Magazine article FDA Consumer

Prostate Cancer: No One Answer for Testing or Treatment

Magazine article FDA Consumer

Prostate Cancer: No One Answer for Testing or Treatment

Article excerpt

Improved screening tests and diagnostics have helped discover prostate cancer in early stages, when it is easiest to cure.

Russ Ingram didn't sense pending calamity when he reported for a company physical seven years ago. After all, he was in good shape and, at 39, still very much a robust young man with no signs of health problems.

During part of the exam, however, the doctor noticed that Ingram's prostate was enlarged. While this can indicate a tumor, often it signals a common benign prostate condition, usually in men much older than Ingram. But a visit to a urologist produced the grim news that his condition was not benign. He had prostate cancer.

"I was devastated," says Ingram. "Due to my age, I didn't think there was anything to worry about. It caught me totally off guard. I didn't even know where the prostate was."

To be sure, Ingram's case is not typical. His age at diagnosis placed him well outside the primary risk group for prostate cancer. Statistically, 80 percent of prostate cancers occur in men over 65. In fact, men in their 30s are not usually tested for prostate cancer in a physical and Ingram says it was just "a fluke" that the doctor discovered the enlarged prostate.

While the disease can strike any man, younger men at increased risk include African Americans, who have double the risk and death rate of white men and often are stricken before age 50. Men with a family link to prostate cancer through brothers or fathers also are at a greater risk of getting the disease before 50.

The American Cancer Society estimates that about 184,500 American men will be diagnosed with prostate cancer this year and 39,200 will die. It is now the second leading cause of cancer death in men, next to lung cancer. Despite the bleak numbers, 89 percent of men diagnosed with the disease will survive at least five years and 63 percent will survive at least 10 years, the society says. These rates are partly due to improved screening tests and diagnostics the Food and Drug Administration has approved that discover cancer in early stages. Also, prostate cancer is very slow growing in some men, who may die of some other cause before the disease takes its toll.

Detecting Prostate Cancer

The prostate is a male sex gland, about the size of a walnut. It produces a thick fluid that helps propel sperm through the urethra and out of the penis during sex. Because the prostate is just below the bladder and directly in front of the rectum, a doctor can check the size and condition of the gland by inserting a rubber-gloved finger into the rectum. This digital rectal exam (DRE) has for years been the gold standard for detecting prostate cancer as well as the noncancerous disorder benign prostatic hyperplasia (BPH).

In 1985, FDA approved the first test for monitoring blood levels of a substance called prostate specific antigen (PSA), which, when elevated, can indicate cancer presence. Several companies now have approved PSA tests, which, experts say, have revolutionized the screening and monitoring of patients.

PSA is an ideal marker for prostate cancer because it is basically restricted to prostate cells. A healthy prostate will produce a stable amount--typically below 4 nanograms per milliliter, or a PSA reading of "4" or less--whereas cancer cells produce escalating amounts that correspond with the severity of the cancer. A level between 4 and 10 may raise a doctor's suspicion that a patient has prostate cancer, while amounts above 50 may show that the tumor has spread elsewhere in the body.

Most PSA tests measure "total PSA," or the amount that is bound to blood proteins. In March, FDA approved the Tandem R test, which measures not only total PSA but another component called "free PSA," which floats unbound in the blood. Comparing the two helps doctors rule out cancer in men whose PSA is mildly elevated from other causes. A 1995 study in the Journal of the American Medical Association showed that the free PSA test can reduce unnecessary prostate biopsies by 20 percent in patients with a PSA between 4 and 10. …

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