Attention Men: Prostate Cancer detection and options for treatment

Hampton Roads offers plenty of options for prostate cancer treatment, but early detection is key

Starting by age 50—earlier if you have a family history—men should talk to their physicians about early detection of prostate cancer, says Dr. Mark T. Fleming of Virginia Oncology Associates, with offices on the Peninsula and in Gloucester. African-American men are at higher risk. All men—if your significant other handed you this article, it’s because she cares.

“Most men with prostate cancer are cured,” Fleming says. “Our treatmentoptions are better. We are blessed in Hampton Roads with multiple treatment options.

We have great surgeons. Wehave great radiation facilities. We have the Hampton University Proton Therapy Institute. We have laser surgery. We have robot surgery. We have novel radiation treatment (including radioactive seeds).

You do not need to go out of Hampton Roads to get the best medical care.”

Women are accustomed to regular cervical cancer screenings (PAP smears),but men aren’t as likely to schedule regular physical exams, doctors say. But getting regular medical care is important for men too. “Men go to the doctor when they have a problem,” Fleming says. He emphasizes that seeing your doctor and having the conversation is important—not simply getting a screening test done at a mobile medical truck.

The PSA test is the first screening test,but it’s not a perfect test, Fleming says. A PSA of less than 10 is deemed to be normal. But a man could have a so-called normal PSA and still have prostate cancer, he says. Or a man could have an elevated PSA and not have prostate cancer,Fleming says. That’s why it’s important to supplement the test with a digital rectal exam and if deemed necessary, a biopsy.

The biopsy yields what’s called a Gleason score, says Dr. Biral Amin of Oncology Associates of Virginia, with locations throughout Hampton Roads. If
the cells are angry looking and don’t closely resemble normal prostate cells, the Gleason score is higher. A higher Gleason score often indicates more aggressive treatment is needed. “Generally prostate cancer is slow-growing. But if you have a very high Gleason score, it can grow quickly.”

Your doctor will look at your Gleason score, your age, your overall health and other factors to determine what treatment is best for you, Amin says. If a 75-year-old man is obese, has had a stroke and a heart attack and has a low Gleason score, “Why put him through surgery or any type of radiation,” Amin says. Unfortunately, “Something else will get him first.”

On the other hand, a 75-year-old man who jogs every day and has no other medical problems might be treated with conventional radiation and/or seeds or even hormones, alone or with seeds or radiation, he says.

Men are rightly concerned about the side effects of any treatment. With conventional radiation and with seeds, about 60–80 percent of men keep their ability to have an erection, Amin says. Of the 20–40 percent who do not, more than half respond to Viagra or Cialis, he says. Other side effects include short-term urinary irritation and diarrhea, which are common. Incontinence and bowel problems are very rare.

Surgery poses a higher risk of side effects, Amin says, advising potential patients to get answers and statistics from surgeons they are considering. The cure rate after 10 years is about the same for seeds, conventional radiation and surgery to remove the prostate, Amin says.

So why get surgery at all? Some men, especially younger patients, opt for surgery because if they are among the 10 percent whose cancer reoccurs, they can then try radiation and other treatments, he says.

Surgery is not advisable after radiation because there’s too much scar tissue, Amin says. “You have more options later with surgery,” he says. “That’s why younger patients often get surgery first because they have more options if the cancer comes back.”

For more: Hampton Roads Prostate Health Forum at

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