Читать книгу What You Should Know About Prostate Cancer - Daniel C Merrill - Страница 5

2. What are some of the important characteristics of prostate cancer?

Prostate cancer is the most common non-skin cancer in males and is the second most common cancer cause of death in males, right after lung cancer. The bad news is that 1 in 6 males will develop prostate cancer in his lifetime; the good news is that the malignancy is entirely curable if diagnosed when it is still within the confines of the prostatic capsule.

Prostate cancer tends to be a more benign disease in older males as shown by the fact that around 80% of elderly males who die from unrelated conditions have prostate cancer that had not been diagnosed prior to death. Nonetheless, prostate cancer is an extremely serious disease as shown by the fact that over 217,000 males were diagnosed with prostate cancer in 2010 and over 32,000 died from the malignancy.

My experience in treating prostate cancer at the Veterans Administration Medical Center in Martinez California, suggested that prostate cancer was a must more aggressive tumor in black men than it was in Caucasian males. This observation has been confirmed by numerous workers in the field. The fact is that black males are 1.5 times more likely to develop prostate cancer than are their Caucasian counterparts and are 2 to 3 times more likely to die from the disease. I believe that this is due to the fact that the Gleason scores (the histological grade of the cancer) are, on average, much higher in newly diagnosed black men with prostate cancer than they are in white males of the same age when they are first found to have the disease.

The second important exception to the general rule that prostate cancer tends to be a relatively benign disease relates to the age of the patient when the cancer is first diagnosed. My experience suggests that prostate cancer is a much more virulent and aggressive tumor when it is diagnosed in young males irrespective of race. As a result, we tended to treat men in their 50s with newly diagnosed prostate cancer much more aggressively than those who were diagnosed in their late 70s. In my view, watchful waiting is a poor option for younger males because, even if their cancer is low grade when first diagnosed, it will certainly become more aggressive as time goes on and, as the aggressiveness of the tumor increases, the chances that it will metastasize and become incurable also increases. Therefore, younger males might as well bite the bullet and do everything in their power early on to eradicate the cancer while it is still confined to the prostate and is curable.

Now for a question that demands our attention. Despite our advances in early detection over the past 30 to 40 years, primarily due to the availability of PSA testing, the mortality rate for prostate cancer has actually increased over the past three decades. For example, in 1973 the mortality rate for prostate cancer in white males was 20/100,000; in 1995, 22 years later, the mortality rate from prostate cancer had increased to 22/100,000 in Caucasian males. During the same time period, the mortality rate for blacks with the disease increased from 40/100,000 in 1973 to 52/100,000 in 1995. The significance of these statistics is that approximately, 30,000 American males died of prostate cancer in 1990 while 32,000 died from the malignancy in 2010.

What in the world is going on here? Early diagnosis is much easier to achieve with the PSA blood test than it was when we had to rely on the rectal-digital examination and crude transrectal biopsies to diagnose the disease. Some would argue, although I would not, that the treatment for prostate cancer also has advanced considerably over the past 40 years. So, why are so many males still dying of prostate cancer?

I believe the answer is quite simple, the watchful waiting crowd which includes many of the primary care physicians and the internists who in today’s medicine are the gate keepers for all things surgical have not taken this malignancy seriously enough. In short, they tend to fiddle around while Rome is burning, or in this case, while the cancer is escaping the confines of the prostate and, in so doing, becoming incurable. I hope, after reading this eBook that you will agree with me. If so maybe it would be a good idea to give a copy of this book to your primary care physician for XMAS. After all, a little knowledge never hurt anyone.