. 11-17, 2020 BTR
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MICHELLE GABRIELLE CENTAMORE
While treatments are improving, the
American Cancer Society (ACS) estimates
for prostate cancer are 191,930 new cases
and 33,330 deaths in the United States this
year. And Long Island men are not immune.
The New York State Department of
Health estimates that from 2012-2016, Nassau
County presented with average annual
cases of 1,118.8 and 107.8 deaths per year;
Suffolk County reported 1,093 average annual
cases and 113 deaths per year.
“It is certainly an important medical
problem on Long Island, similar to the way
breast cancer is in this region,” states Dr.
Manish A. Vira, system chief of urology
at the Northwell Cancer Institute. With
greater awareness, screening, and improved
treatment, the majority of men who
are diagnosed typically have positive outcomes,
Diagnostics for prostate cancer include
a physical examination to ascertain
if there is unusual fi rmness or a nodule on
the prostate, and prostate-specifi c antigen
(PSA) screening. PSA is a protein produced
by both cancerous and noncancerous tissue
in the prostate. The PSA test measures
the amount of PSA in the blood.
The American Urological Association
recommends “shared decision-making” between
doctor and patient for men ages 55 to
69 years who are considering PSA screening.
Men in their 40s or 50s who are at risk
may consider getting screened earlier.
At-risk males include those with a family
history of prostate, breast, ovarian, and
colorectal cancer and specifi c genetic factors.
“We know that men who carry the
BRCA mutation gene mutations associated
with increased breast cancer risk
also carry increased risk of not just prostate
cancer but aggressive prostate cancer,”
Dr. Vira says.
An elevated PSA does not necessarily
equate to a defi nitive prostate cancer diagnosis
or necessitate a biopsy, says Dr.
Michael P. Herman, chief of the division
of urology at South Nassau Communities
Hospital. There are two additional blood
tests — the 4Kscore® and the Prostate
Health Index (PHI) — that can aid in determining
whether or not a patient needs
“If needed, MRI-guided biopsies could
increase accuracy of the biopsy,” Dr. Herman
says. “We’re biopsying fewer people
because we’re able to fi gure out which men
don’t actually need it, but the ones we’re biopsying
are the ones that are truly at risk,
not just because of the high PSA.”
Surgery has improved by using robotics,
says Dr. Herman.
“We’re able to construct everything very
precisely and give people the best outcomes
when it comes to urinary control and sexual
function,” he says.
Recovery from surgery tends to be very
fast, too, he adds. Treatment time for radiation
for prostate cancer is also much different
than it is for other cancers.
“Radiation treatment can be as short as
a week or up to two months, but once you’re
done with radiation, that’s typically it,” Dr.
Treatments for men diagnosed with
Stage 4 prostate cancer especially have dramatically
improved over the years, notes
“Traditional stage 4 prostate cancer was
treated with hormonal therapy to eliminate
testosterone from the body and that treatment
would be successful for a period of
time, but eventually the cancer would start
to grow again,” he explains.
Several drugs or treatments have been
developed for patients who have failed hormonal
therapy. A drug called olaparib has
shown positive results in clinical trials in
men who have the BRCA mutation, Dr. Vira
says. A big avenue of treatment is actually
no treatment at all, he adds.
The idea behind “active surveillance” is
that “many men who have no risk of prostate
cancer at diagnosis may not need treatment
right away, because their cancer is
going to have a very slow and somewhat indolent
Surveillance, monitoring, and routine
PSA testing would be recommended. If the
cancer becomes more aggressive, treatment
such as surgery or radiation could follow.
“Treatment recommendations should
always be tailored to the individual and
their personal approach,” says Dr. Herman,
“and with a physician that is willing to take
that personal approach, work with the individual,
and understand where they are
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