Screening for Prostate Cancer
with Dr. Jeffrey Bahr, Advanced Healthcare
Prostate cancer is one of the most common types of cancer found in American males today and it kills more of them than any other type of cancer except lung cancer.. So it's understandable that a lot of media attention has been paid to the importance of detecting the disease. Such notable men as Robert Urich, TV's "Spenser For Hire"; Len Dawson, former pro football quarterback; and Marv Levy, former coach of the Buffalo Bills, have gone public about their bouts with the disease.
"Caught in its earliest stages, before it can spread out of the prostate gland, prostate cancer can be successfully destroyed," said Dr. Jeffrey Bahr, general internist at Advanced Healthcare's Good Hope Rd. facility in Milwaukee.
Prostate cancer is a disease in which cancer cells form and begin to grow in the tissues of the walnut-sized prostate gland, an internal organ of the male reproductive system. Located just below the bladder and in front of the rectum, the gland surrounds part of the urethra, the tube that empties urine from the bladder. It's the prostate that produces fluid that makes up part of semen.
"Primary care physicians try to educate our patients about the importance of screening for early detection of the disease," said Dr. Bahr. "Men in general don't seek health care quite as often as women do. And men are sometimes turned off by some of the screening methods, which can be uncomfortable. We have to encourage them to be screened."
Dr. Bahr said that screenings begin with a simple doctor/patient interview to determine if the patient has any risk factors for the disease. "Typically, men aged 45 or older are at risk. And the risk increases with age. African-American men, for reasons, we're not clear on, have an increased risk, too. And family history is a factor. Men with close relatives--brothers, fathers, and uncles--who have had prostate cancer are at increased risk as well.
"After we get that information, we give the patient a digital rectal exam," he explained. "By palpitating the prostate gland we can determine if there are any irregularities--any nodules or asymmetry. The screening also involves a PSA test--a blood test to learn what the patient's prostate specific antigen count is. An elevated count may--or many not--mean the presence of cancer. There are other things that can cause an elevate count. And likewise, a normal PSA doesn't mean you don't have prostate cancer. The PSA level can be normal in the early states. So we really have to take all these things into account. A single test is probably inadequate. It has to be done in conjunction with the others."
If a screening shows the possibility of cancer, Dr. Bahr refers his patient to a urologist, a doctor who specializes in the diagnosis and treatment of prostate cancer and other urinary tract problems. "First a transrectal ultrasound guided biopsy is taken of the prostate gland. It's not invasive surgery, it doesn't require any anesthesia and can be done in an outpatient setting," he said. "It is typically done with the help of ultrasound, which guides the biopsy needle to the suspected area. In the urologist's hand it's a relatively fast and simple procedure."
If the biopsy indicates cancer, there are treatment options for the patient and the doctor to consider. The choices are dictated by two scenarios, according to Dr. Bahr. "Is the cancer confined to the prostate gland? Has it spread beyond the walls of the prostate? If it's the first scenario and we catch it early enough, there's an excellent chance for success. If it's the second scenario, that's problematic because as of now there's no cure. If that's the case we can only control the symptoms."
