A previous Air Force operative service specialist who completed several trips of responsibility in Iraq and Afghanistan, Alexander was getting ready to retire from the military services and make a transition to teaching high school in Warner Robins, Georgia. As part of a regular pre-retirement physical exam, his doctors performed a PSA (prostate specific antigen) test, and the PSA level was high.
A biopsy in early 2013 uncovered the clear existence of cancerous cells. Alexander was having regular back pain, which he thought was from joint disease. Based on his back again pain and some suggestive bone scans, a radiation oncologist in Warner Robins suspected that the tumor experienced already metastasized. He was told to “get his affairs in order.” However, another of his local doctors didn’t agree and to resolve the uncertainty, he arrived to Winship Cancer Institute.
He met with a team of Winship doctors and they determined that the cancer tumor, while appearing intense, was localized probably. Together they developed a coordinated treatment plan. Among the big decisions some men face as of this true point, surgery, or radiation, was not a huge hurdle for him. First, his prostate gland was removed with a laparoscopic procedure.
Positive margins – and therefore some cancer cells might have been left behind – indicated that he should arrange for radiation and a restricted course of treatment with leuprolide, a testosterone-lowering drug. The radiation treatments were grueling, however in the springtime of 2015, Alexander was back again at the job, instructing his junior ROTC students and planning for summer camp. Alexander’s journey with prostate cancer has been a good example of fast. Most men’s preliminary encounters with prostate tumor don’t play out as quickly. Most of the right time, when an increased PSA level spurs a man to truly have a biopsy, no cancers are discovered.
Health care experts have criticized the PSA test for traveling many men to get definitive treatment for malignancies that might not pose a danger, years down the line even. And on the far side of the coin, a short biopsy sometimes doesn’t detect a cancer whose presence is suggested by rectal examination.
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This doubt leaves men like David McGahee of Atlanta stumped. McGahee had two elevated PSA readings and a urologist he previously was talking to assumed he would check out a biopsy. He wasn’t so sure. Having lately began a fresh relationship at 69, he was worried about the risks, however small, of nerve or infection damage that come with a biopsy.
He began looking for other assessment options. Winship reaches the forefront of research aimed at helping men at all levels of their journeys with prostate tumor. Men like McGahee, who may or might not be in the early stages, will want to learn about whether a biopsy or quick treatment is really necessary. Some might need basic information and help making a decision about different kinds of treatment and their possible side effects such as impotence or incontinence (see sidebar). Some men will have the choice of active monitoring, called watchful waiting sometimes, rather than immediate definitive treatment such as radiation or surgery.
Those at more complex stages could benefit from information in regards to a cancer’s recurrence or spread, and effective treatments that could stop a recurrent cancer’s growth for years. Peter J. Rossi, a Winship rays oncologist who snacks men with prostate cancers at Emory Saint Joseph’s Hospital, says he helps patients evaluate their anxieties and quality of life issues, but the ultimate decision is up to each individual man. At Winship, urologists and cancer biologists are part of the nationwide effort to develop new blood and urine tests that could substantially improve detection and diagnosis of prostate cancer.
Martin G. Sanda, director of Winship’s prostate tumor program and chairman of the Department of Urology at the Emory University School of Medicine. A test for just one of these markers, PCA3, a gene that is hyperactivated in prostate tumor, has already been FDA-approved for men who are thinking about a repeat biopsy after a short negative result.