Military Officer - February 2008 - (Page 48) askthedoctor Prostate Cancer About one in six men will be diagnosed with prostate cancer. Fortunately, treatment of this disease can be effective when it is diagnosed early. By Rear Adm. Joyce Johnson, D.O. M Don’t Take Chances With Your Health ■ If you are a man with any risk factors for prostate cancer, talk with your health care provider about getting the prostate-specific antigen test and a digital rectal exam. ore than 200,000 men in the U.S. each year learn they have prostate cancer (two-thirds of them are over age 65), and more than 30,000 men die each year from prostate cancer, which ranks second (behind lung cancer) among all cancers in men. This is a tragedy, because with screening, prostate cancer often can be diagnosed early, before there are noticeable symptoms and when it is most easily and effectively treated. There are two screening tests for prostate cancer. A digital rectal exam involves a health provider inserting his or her gloved and lubricated finger into the rectum and feeling the prostate for lumps or growths. The prostate is about the size of a walnut, located in the lower pelvis in front of the rectum and under the urinary bladder. Normally smooth and firm, its surface can change if large tumors are present. Unfortunately, the digital rectal exam can identify only tumors large enough to feel. Another screening exam, sometimes performed in conjunction with a digital rectal exam, is a blood test for prostatespecific antigen (PSA). The PSA test measures levels in the blood of a protein produced by prostate cells. Many experts strongly advocate use of the PSA test for prostate cancer screening; others are not convinced the benefits outweigh the risks. An initial PSA screening often is recommended for healthy men over age 50. Even if results of this test are normal, it provides a good baseline to determine whether levels rise in the future. If there are other risk factors, PSA screening generally starts around age 40 to 45. Black men and those with a personal or family history of prostate cancer are at greater risk. The PSA test can be difficult to interpret. PSA levels typically increase slowly with age, so “normal” values differ with a patient’s age. Increasing levels of PSA sometimes can be a warning sign of prostate cancer, so many physicians test patients every year or two to track results. The PSA test does not diagnose prostate cancer. Cancer is not the only reason PSA levels can be elevated. Infection, inflammation (prostatitis), and benign prostatic hypertrophy are three common causes. If PSA test results are worrisome, the next step is usually a biopsy, which involves taking tiny snips of tissue from several parts of the prostate. (This is a fairly minor procedure done in a physician’s office.) The tissue is examined under a microscope to determine the specific cell structures. If cancer cells are found, they receive a “Gleason score” from 2-10. A lower score signifies a less-aggressive cancer. Prostate cancer generally is a slow-growing tumor. Whether a cancer remains localized or has spread also is important. Patients and health care providers consider these and other factors to make treatment decisions. MO — Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at www .moaa.org/wellness. For submission information, see page 20. PHOTO: STEVE BARRETT 48 MILITARY OFFICER FEBRUARY 2008 http://www.moaa.org/wellness http://www.moaa.org/wellness
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