Dhiren Dave, M.D., urologist and robotic surgeon at Somerset Medical Center.
By Jeff Bahr
Observer Correspondent
As men age, their bodies become susceptible to an ever greater number of ailments, conditions and diseases. The expression,“You’re not getting older, you’re getting better,” might be apt when gauging one’s intellect or accomplishments, but physically speaking the statement holds about as much water as a kitchen strainer. While we sometimes hate to admit it, the vessels that we call our bodies do indeed have a shelf life. And like any vessel, they tend to weaken as the clock advances.
A good example of this comes in the form of the male prostate gland. Though relatively small (slightly larger than a walnut) it can turn cancerous and pose a legitimate threat to a man’s life if it’s not regularly examined.
With September designated Prostate Cancer Awareness Month, The Observer thought it prudent to learn the whys and wherefores of this potential killer and to share those findings with our readers. Dr. Dhiren Dave, urologist and robotic surgeon at Somerset Medical Center, agreed to answer our questions concerning prostate health.
“Prostate cancer is the most common non-skin cancer in men, accounting for approximately 200,000 new cases annually,” explained Dr. Dave. “The overall risk of developing prostate cancer in a man’s lifetime is one in six. This goes up to one in four if you have a strong family history or are African American. Prostate cancer remains the second leading cause of cancer death among men, with almost 30,000 men dying of the disease annually. One out of every 30 men will die of prostate cancer.”
The risk of developing prostate cancer rises as one ages, according to Dr. Dave, who pointed out that, “65 percent of men with prostate cancer are over the age of 65…. As we age, a greater number of abnormalities can occur from damage to cells, making it more likely for cancer to develop.”
Early detection is the key in keeping this beast at bay but prostate cancer can often be missed if one waits for symptoms to appear, explained Dr. Dave.
“Prostate cancer often does not cause symptoms except in advanced stages.” he continued. That’s why Dr. Dave recommends the PSA (prostate- specific antigen) test once annually for men over age 50, unless one is African American or has a family history of the disease. For those individuals, testing should begin at age 40, according to Dr. Dave.
That test, however, has fallen under scrutiny and its effectiveness has been openly challenged by the U.S. Preventative Services Task Force (USPSTF), according to Dr. Dave. In fact, the USPSTF no longer recommends the PSA test for use in cancer screening. This development doesn’t sit well with the physician.
“We strongly disagree with the new recommendations of the USPSTF against PSA testing,” stated Dr. Dave emphatically. “These recommendations do a great disservice to men and may lead to higher death rates from prostate cancer in the U.S.”
To bolster his argument, Dr. Dave points to the fact that “no urologists or oncologists participated in the formulation of recommendations by this task force” and, therefore, had never directly treated prostate disease or prostate cancer.
“In fact,” Dr. Dave continued, “this same task force recommended against mammography for women under 50 years of age. Breast cancer experts refuted those recommendations.”
When a diagnosis of prostate cancer is made, the patient can face a myriad of treatment choices. Implementation of one treatment over another will depend heavily on the extent of disease plus other variables, according to Dr. Dave. Where prostate cancer is concerned, one size clearly does not fit all.
For men with clinically localized disease (cancer that hasn’t spread to other parts of the body), Dr. Dave considers options of active surveillance (the cancer is watched through serial PSA testing and periodic prostate biopsies), radiation therapy and surgery to remove the prostate – the three of which comprise the “gold standard” of treatment according to the physician.
“Radiation comes in several forms including external beam radiation and radioactive seed implantation into the prostate (also called brachytherapy),” said Dr. Dave. “Surgery is designed to remove the prostate entirely, thereby eliminating the cancer.”
For those suffering from advanced prostate cancer – where the disease has spread to other parts of the body – different strategies are called into play.
“The mainstay of therapy in these patients involves the lowering of testosterone levels,” notes Dr. Dave.
Nobel Prize-winning research has shown “that prostate cancer growth is dependent on the presence of chemical signals and hormones such as testosterone.”
Dr. Dave’s approach in these cases is to utilize “therapies designed to significantly decrease testosterone levels or block the receptors upon which testosterone acts in order to starve the cancer of its ‘fuel.’ ”
“Chemotherapy has also demonstrated effectiveness in prolonging survival in men with advanced prostate cancers that no longer respond to hormone therapy.”
New strategies for dealing with advanced prostate cancer have come on the scene in recent years.
“These strategies involve drugs that are either more potent inhibitors of testosterone production or stronger blockers of the testosterone receptor,” explained Dr. Dave.
An “additional novel form of immunotherapy” has also entered into the advanced cancer treatment realm, according to Dr. Dave.
“This therapy involves the stimulation and activation of the patient’s own immune cells which are then specifically targeted towards their prostate cancer.”
All prostate cancers are not aggressive. This means, Dr. Dave said, that some of them won’t require treatment at all – only surveillance. In order to make this distinction, Dr. Dave recommends a “prostate biopsy if one’s PSA is abnormal or if one’s prostate examination is suspicious. By having prostate tissue to analyze, we can decide if a man needs treatment and if so, which treatment would be best.”
For Prostate Cancer Awareness month, Dr. Dave weighed in with proactive advice.
“Prostate cancer screening with PSA testing saves lives,” he reiterated. “It enables the patient and his urologist to identify a potentially dangerous prostate cancer. With biopsy results in hand, the patient and his urologist can make a decision about treatment from a position of knowledge.”
