Are you part of this boys club?
Most people in the US are aware that Angelina Jolie was diagnosed and treated for breast cancer. But can you tell me what Robert DeNiro, Warren Buffet, California Governor Jerry Brown, Rudy Guliani, Hall-of-Famers Len Dawson and Julius Erving, Chi Chi Rodriguez, Colin Powell, Michal Milken, Joe Torre, Arnold Palmer, Bob Dole and John Kerry-to name just a few-have in common? These high-profile individuals as well as more than 200,000 additional Americans every year are told they have prostate cancer. The American Cancer Society estimates that nearly 30,000 men will succumb to this disease this year.
Prostate cancer is unique in that if you live long enough, you are likely to ultimately develop the disease. By age 80, autopsy studies show that 80% of men will have the disease. Due to its being a disease that becomes more common with advanced age, prostate cancer is more prevalent than breast cancer (ACS estimates that 1 in 7 men develop prostate cancer and 1 in 8 women develop breast cancer). For many years, despite the huge prevalence of the disease, prostate cancer received very little press.
It was not so long ago that prostate cancer was a taboo topic. People with prostate cancer would usually suffer immensely. Surgical techniques were not perfected and medications that helped treat the disease were not available. Some of the more widespread treatments such as surgical castration were not common topics of discussion.
However, over the last 30 years, the treatment of prostate cancer has come a long way. These successes have stirred a huge amount of interest in this disease. Most communities have prostate cancer support groups where men who have been afflicted with this disease are able to discuss their concerns with one another. It is OK to discuss your disease with other patients who are in a similar situation, and many find this very helpful. The first of these advances was at Johns Hopkins, where the surgical technique was refined with the mapping of the nerve supply to the penis. Nerve sparing techniques led to preservation of erectile function in large numbers of patients. Robotic technology has further refined the radical surgery, minimizing hospitalization, recovery time and the size of the incisions.
Radiation therapy has also undergone significant refinements. IMRT is now the most common form of ration therapy for prostate cancer. It is associated with a good outcome, acceptable complication rates, and is appealing to patients due to its non-invasive nature. Cryotherapy is another minimally invasive technique of treatment for many patients with prostate cancer. This technology as well has undergone numerous modifications since it was first described resulting in excellent cure rates and minimal complications. Cyberknife therapy is the newest technology, with little long-term data supporting its use, but it is being advertised extensively in those communities that possess the technology.
In addition to the advances that were mentioned above, there are numerous new medications that are being utilized for those patients who have advanced disease. There are now 2 new pills that are available to patients with advanced disease. Not long ago, there was little to offer the patients that had metastatic prostate cancer, but in 2014, there are several different options for treating these patients. Despite having metastatic disease and not being curable, these treatments are able to prolong life in many patients. Some of these drugs are revolutionary as they involve manipulation of the immune system.
Despite all the advances that have been made, much of the interest in prostate cancer has occurred for perhaps the wrong reason. The recommendation made by the USPSTF regarding PSA testing is extremely controversial. A "D" rating was assigned to this test, yet many feel there is evidence that the test in not deserving of this adverse rating. To date, there is nothing more effective for helping urologists diagnose disease. The American Urological Association is promoting a bill on Capital Hill that if passed would make the task forces process a more transparent one. This task force was able to render a decision on prostate cancer, despite not having Urologist, medical oncologist or radiation oncologist on the committee. The Urological community is very optimistic that this bill will be passed.
Prostate cancer does not discriminate on the basis of political party and has affected both sides of the aisle. Senator Tom Coburn (R-Okla) who is stepping down at the end of this session has been found to have a recurrence of his prostate cancer. It is ironic that it has been reported (Politico) that his ObamaCare insurance that he was obligated to use since he is a member of the senate, does not cover his cancer specialist. Senator Ron Wyden (D-Ore) has also undergone surgery for prostate cancer. We hope that this bill gains bipartisan support and I encourage you to reach out to your representatives.
Celebrity deaths attributable to prostate cancer also bring additional attention to this disease. Merv Griffin, Bill Bixby, Steve Ross, Telly Salvalas, Frank Zappa and Dan Fogelberg have all had premature tragic deaths from prostate cancer. This disease can certainly lead to death, and this fact makes the task force decision even more difficult to understand.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.