Prostate cancer tests, treatment advancing

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— If you are a man -- or a woman who loves a father, brother, husband or male friend -- you need to know about prostate cancer. Sooner or later, this disease is likely to have an impact on your family or circle of friends.

Prostate cancer is the second most common type of cancer diagnosed in American men. Only skin cancer is seen more frequently. The good news is that early detection is catching more cases in their early stages.

"When I finished my residency in 1977, there was no early detection method," Steamboat Springs urologist Dr. Stacy Childs said. "By the time a cancer nodule is large enough to be felt through digital rectal exam, it is large enough to limit treatment options. Now, 90 percent of prostate cancer is detected by PSA tests, and many tumors are discovered when they are smaller."

PSA, or prostate-specific antigen, is produced by the prostate cells. An elevated PSA level alone does not necessarily mean cancer.

But when combined with factors such as previous PSA levels, family history and race (African-American men have a higher risk), a high level may prompt a physician or urologist to recommend a biopsy.

That's exactly the situation Childs found himself in four years ago. His PSA level had been rising for several years and his father and grandfathers had prostate cancer.

"I knew I was at risk, but I thought I'd be in my 70s by the time I got it, not in my 50s," he said. "I was just too busy taking care of other people to take care of my own health. Plus, I was in a little bit of denial."

Childs had a radical prostatectomy -- gical removal of the entire gland and all or part of the seminal vesicles -- which is one of the standard treatments for prostate cancer. Treatments depend on the patient's circumstances.

"I recommend options based on a man's general health, age, sexual function, fitness and activity level, weight, size of prostate gland and size and location of the tumor," he said.

Other options include localized lobe treatment through cryotherapy, hormone therapy, external beam radiation and brachytherapy, or radioactive seed implants.

The first two treatments are done at Yampa Valley Medical Center, the third is provided at urologists' offices and the last two are available at larger hospitals and cancer centers.

Childs began performing cryotherapy at YVMC in July. The procedure, also called cryoablation or cryosurgery, involves the precise insertion of ultra-thin needles into the prostate. The cryotherapy system forms "ice balls" at a temperature of minus 40 to minus 94 degrees Fahrenheit. The extreme cold kills the cancer cells within the tumor, and Childs extends the freeze zone to create a healthy margin around the tumor.

Cryotherapy is minimally invasive and does not subject patients to radical surgery or potential blood loss. It can be repeated, or used as a second treatment if radiation does not eradicate the tumor.

Like all treatments for prostate cancer, cryotherapy does have potential risks and complications. Childs balances many factors in recommending cryotherapy for older men who have a more aggressive form or larger volume of the disease.

Through a combination of new or evolving treatments and early detection, the death rate for prostate cancer has decreased over the past 10 years. That is a trend that Childs and other physicians would like to see continue.

"PSA is a simple blood test," Childs said. "I would encourage every man to follow the recommendations and get a PSA and (digital rectal exam) annually beginning at age 50. African-American men or those with a family history should start at age 40.

"This is a personal experience for me," he said. "I talk to people all over the country because other urologists know that I've had cancer and I'm willing to talk about it in more than just a medical sense."

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