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Screening for Prostate Cancer

Posted Aug 24 2008 1:49pm
PAUL MONIZ: Here to discuss what prostate cancer is, and how it is diagnosed, are two specialists in the field. To my left we have Doctor Daniel Shasha. He is an Assistant Professor of Radiation Oncology at the Albert Einstein College of Medicine, which is affiliated with the Beth Israel Medical Center. Thanks for joining us.


PAUL MONIZ: Next to him we have Doctor Robert Salant, who is an Associate Professor of Urology at the NYU School of Medicine.

PAUL MONIZ: If the patient had been undergoing regular screening it would have been caught, conceivably, early.

ROBERT SALANT, MD: The whole purpose of screening is to catch cancers when they're localized, when they're small, and when they're potentially curable. Something like this, you hope would not happen in a patient who has been properly screened.

PAUL MONIZ: Doctor Shasha, there are guidelines. Generally, it's 50 years old for men who are Caucasian. 40 years old for African American men, yearly, and also for people who are at risk. What about younger men? Do younger men get prostate cancer?

DANIEL SHASHA, MD: Generally not. Prostate cancer is a disease that has an average age in this country of occurring anywhere between 55 to 65 years old, depending on who's doing the screening and how old the screening happens. It's generally a disease of older men.

The reason we screen at younger ages is because we have the PSA. It is such a more sensitive means of detecting as a complement to the digital rectal exam, that we're now discovering these tumors earlier in their stages. Therefore, we believe, we're curing more of them.

PAUL MONIZ: People that have recently been diagnosed, some of them more prominent, have broken down some of the walls about prostate cancer. People are talking about it. But there's still a tremendous sense of fear among men, and also reluctance to get tested and get treated. How do you address some of those fears? In closing, what do you want to tell our audience about the importance of facing up to the possibility that they could have something?

ROBERT SALANT, MD: In my practice, I think the biggest obstacle to finding prostate cancers early is the natural reluctance of men to avoid a rectal examination. It is an examination that men dread more than virtually anything else. However, it is relatively innocuous. It is done with a gloved, lubricated finger. It is a little uncomfortable, but not terribly painful. And the potential benefits far outweigh minimal risks. So in my mind, when I see a patient in my practice, I stress this point to the max. I've had only one or two patients in the course of 12 years who have absolutely refused rectal examination.

PAUL MONIZ: That's a fairly good record, considering the number of patients you see.

ROBERT SALANT, MD: Absolutely. I can tell you that we have found a lot of early-stage prostate cancers because of this.

PAUL MONIZ: Doctor Shasha, your closing comments in terms of what is prostate cancer, and what you want to get out there to patients?

DANIEL SHASHA, MD: I think the important points have been made. One of them is screening. The second one is, what screening can really do for people, and that is to improve their chance of being cured. At the same time that we've developed better diagnostic methods with PSA, we have also turned around and have much improved the surgical techniques and the radiation techniques that had been available.

Together, these have translated into our improved ability to positively impact our patients, and to avoid side effects, which as recently as five or ten years ago were much more common than they are today.

PAUL MONIZ: All right. Some very good information. I appreciate it. Doctor Daniel Shasha, I appreciate your time. And Doctor Robert Salant, as well.

I'm Paul Moniz, thanks for joining us.

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