Prostate cancer treatment plans take expertise

October 31, 2016

Prostate cancer is the second most common form of cancer among men in the United States, according to the American Cancer Society. On average, 1 in 7 men will be diagnosed with it during their lifetime, while 1 in 39 will die.

The good news is that, if caught early, most men diagnosed with prostate cancer will not die from the disease. Surprisingly, some patients may not require treatment at the time of diagnosis, according to Dr. Irving LaFrancis, MD, who sees patients at Mercy Clinic Oncology and Hematology – Carthage.

“You can have patients with prostate cancer who never need any type of treatment,” said Dr. LaFrancis, a medical oncologist who also treats patients in the Mercy Cancer Center in Joplin. “The challenge for us is finding the line between needing treatment and not needing treatment.”

Several risk factors go into whether treatment is warranted, according to Dr. LaFrancis. These include overall health, family history, ethnicity, other chronic conditions and abnormal examinations. The National Comprehensive Cancer Network recommends that men speak to their physician to decide whether to screen for prostate cancer through a baseline prostate-specific antigen (PSA) blood test and/or digital rectal exam beginning at age 45.

If patients receive abnormal results from the PSA or exam, doctors can perform biopsies and other exams to make an accurate diagnosis. There are several treatment options for individuals diagnosed with prostate cancer, including surgery, radiation, chemotherapy and active surveillance (monitoring without treatment).

“The problem with prostate cancer,” Dr. LaFrancis said, “is it has a high degree of being different from patient to patient.” That’s why a good diagnosis and a doctor’s watchful eye are so important.

According to the National Cancer Institute, there is no specific normal or abnormal PSA level. In the past, most doctors considered levels of 4.0 ng/mL (nanograms per milliliter of blood) and lower as normal. If a man had a PSA level above 4.0, doctors often would recommend a prostate biopsy to determine whether prostate cancer was present.

“The PSA is like the canary in the coal mine. The PSA level will go up far in advance of other signs,” he said. “Nowhere in PSA is the word cancer. There are other things that can make a PSA level go up, such as a prostate infection, so it’s not specific to prostate cancer, but to prostate tissue.”

Even if a man has prostate cancer, it may not be life-threatening, according to Dr. LaFrancis. He pointed out an autopsy study of men over the age of 80 where 50 percent had some degree of prostate cancer.

“Clearly, many of those men died with prostate cancer, not of prostate cancer,” he said. “The findings were common enough that it led some to discuss whether prostate cancer can be a normal process of aging.”

The survival rate after five years is nearly 99 percent, but drops to 29 percent if cancer spreads beyond the prostate gland. The survival rate was 66 percent in 1975.

Clearly, prostate cancer can be deadly, so knowledge is power. Talk to your doctor about whether you should be screened.

Mercy Clinic Oncology and Hematology at Mercy Hospital Carthage on the McCune-Brooks Campus, 3125 Dr. Russell Smith Way, can be reached at 417-782-7722.