Prostate cancer is a more common disease among men than breast cancer is among women. It generally occurs in more than 50 percent of men in developed nations.

Black men have a 50 percent greater chance of getting prostate cancer than whites and are twice as likely to die from it.

A strong family history boosts a man's risk of getting the disease to one-in-three.

Leslie D. Michelson, president and chief executive officer of the Prostate Cancer Foundation, ticks off one striking statistic after the next, unable to overstate the threat posed by the disease.

Yet few men recognize the toll that prostate cancer could exact on their health and sexual well-being. Many men feel they're immortal, Michelson said. They're squeamish about discussing a cancer that potentially can affect their ability to have erections.

"Prostate cancer is really the last major disease still behind the curtain," he said. "It is only a male disease. It is the male disease."

September is Prostate Cancer Awareness Month, a good time to break the silence. With recent improvements in treatment, greater hope for recovery, and an aging population at risk for the disease, it's more important than ever for men to get routine screenings.

The prostate, a walnut-sized gland tucked beneath a man's bladder, makes the milky liquid contained in semen.

A simple blood test, called a prostate-specific antigen (PSA) test, and a digital rectal exam are the methods used to detect prostate cancer.

The American Cancer Society recommends that men receive these tests annually beginning at age 45 if they have a family history of the disease or are black. Men at even greater risk, say, with several first-degree relatives who had prostate cancer at an early age, should begin testing at age 40. Everyone else should be screened beginning at age 50.

But some experts now believe testing should begin even sooner to establish an early baseline against which to measure annual PSA results. A study in the July issue of the New England Journal of Medicine found PSA changes over time -- as opposed to an absolute number -- are the most important predictor of a man's risk of dying from prostate cancer.

"A change of two points in a year means that you've already gone beyond what surgery can handle in most cases," said study author Dr. Anthony D'Amico, an associate professor of radiation oncology at Harvard Medical School.

D'Amico and his colleagues suggest men get a baseline PSA test at age 35 with annual follow-ups after that.

A study released last week by Stanford University researchers called into question the value of PSA testing. Twenty years ago, the researchers said, there was a strong correlation between a high PSA level and prostate cancer because the test was usually done only when a physician suspected cancer. Today, the test is usually done as a matter of routine. Since PSA production is related to the size of the prostate, a high level usually is related to benign prostatic hyperplasia, the harmless increase in prostate size that occurs with aging, the researchers said.

In addition to annual screening, men can help themselves by maintaining a normal weight. Studies show prostate cancer is more aggressive and difficult to treat in men who are obese.

Diet makes a difference, too, according to the Prostate Cancer Education Council. Fatty foods boost a man's risk of developing prostate cancer. But foods rich in antioxidants -- such as vitamin E, selenium and lycopene, found in tomato products such as spaghetti sauce, for instance -- have been shown to reduce cell damage and may help prevent prostate cancer, the council says.

If you happen to be one of the 240,000 American men diagnosed with prostate cancer this year, take time to consider the various treatment options, including surgery and radiation. There's no standard treatment, and what's right for you may hinge on your cancer, your age, your overall health and the benefits of a particular intervention versus the risks and side effects.

Surgical and radiation techniques have improved tremendously in the past five years, Michelson said. Using laparoscopic -- or minimally invasive -- techniques, surgeons in many cases can remove the cancerous prostate gland while sparing nerves that control urinary incontinence and erectile function. And sophisticated computer technology makes it possible to deliver high doses of radiation more precisely, he said.

Prostate cancer typically progresses very slowly, though, and may not demand immediate action, particularly if it isn't producing symptoms. Those symptoms can include difficulty urinating or frequent need to urinate, blood in the urine or semen, or difficulty having an erection. In those cases, the best advice may be to watch and wait.

"I think watchful waiting is still appropriate in men with a short life expectancy," D'Amico said. "But certainly if their life expectancy is more than 10 years and they've got a PSA jump of two points, it probably is not indicated."

Men whose cancer recurs despite treatment may require more aggressive treatment. These men are likely to undergo hormone-deprivation therapy to shrink levels of male hormones in the body.

There's also new hope on the medication front. In May, the U.S. Food and Drug Administration approved the chemotherapy drug Taxotere, the first-ever treatment for patients with advanced metastatic prostate cancer.

Current research may yield other drug treatments. Michelson said scientists are studying therapies that would attack prostate cancer by shutting down signaling pathways that trigger cellular division and replications; delivering toxins to destroy prostate cancer cells; or halting the growth of new blood vessels that feed those rogue cells. There's another promising approach in the works -- a vaccine that would tell the body's immune system to attack the cancer cells, he said.

With more and more baby boomers hitting their 50s, the number of new cases of the disease will rocket upward to 300,000 a year by 2015, the Prostate Cancer Foundation said. More than ever, men need to heed those numbers by getting screened and watching their diet.

"We've got about 2 million men battling this disease today," Michelson said, "and we've got 3 million more who will be compelled to join this battle in the next decade."

More information on Prostate Cancer

Learn how prostate cancer is diagnosed and treated by visiting the American Cancer Society.

Reference Source 101
September 14, 2004

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