No-Shave November is an annual movement to bring awareness to men’s health issues in a provocative way. Men participate by growing a beard and/or mustache throughout the month of November. They take a photo of their clean-shaven face on November 1st and a final picture on the 30th. Hopefully, during the thirty days in between, they can have conversations about important men’s health topics, including prostate cancer.
Prostate Cancer is the second-most common cancer affecting men
Prostate cancer is enormously common in the United States. After skin cancer, it is the most common cancer for men. Each year, more than 200,000 men in the U.S. find out they have the disease. That’s one in six men!
Depending on the stage of the disease, there are various treatment options, including active surveillance (“watchful waiting”), radiation therapy, hormone therapy, surgery, and chemotherapy. Which treatment your doctor recommends will depend on a combination of tests designed to assess your risk level.
Prostate Cancer Risk Assessment
Risk level is assessed using three basic tests.
The PSA Test. This is a blood test that looks at the levels of prostate-specific antigen in your bloodstream. According to Dr. Curtis Mack, radiation oncologist at Arizona Oncology, “For those with prostate cancer- zero to ten is favorable, ten to twenty is intermediate, and twenty and up indicates a higher risk disease.”
Gleason Score. The Gleason score measures the pathology of prostate cells under a microscope. The more the cells resemble normal prostate cells, the lower the score. Scores range from one to five. Typically, two major types of tissue are found, and those two scores are added together for a result. According to Dr. Mack, “We consider Gleason six (3+3) to be good, seven to be middle-of-the-road, and eight, nine and ten to be at higher risk of progression/spread.”
Physical exam. Part of the evaluation for prostate cancer includes a digital rectal exam. That provides a “T score.” “The most common finding is no suspicious nodules and that is T1c. T2a indicates a small nodule in less than half of one side of the prostate, with more extensive disease going as far as T4, which is suspicious for invasion outside of the prostate into the surrounding tissues such as the bladder and rectum,” Dr. Mack said.
“When you add those things together, we can put people into different risk categories which helps determine what options you have,” said Dr. Mack. “For example- the lowest risk patients- those with a Gleason score of six and a PSA of less than 10, and T1-C or maybe T-2A disease, are very favorable and have a survival of approximately 90 percent. For many of these patients, we now routinely recommend active surveillance instead of routine treatment.”
Another factor to be considered is the percentage of positive biopsies. “If six cores were taken and five of six have cancer in them, that’s different than if just one of six or one of twelve cores have cancer in them,” Dr. Mack stated.
Doctors also look at your general health and if cancer is present in another area of your body. Prostate cancer is a slow-growing cancer. Many older men or those in poor health will die of another cause before prostate cancer threatens their life. In these cases, active surveillance may be the best option.
Treatment for Prostate Cancer
If you choose watchful surveillance, your PSA level will be checked every four to six months. MRI of the prostate and additional biopsies of the prostate may be recommended as well. You and your urologist can re-evaluate this decision each time your levels are checked.
If you will have treatment for your prostate cancer, some of the options to be discussed include radiation therapy, surgery, or a combination of treatment types.
Radiation Therapy for Prostate Cancer
Radiation therapy is a common treatment for prostate cancer and is a curative option at most stages of the disease. It is also often helpful in advanced stages that cannot be cured but need symptom relief (i.e. pain or obstruction).
The goal of radiation therapy is to deliver a high dose of radiation to the prostate while reducing the side effects due to radiation exposure of nearby organs like the bladder and rectum. Dr. Mack talks more about this in an online video series available at https://arizonaoncology.com/prostate-cancer/.
At Arizona Oncology, we offer an option to help reduce side effects caused by spillover radiation, called the SpaceOar Hydrogel System. The SpaceOar Hydrogel system is a safe, non-toxic gel compound used to create space between the prostate and the rectum. It is injected as a liquid during your normal preparation for external beam radiation or during the same procedure when radioactive seeds are implanted. Studies have shown that using SpaceOar Hydrogel reduces radiation exposure to the rectum by 75%.
We hope this No-Shave November that men will take the opportunity to be more aware of their health, to schedule a check-up with their doctor, and to undergo recommended cancer screenings, including those for prostate cancer, if their doctor recommends it.
Learn more about prostate cancer and your options by visiting https://arizonaoncology.com/prostate-cancer/.