A couple of years ago, in honor of Prostate Cancer Awareness Month, we invited Dr. James M. Fitzgerald to join us for a Q&A session to discuss prostate health and prostate cancer. We recently asked him to revisit his interview and provide info on the upcoming ZERO Prostate Cancer Run/Walk on Sunday, September 9.
But first, a quick anatomy refresher: The prostate is a small gland (think walnut sized) located in the male pelvis beneath the bladder and surrounding the urethra (the tube through which urine passes from the bladder out of the body). The prostate plays an important role in reproduction since it produces fluid that mixes with and protects sperm.
As men age, the prostate increases in size (this is known as benign prostatic hyperplasia, or BPH) and often causes urinary symptoms (slow urine stream, frequent urination, awakening during the night to urinate, etc.). The risk for prostate cancer also increases as men get older.
Now, let's turn to Dr. Fitzgerald.
As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.
[Editor's note: This article was reviewed and updated on 5/18/21 with additional links and media.]
Thanks for joining us, Dr. Fitzgerald. Since we last spoke, what's changed in regards to prostate cancer? Has anything changed?
DR. FITZGERALD: Unfortunately, prostate cancer is still a devastating disease that will affect 1 in 9 American men in their lifetime. It's the second leading cause of cancer death among men, resulting in a little more than 80 deaths per day.
In May 2018, the U.S. Preventive Services Task Force released its final recommendations regarding prostate cancer screening, and we believe the Task Force missed the mark. You can read Dr. Michael J. Curran's response, which reflects my own.
Bottom line: early detection saves lives.
At GBU, we follow the American Urologic Association (AUA) Guidelines, which support screening in men between the ages of 55-69 and earlier than age 55 for men who are known to be at increased risk for prostate cancer. This includes men with a family history of prostate cancer and African American men who should be screened as early as age 40.
Some men over age 70 may benefit from prostate cancer screening if they are in excellent health with a life expectancy of more than 10 years. These men should discuss testing with their physician.
What does prostate cancer screening entail?DR. FITZGERALD: Screening involves a PSA (prostate-specific antigen) blood test and a digital rectal exam (DRE).
Again, even though prostate cancer testing has come under scrutiny, we feel that screening in properly selected patients is appropriate and indicated. It is important that men make an informed decision about prostate cancer screening by discussing it with their doctor.
If a nodule is felt on the prostate and/or the patient's PSA level is high, what are the typical next steps?
DR. FITZGERALD: If screening for prostate cancer reveals an elevated PSA or a nodule during a digital rectal exam, then the next step is a discussion between the urologist and patient about the options.
Typically, a transrectal ultrasound (TRUS) is performed to take pictures of the prostate and to provide guidance for biopsies of the prostate. Usually a biopsy sampling is done throughout the prostate with a total of 12 biopsies taken.
This is the test most commonly performed for initial evaluation of patients with an elevated PSA or a prostate nodule felt on exam. Patients who have had prior TRUS prostate biopsies and have a PSA that is continuing to increase (as well as those men with prostate cancer on active surveillance) are candidates for a relatively newer technique using 3D MRI/ultrasound fusion biopsy technology, which is discussed in another article on our website.
If a patient is diagnosed with prostate cancer, what are his treatment options?DR. FITZGERALD: A detailed discussion of the treatment options is beyond the scope of this interview and depends upon the stage of the cancer (confined to the prostate or cancer that has spread). But for most patients with localized (confined) prostate cancer, the options are (in no particular order):
- Active surveillance, which we discuss in more detail here
- Surgery or radical prostatectomy, which involves removing the prostate and reconnecting the bladder to the urethra. This has traditionally been done through a six-inch incision below the belly button but now is almost always done with smaller incisions with the aid of a robot (robotic prostatectomy). [Editor's note: read one man's story on what to expect from a radical prostatectomy.]
- Radiation, which may be external radiation or internal radiation (brachytherapy also known as "seeds")
- HIFU, which involves using high intensity focused ultrasound energy to treat the cancer
- Cryotherapy, which is a technique of freezing the prostate and cancer cells
Since we last spoke, you've received training in a new system, called SpaceOAR. Tell us about it.DR. FITZGERALD: SpaceOAR is an effective system for men who choose radiation therapy to treat their prostate cancer. SpaceOAR hydrogel acts as a protective spacer between the prostate and the rectum and has been clinically proven to reduce the risk of side effects (such as bowel toxicity, urinary incontinence, and erectile dysfunction) during and after radiation treatment.
SpaceOAR is a valuable new tool for us to improve prostate cancer radiation treatment. If you're in the Greater Boston area, you're considering radiation treatment, and you would like to learn more, you can contact me at our North Easton Care Center or Dr. Stephen Craig Gillard in our Plymouth Care Center.
SpaceOAR Hydrogel - Minimize Side Effects Video
[Editor's note: Below is a video that explains SpaceOAR in more detail.]
Is there anything a person can do to promote better prostate health?DR. FITZGERALD: Diet plays an important role in prostate health and may lower a man's risk for prostate cancer. Specific recommendations include the following:
- Eat a low fat diet. This promotes prostate health and has many other health benefits.
- Substitute fat from plants (nuts, olive oil, avocados) for animal fat (meat, butter, cheese, etc.).
- Add fish to your diet (which contains omega 3 fatty acids).
- Choose whole grain breads, pastas, cereals.
- Eat foods rich in lycopene, such as cooked tomatoes, watermelon, and pink grapefruit.
- Include more fruits and vegetables in your diet.
- Limit your intake of sugar and salt.
- Exercise regularly. This promotes general well-being as well as a healthy prostate.
- Stop smoking. Smoking appears to increase a man's risk for developing more aggressive prostate cancer.
As we focus on Prostate Cancer Awareness Month, what are a few things you wish every male patient understood about prostate health and/or prostate cancer?
DR. FITZGERALD: It is my hope that men—and those who love them—will understand the scope and severity of prostate cancer. There has been some controversy and public misperception that prostate cancer is "not serious." Although men diagnosed with prostate cancer very late in life are unlikely to die of their disease, prostate cancer in many men is a very serious problem in this country and worldwide.
Therefore, I would like men to understand the following:
- Other than skin cancer, prostate cancer is the most commonly diagnosed cancer in the United States.
- As mentioned earlier, prostate cancer is the second most common cause of cancer death (after lung cancer) in men in this country, but it can be cured if diagnosed and treated early.
- To emphasize what I said earlier: not smoking, getting regular exercise, and eating a healthy diet are not only important for general and cardiovascular well-being, but also for prostate health and may lower a man's risk for getting prostate cancer.
- We can—and will—continue to fight this disease. At Greater Boston Urology, we are committed to providing our patients with the best possible prostate cancer care.
Thanks, Dr. Fitzgerald!