HEALTH SENSE: Prostate Cancer Awareness Month

By Aaron Marks fAirbAnks urology

Aaron Marks is a clinical care coordinator for Fairbanks Urology. Dr. Tony Nimeh is a urologist and men’s health expert at Fairbanks Urology. Aaron sat down with Dr. Nimeh to discuss Prostate Cancer Awareness Month.

Aaron: We’re here with Dr. Tony Nimeh, and we’re discussing Prostate Cancer Awareness Month. Dr. Nimeh, we hear a lot about the PSA blood test for testing for prostate cancer. Is this a reliable test?

Dr. Nimeh: The PSA is a very important test in prostate cancer detection. It is very reliable for some things, but it’s not very reliable for other things. Prostate-specific antigen, or PSA, is a protein produced by normal cells, as well as cancer cells, of the prostate gland. The PSA test measures the level of PSA in a man’s blood.

The analogy for this test that I like to use with my patients is that the PSA is like oil for your car engine. The oil is supposed to be there. But if you park your car in front of the house and in the morning you find there’s oil all over the ground, that’s a problem and you need to figure out why there is a leak.

Same thing with a prostate and the PSA. The PSA is inside the prostate. If we do a blood test and we find the PSA is elevated, that means there’s a leak. The PSA is leaking out of the prostate into the bloodstream, and we can measure an elevation in the PSA in your blood. We’re testing to see if there’s a leak in the prostate. Now with that being said, prostate cancer is not the only thing that can cause a leak. That’s why when you go see your doctor and they see an elevation in the PSA, they say, well, we need to investigate this further. So what else can cause the PSA to leak? Well, there’s a few different things. Sexual activity before the test can cause it. Also, any procedure on the urinary tract, or urinary tract infections. Plus any physical activity like horseback riding or snowmachining can make an impact.

Aaron: So when should a man get a PSA test done?

Dr. Nimeh: The PSA is a screening test for prostate cancer that is done at the age of 50. And it’s done annually from 50 until the age of 70.

The reason why we call it a screening test is that we are trying to find the cancer before it becomes symptomatic. If we find the cancer before it becomes symptomatic, then we have a chance of catching the cancer early on and if we do that, then the chance of a cure is very high.

If we wait until it starts to give off symptoms, such as affecting the organs or leave the prostate and goes to the bone which can create fractures, then that means the prostate cancer has become quite advanced and it’s a lot more difficult to cure.

We can still treat it, but we want to catch it before it becomes advanced.

Aaron: If the PSA is elevated, how do we make sure it’s not from prostate cancer?

Dr. Nimeh: Once we have an elevated PSA, we do a prostate biopsy. It takes about 15 minutes, and we send the biopsy off to a pathologist. If there is a cancer, it all depends on what type of cancer.

Aaron: What happens if the prostate biopsy is positive?

Dr. Nimeh: The American Urological Association has categorized prostate cancer into four categories: very low risk, low risk, medium risk, and high risk.

Depending on where the patient is, we will recommend different courses of action. For example, for the very low risk category, we actually do not recommend any treatment at all. Of course, for the high risk category we do recommend treatment.

Aaron: We hear a lot about chemotherapy. Is this used in the treatment of prostate cancer?

Dr. Nimeh: Chemotherapy is rarely used in prostate cancer. It is effective with other types of cancer but not for prostate cancer. The different options for prostate cancer are active surveillance, hormone therapy, surgery, and radiation therapy.

Chemotherapy is used only for very

advanced cases. If we are talking about active surveillance for low risk cancer, then all that means is that we are actively monitoring this cancer because we believe if we keep an eye on it, then the second it becomes more aggressive we still have a chance to completely cure it. If we diagnose a low risk cancer and we keep an eye on it for let’s say five years, and then five years later it becomes more aggressive and we intervene at that point, then we still have a chance of curing it.

Aaron: But what have we gained by waiting for five years while the man is on active surveillance?

Dr. Nimeh: Well, we gained that for five years that patient did not have to have therapy and did not have to suffer the side effects. Unfortunately, every therapy that we use in prostate cancer will have some sort of side effect. There’s always a downside. So by saying we’re going to implement active surveillance, then there was a five-year period where that man didn’t suffer any form of erectile dysfunction, incontinence, or any of the side effects that can come with it.

If we fast forward and it’s five years later and this cancer is now moderate or high risk, there are two treatments: One is surgery. The second is radiation. Radiation usually comes with some sort of hormone therapy. The surgery involves removing the entire prostate.

Aaron: What in your opinion is the best treatment?

Dr. Nimeh: Again, that depends on the type of cancer and the age of the patient.

For younger patients, we tend to recommend surgery. Older patients tend to go for radiation. Mostly because the surgery has a higher risk when the patient is older. Also if a younger patient has surgery and they have a recurrence, they can have radiation done later.

Doing surgery on tissue that has been through radiation is more difficult because the tissue doesn’t heal as well as tissue that has not been through radiation.

Concerning radiation, there is a new technique to decrease the side effects of the radiation on the surrounding organs such as the bladder and the rectum. The radiation is focused on the prostate, and the rectum is at risk for receiving part of that radiation and will suffer from side effects.

A new technique we’ve been doing is putting a gel called SpaceOAR gel, which is a spacer that creates a space between the prostate and the rectum. So now when the radiation is going to the prostate, there is less impact on the rectum. This is an advanced technique that we’re doing here in Fairbanks that will allow patients to have less side effects from the radiation.

Aaron: Thank you so much Dr. Nimeh!

Caroline Atkinson MA, LPC Licensed Professional Counselor

Cathy Johnson RN, MSB, ANP Advanced Nurse Practitioner

Elizabeth Kraska MA, LPC Licensed Professional Counselor

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