More Utah men die of prostate cancer than any other cancer, although nationally, lung cancer is No. 1. Nationally, a new case is diagnosed every 2.5 minutes, and someone dies every 17 minutes from the disease.
"A nonsmoking man is more likely to get prostate cancer than lung, colon, rectal, bladder, lymphoma, melanoma, oral and kidney cancers combined," said Dr. George Middleton, a urologist at Cottonwood Hospital.
The good news is that it's typically slow-moving and, with early detection, the cure rate is impressive. But that requires vigilance on the part of men, who should begin annual screenings at age 50 with both a blood test that measures prostate-specific antigen and a digital rectal exam.
Prostate cancer is the topic of tomorrow's Deseret Morning News/Intermountain Health Care Hotline. Middleton and Dr. Richard Labasky, an Alta View Hospital urologist, will take questions about screening and treatment options from 10 a.m. to noon. All calls are confidential.
Labasky describes the prostate as a thick doughnut, about the size of a walnut, that wraps around the urinary channel. It can become greatly enlarged, but the size alone does not define whether a man will have problems. Men with very large prostates may have none and men with small prostates may be miserable.
The need for the two-punch screening is simple. Each of the two tests has about a 20 percent false negative rate, said Middleton. But between them they detect prostate cancer well.
The survival rate overall is 98 percent, even with no treatment. At 10 years the relative survival rate is 84 percent. At 15 years, treated or not, the rate is 56 percent. That's a compelling argument for not treating someone who is over 80, since that individual is likely to die with, not of, prostate cancer.
If it is painful for the elderly, the pain is treated. And there's a lot that can be done without radical intervention, Middleton said.
Someone who waits until there are clear symptoms is unlikely to survive, he said.
Early on, there may be no symptoms or symptoms that are not specific, the kind of thing that occurs with enlargement of the prostate, which most men experience, Labasky said.
The cardinal symptom is frequent urination and a sense of urgency. Advanced cases may be painful because the cancer tends to spread to the big bones — the ribs, the scapula, the spine. Twice in his career, Middleton has seen paraplegia caused when the cancer encroached on the spinal cord. Anemia could be a symptom, as well.
The vast majority of patients, 85 percent, are diagnosed over age 65, which is why screening should begin at age 50. There are exceptions to that rule, however. Someone with a father or brother or uncle who had prostate cancer should begin screening at 40.
It's a disease that hits African-Americans particularly hard. They are 65 percent more likely to be diagnosed with prostate cancer than Caucasians and twice as likely to die from it. The rate is lowest in Asians, unless they have adopted Western lifestyles, in which case the rate is closer to that of Caucasians.
The biggest risk factor, said Middleton, is genetics. If a close relative had it, a man is twice as likely. With two close relatives, it's three times more likely. In families where three close relatives are affected, it's "almost a foregone conclusion you're going to get it," he said.
Other things play a role; Middleton believes they may be the trigger in those with genetic predisposition. Those include diet, obesity and nutrition. People who eat a lot of animal fats or polyunsaturated fats are at increased risk, while those who eat a lot of fruits and vegetables have lower incidence. Cooked tomatoes are particularly protective, filled with cancer-fighting agents that help prevent the disease from manifesting. Vitamin D protects against prostate cancer, the best source being absorption of a little sunshine each day through the skin.
Tomorrow: treatment options