Experience and knowledge are tools for fighting prostate cancer

Published: Thursday, June 19, 2008 at 2:31 a.m.

Regarding Sunday’s front-page article, “As prostate drug gets new look, it stirs new debate”: I’d like to comment. Having spent more than 25 years studying prostate cancer, and treating more than 10,000 men, I am well aware of the dilemmas presented by new drugs (such as finasteride — Proscar) and treatment options (such as high-intensity focused ultrasound or proton therapy).

Regarding the question of using Proscar and its counterpart Avodart: These are the first drugs identified to have a preventive effect on the development of a potentially lethal malignancy. Surely the patient should be fully informed about the drugs’ potential, as well as their possible side effects, and have the option to take one of them or not. Should we blanket every male with the drug? Absolutely not. There are, however, those men with a higher risk for developing prostate cancer who could benefit by the use of finasteride as a preventive. These men must understand that taking the drug does not make them prostate-cancerproof, and it is incumbent on them to adopt and maintain a healthy lifestyle in combination with the preventive drug.

Most Americans don’t know that with the exception of skin cancers, prostate cancer is today’s most commonly diagnosed cancer — even surpassing breast cancer. More than 230,000 men will learn they have the disease this year. And sadly, 30,000 men will die from the disease.

We are learning more each day but there are still deep mysteries about this disease. Some prostate cancers are rather indolent and slow-growing. At the same time, some are rapidly spreading, fierce killers. Some prostate cancer tumors make themselves known by driving up prostatic specific acid, while others lurk in the gland without raising the PSA red flag and can only be identified through skilled digital examination and with highly sophisticated technologies such as color-flow Doppler ultrasound.

What is a man to do in the face of these contradictions and debates? My advice is to adhere to the suggestions of the American Cancer Society, the National Cancer Institute and every other mainstream organization addressing cancer issues: Get an annual prostate exam by a board-certified internist or urologist, beginning at age 45 (or 40 if there is a family history of prostate cancer or if the man is African-American). The exam should include both the PSA blood test and a digital rectal exam. Adopt a prostate-healthy diet — basically, the “Mediterranean Diet,” limiting red meat, fried food and processed flours and sugars. Maintain a healthy weight and get sufficient exercise. Practice stress management and get proper sleep.

Unfortunately, in the early stages there are very few symptoms to alert you to the presence of this cancer. Know these symptoms of prostate cancer: blood in the urine; pain or difficulty urinating; urgency or frequency of urination, especially at night; pain or discomfort in the area of the prostate gland; unusual or unexplained weight loss; continual pain in the bones of the lower back, hips or pelvis.

If you are suspected of having prostate cancer, the only way to be sure is through a biopsy. Make sure your doctor takes at least 12 core samples in the biopsy — the more, the better your chance will be of getting an accurate result.

And if you are found to have prostate cancer, give yourself time to review ALL your treatment options. Don’t make a panicked, knee-jerk decision while in the shock of hearing your diagnosis. We are fortunate to live at a time when there are several good treatment options. Ask the hard questions of any treatment you may consider: How many men have YOU treated with this therapy? How many have a profile like mine? What are the published success rates of this therapy? What are YOUR success rates? Seek out other men who have experienced prostate cancer. Visit a Man-to-Man meeting, sponsored by the American Cancer Society. Gather all the facts; then make your fully informed treatment decision.

Remember that just because something is “new” doesn’t mean it is better. You will want to place your confidence — and your life and quality of life after prostate cancer — in the hands of an experienced physician who can show you his long-term track record.

Michael J. Dattoli, M.D., is physician-in-chief of the Dattoli Cancer Center in Sarasota.