Prostate cancer: to treat or not to treat?

Apr 28, 2013

This week on Take Care, Dr. Anthony Scalzo talks about the diagnosis of the most common cancer for men -- prostate cancer -- and its treatments. Dr. Scalzo is a medical oncologist at Hematology/Oncology Associates of Central New York, and medical advisor for the support group Man to Man, which helps men cope with prostate cancer and is sponsored by the American Cancer Society.

Click 'Read More' to hear our interview with Dr. Anthony Scalzo, and for more information.

Over 238,000 new cases of prostate cancer are diagnosed in the United States each year. One out of every six American men will face the disease in his lifetime, yet most men will not die from it and many won't even need treatment.

The greatest challenge of prostate cancer may be deciding what to do. Within the medical community, there's disagreement over who needs to be screened and who needs to be treated if the disease is found. If the diagnosis isn't terminal, some physicians believe is not worth risking the side effects of treatment which can be physically and psychologically devastating.

Credit Hematology/Oncology Associates of Central New York / hoacny.com

Dr. Scalzo explains that most prostate cancers are not fatal. In fact, only about three percent of men diagnosed with prostate cancer die from it. Many types, he says, are treatable and still others are biologically insignificant - meaning they develop too slowly over the period of a lifetime for the patient to ever be affected by it.

However, it is not the diagnosis that is the issue, he says. It is the question of if and when to treat.

“With the state of knowledge we have right now we can’t determine which of these cancers are going to be aggressive and really require treatment or which can be maybe simply monitored and may not require treatment,” Sclazo said.

There is conflict then, is between the usefulness of early detection, and the damage of unnecessary treatment.

“The concern with screening is that you may end up decreasing the quality of someone’s life because of the side effects of the treatment for a cancer that may not be biologically significant,” he said.

Dr. Scalzo says before any screening starts, men should have a conversation with their doctor about the pros and cons. But, he says, it is a very individualized decision and men should take that in to account when faced with their options.

There are two risks factors involved in prostate cancer, says Dr. Scalzo, one is age, and the other is genetics.

“If you have a first degree relative, either a father or a brother, with prostate cancer then your risk of prostate cancer is higher. Also, we know that the same genes that are associated with a higher risk of breast cancer, the B.R.C.A. or BRACA 1 and BRACA 2 gene, if a male has one of those genes his risk of prostate cancer is higher as well.”

Because the incident rate for prostate cancer for men in their seventies and eighties is about 40 to 50 percent, Dr. Scalzo suggest being on the lookout for early symptoms.

Symptoms include:

  • An increase frequency of urination
  • Painful urination
  • Blood in urine
  • Impotence
  • Bone pain