With November designated as Prostate Cancer Awareness Month, Dr. Kiavash Nikkhou, a urologist specializing in Urologic Oncology, shares the most recent statistics and treatments about this disease.
The second most common cancer and the second leading cause of cancer death in men, prostate cancer develops because of uncontrolled mutation of prostate cells.
“In more advanced stages, prostate cancer can locally extend out of the prostate gland or metastasize to other parts of the body, including lymph nodes, bone, lung or liver,” Dr. Nikkhou explains.
While the cause of prostate cancer is unknown, factors such as age, African American ethnicity and positive family history in a first-degree relative can increase the risk of developing prostate cancer.
“Patients with strong risk factors should consider earlier screening,” recommends Dr. Nikkhou, who shares his expertise about the latest prostate cancer facts and treatment options.
Q. What are the most important factors a man should know about prostate cancer?
1. Prostate cancer does not only affect older men—an estimated 35% of new cancer diagnoses are in men younger than 65 years of age.
2. Men with prostate cancer are often without symptoms and early detection of prostate cancer is dependent on routine screening.
3. There is a wide range of prostate cancers and most are slow growing. Some prostate cancers may not become clinically significant or require treatment. Workup and treatment are dependent on patient’s age, medical history and risk factors.
4. When detected and treated at an early stage, prostate cancer is a treatable and potentially curable condition with an estimated 98% five-year survival rate.
Q. What treatments do you offer men with prostate cancer?
Several treatment options are available for localized prostate cancer, including Active Surveillance, Robotic Radical Prostatectomy (surgery), Radiotherapy or Cryotherapy.
More recent focal therapies, including High Intensity Focused Ultrasound and Focal Therapy (HIFU) or Proton Beam Therapy (PBT) are available but lack robust evidence of efficacy.
“The appropriate treatments are based on patient’s age, comorbidities and extent of prostate cancer,” Dr. Nikkhou explains.
● Active Surveillance is a reasonable option for patients with low volume, low stage prostate cancer. Patient on active surveillance are closely monitored with routine PSA and prostate exams and are encouraged to have confirmatory and surveillance imaging and biopsies. If progression in disease is seen on PSA, imaging or biopsy, the patient will then be offered definitive therapy based on the new findings.
● Surgery for prostate cancer, known as Robotic Radical Prostatectomy, involves removal of the prostate gland, seminal vesicles and regional lymph nodes. It is now a minimally invasive surgery using the Da Vinci® Robotic platform. Removal of the prostate can also improve obstructive symptoms that many older men can experience and is the preferred treatment for those who can tolerate surgery. Younger and healthier men are more likely to experience cancer control benefits from prostatectomy than older men.
● Radiation Therapy or Cryotherapy can be offered as monotherapy or in combination with hormone suppression. Oncologic outcomes for radiotherapy are equivalent to surgery and may be the preferred treatment option in elderly men who are not surgical candidates, or men who prefer to avoid surgery. Cryotherapy may be considered in some patients who are not suitable for surgery or radiotherapy, but have a reasonable life expectancy.
Q. What is the biggest myth about prostate cancer?
Myth: “High Prostate Specific Antigen (PSA) level equals prostate cancer, and low PSA rules out prostate cancer.”
“This is false,” Dr. Nikkhou says. “PSA is an antigen secreted by normal and abnormal prostate tissue,” he explains. “Many factors can lead to a rise in PSA and does not necessarily mean prostate cancer. Conversely, prostate cancer can be found in men with low PSA, as not all prostate cancers secrete PSA. For this reason, prostate cancer screening should include PSA blood test and rectal exam.”
Q. Is prostate cancer on the rise?
The number of men diagnosed with prostate cancer each year is on the rise, “but it is as a result of the increase in screening and awareness for prostate cancer,” Dr. Nikkhou says.
“Healthy men above 50 years of age should have a PSA blood test and a digital rectal exam each year to screen for prostate cancer,” he advises. “Men with abnormalities in PSA or rectal exam should be referred to a urologist for further evaluation.”
Q. What preventive measures can a man take to potentially avoid prostate cancer?
“There is no proven measure to avoid prostate cancer,” Dr. Nikkhou emphasizes. “Risk factors, including age or family history cannot be avoided. Routine screening, however, can avoid complications of advanced or metastatic prostate cancer.”
Q. What advice can you offer men with prostate cancer?
Advances in minimally invasive surgery and radiation have enhanced the treatment of clinically localized prostate cancer with lower morbidity and complications, Dr. Nikkhou notes.
“Prostate cancer is now a potentially curable condition. More advanced or metastatic prostate cancer can be treated with hormone suppression or chemotherapy to improve overall survival,” he says.
Coping with a diagnosis of cancer can be difficult, Dr. Nikkhou adds. “Support groups can be a wonderful resource where patient can share stories, treatments and advice on management of this condition,” he recommends.
Q. When it comes to prostate cancer, what’s the bottom line?
Men over 50 years of age with normal life expectancy should have annual screening with PSA and rectal exam, Dr. Nikkhou reemphasizes.
“Men with significant risk factors should consider earlier screening—any abnormalities in PSA or rectal exam should be evaluated by a urologist,” Dr. Nikkhou advises.
The diagnosis of prostate cancer requires long-term treatment and surveillance, he adds.
“The key for patients diagnosed with prostate cancer is to feel comfortable with their urologist and understand their condition and all available treatment options,” Dr. Nikkhou says.
Dr. Kiavash Nikkhou is located at 415 Rolling Oaks Drive, Suite 260, in Thousand Oaks. For more information, call 805.309.2555; or visit NikkhouMD.com.