Checks for all men over 50

Probably not more than 10 percent of all prostate cancers are genetically linked, maybe less than that. So what we at Johns Hopkins believe is that it’s exposure to things over a lifetime that drive the evolution of prostate cancer – the oxidative stress or continued exposure of the cells of the prostate to things that cause damage to the DNA. If they continually are exposed to this substance, which, believe it or not, comes from overcooked meat, this is the way humans get most highly exposed to this substance. They tested this very specifically and when this occurred, the (laboratory) animals had a higher risk of getting prostate cancer. So trying to minimize charred animal fat, we believe, is probably one of the most important steps in reducing the risk of prostate cancer. What age should men start having PSA tests? We’re very confident in saying that the average person should start at the age of 50 with an annual PSA and digital rectal examination. If the patient has a family history of prostate cancer – that is, his father or brother has a diagnosis of prostate – that person should start one decade earlier, at the age of 40. And then in the US, men who are of African-American descent should start at that earlier age because their risk of prostate cancer is higher for reasons that are not clear. At what stage of the cancer do you start therapy? You said that this is a dilemma. Unless the men meet the criteria I told you earlier – the very earliest low-risk cancer patients – other than that, we treat everyone. Then it is the selection of treatment that is the very important element. So if they have earlier stage prostate cancer, they have both a surgery and a radiation option. That’s for men who have the lowest risk of cancer outside their prostate. Apart from those men, then all men – at least in Johns Hopkins – tend to be treated with radiotherapy; some of them also get hormonal therapy. The selection is very clear. Unless they meet the defined criteria, everyone is treated. What would you tell someone today who is diagnosed with prostate cancer? I think the most important news for someone with prostate cancer is that it is highly unlikely they will die from the cancer. That’s the most important thing to know. It’s not that they should not seek treatment, there’s a portion of men who can avoid treatment if they have the most early stage, lowest risk prostate cancer. In consultation with their physician that might be something that they can do, but the majority of patients require treatment. The good thing is most of them will be able to be cured and with modern techniques and technologies, both surgical and non-surgical, it’s likely they will have a great quality of life.

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