To promote awareness of prostate cancer, dailyRx interviewed a leading expert in the field - Brian J. Miles, M.D., F.A.C.S., a urologist with Methodist Hospital in Houston, Texas. Dr. Miles answered questions about a number of issues relating to the most common cancer in men.
Q. What's the biggest myth about prostate cancer?
A. If you read the lay press, there's a sense generally that this is an over-diagnosed and overly treated cancer in the country. And to me, that's the greatest myth. I think we have to be careful about that because this encourages people to think "nobody dies from it, so I can ignore it." That's simply not the case, and I don't want men to believe that.
Q. What's the most important thing for men to know about prostate cancer?
A. That early detection matters, and that cure is not only possible but likely with early detection.
Q. There's some controversy about when screening should begin. What's your recommendation for the average man who has no family history of prostate cancer?
A. For the average man with no family history and who is not African American, I recommend testing begin at age 50. Testing involves a blood test called Prostate Specific Antigen (PSA), which is a protein made by the prostate, some of which gets into the blood stream. And then also a digital rectal examination. Both are necessary and recommended because while most prostate cancers are found with the blood test, the fact is 10 to 20 percent are discovered with a normal blood test, but an abnormal feeling prostate that leads us to perform a biopsy.
Q. Where should a man go to get screened?
Going to a good internist or family practitioner is very appropriate. They can do that screening and then if they have any suspicious findings, that patient can be referred on to someone like me.
Q. How often should a man without any elevated risks have these screenings?
A. I recommend the first test at 50 and then yearly for a while. We used to recommend every year, and most organizations still say this. But I look at it differently. If after three or four years a man's PSA has changed little and his prostate feels fine, I think he can go every other year or perhaps even every third year because it's not going to change that much year-to-year once you have a fairly stable pattern.
Q. At what age should prostate cancer screening stop?
A. I don't think age should be the sole determining factor. There's a lot of discussion about this. The general thinking is that most men are going to die with prostate cancer rather than of it, so why bother finding it. I have a different view. Some people are very active and healthy and living much longer. If someone is in their 70s and in very poor health, maybe you don't do the blood test but I think a rectal exam is still appropriate. Because if the prostate is very hard, you can't ignore that. In terms of doing both the blood test and the rectal exam, I think that should be based on the man's general health, not his age. If someone's 75 and in good health and he has a very aggressive cancer, then why would you ignore it? This guy could live to 100. So I don't think there is a specific age when you should stop screening, but there's not universal agreement on that.
Q. What are your screening recommendations for patients who are at high risk?
A. Men who have a strong family history of prostate cancer or are African American, I think, should start yearly screening at age 40.
Q. Can a pattern of normal PSA tests suddenly turn into an aggressive cancer?
A. The PSA tells me nothing about how aggressive the cancer is or how much is there. It's just a trigger that tells me when to biopsy the prostate. So let's say someone has a not very aggressive cancer, and we're following that person along with blood tests and digital rectal exams, the PSA alone is not a very good tool for follow up. It doesn't tell you when the prostate cancer has changed to a more aggressive variety, and it's not a great tool to tell you when it's undergoing explosive growth. So anyone who is on what we call "active surveillance," we periodically re-biopsy to make sure it hasn't changed either by volume or aggressiveness.
Q. Is red meat bad for men in terms of prostate cancer?
A. When we looked at the causes of prostate cancer, there appeared to be an association - a weak but identifiable association - with a high red meat diet. But as with everything in the dietary field, recommendations have changed. Now if you're eating that 32-ounce rib-eye and that two-pound baked potato with all the fixings on a regular basis, that style of eating puts you at a higher risk. What's important is your overall diet, and the key is balance. High meat - high carbohydrate is going to be worse than high meat alone.
Q. What are the best things a man can do to prevent the onset of the disease?
A. That's a tough one. At this point there's nothing we know of. My sense would be to keep your immune system strong, exercise frequently, eat a healthy, balanced diet and get tested. We don't know yet what to avoid in our environment or in our diet that would absolutely decrease the risk of getting prostate cancer.
Q. What are the most promising areas of research?
A. I'm intrigued by work that's being done in the immunological area with agents to prevent prostate cancer or to make aggressive cancers more curable. The other one would be finding ways to radiographically view the cancer so we could we treat just the cancer - not whole gland as we do now. This would enable us to do a form of lumpectomy like they do with breast cancer. I find those areas the most exciting.
