Meet our doctors: Philip Pearson and David Rhodes on active surveillance
Cancer of the prostate is the No. 2 cancer killer of men, behind lung cancer, accounting for more than 29,000 deaths annually in this country. But because prostate cancer advances slowly, good prostate health and early detection can make all the difference.
Many prostate cancer tumors don't require immediate treatment because they're small, confined and slow-growing. For patients with these type of tumors, so-called "watchful waiting," increasingly known as "active surveillance" may be the best course of action. In "active surveillance," physicians closely monitor patients so they can identify early signs of disease progression and treat the cancer before it spreads outside the prostate.
Here, Philip G. Pearson, M.D., and David W. Rhodes, M.D., of City of Hope | Pasadena, provide simple strategies that can help men better understand this important gland. They also explain why active surveillance is becoming a more common prostate cancer management option.
What tests are available to measure prostate health?
Pearson: The main test to measure prostate health and screen for cancer is the prostate specific antigen (PSA) test. That test, along with a physical exam that includes the examination of the prostate, are the most important tools required in monitoring one’s prostate.
When should prostate screening begin and how often should it occur?
Pearson: The recommended age to begin annual prostate screening is age 50. However, men with a family history of several close relatives diagnosed with prostate cancer at an early age and men of African-American decent should begin screening at age 40.
Rhodes: Because African-Americans have a higher incidence of prostate cancer, they should start discussing prostate cancer early detection tests with their physician beginning at age 45. It’s worth noting that if an African-American man is tested at age 45 and the PSA is very low, he can be retested at age 50. He doesn't have to be tested every year.
Does family history of prostate cancer increase one’s risk of getting it and are certain ethnicities at higher risk?
Pearson: There is no doubt that prostate cancer runs in families. Furthermore, having a first-degree relative such as a father or brother with prostate cancer more than doubles a man's risk of developing the disease, compared to a man with no family history. The risk is much higher for men with several affected relatives, particularly if those relatives were young at the time the cancer was found.
Rhodes: As mentioned previously, African-American men have the highest prostate cancer rates of any racial or ethnic group in the U.S. and are more than twice as likely as Caucasian men to die of the disease. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic whites. Researchers still don't have a full understanding of why these differences exist.
What can a man do to prevent or decrease his risk of prostate cancer?
Pearson: There's no proven prostate-cancer prevention strategy. But the risk of developing prostate cancer can be decreased by making healthy choices, such as exercising and eating a healthy diet that's low in fat and full of fruits, oils, vegetables, fish and lean meats. Also maintaining a healthy weight is key. There is already evidence that obesity increases the risk of developing cancer, including prostate cancer, and increases inflammation throughout the body. Men with excess inflammation of their prostate gland are at greater risk of having high-grade, aggressive prostate tumors.
Rhodes: There have also been many dietary studies highlighting the benefit of lycopene which is found in tomatoes. Most research focused on foods containing lycopene because, as an antioxidant, it fights off toxins called free radicals. These can cause cell damage, which may lead to cancer. Although lycopene is found in foods such as shellfish, watermelon and pink grapefruit, tomatoes are the richest source.
What precisely is “active surveillance,” and can it be considered a management option in lieu of treatment for prostate cancer?
Rhodes: Active surveillance is a way of monitoring prostate cancer that aims to avoid or delay unnecessary treatment in men with less-aggressive cancer. Prostate cancer can be slow-growing and, for many men, the disease may never progress or cause any symptoms. In other words, many men with prostate cancer will never need any treatment. Determining whether active surveillance is a viable management option is really an individual decision based on each patient’s age, overall health, and how much cancer is present.
Pearson: And with this management option, patients undergo periodic blood tests and other interventions to make sure that the disease is not getting out of control. There have been some studies out of Europe and Scandinavia that have shown that in many cases, prostate cancer is overtreated and that patients in the elderly population who have a mild case of prostate cancer don’t need to undergo radical surgeries or therapies that may have side effects for the patient. Following these studies, there has been a trend toward more active surveillance now than perhaps in the past. Active surveillance can be a suitable option for men with low-risk early stage prostate cancer that is contained within the prostate gland.
What are the changes you look for that indicate comprehensive treatment, such as radiation therapy, hormonal therapy or surgery, is needed?
Pearson: In active surveillance, urologists are managing a patient’s prostate cancer by monitoring it very closely. If during this process, a patient’s PSA keeps rising and rising, or on rebiopsy, the cancer appears to have gotten to a more aggressive stage or has taken over more of the prostate, then it’s time to rethink management and intervene with some form of treatment, whether it be surgery, radiation or hormone therapy.
What inspires you to do the work you do?
Rhodes: When I was in medical school, I initially decided I wanted to be a general surgeon because I personally like to fix things. But during my general medicine internship, I discovered I enjoyed urology more than many other areas of surgical specialty. And urologists are said to be a more laid-back group than many other specialists. This may, in part, be because the work we do generally has positive outcomes. Urology is fairly straightforward in that most of the conditions have known causes. Kidney stones, incontinence, bladder infections and even most of the cancers urologists see are treatable and curable.
Pearson: I got into urology for a variety of reasons. Mostly for the diversity of patients, from a pediatric patient with urinary tract infections, incontinence issues in adults, to older patients with urologic cancers. There is a wide variety of patients and with most of these problems, you can intervene and really help someone regain quality of life. While urology can be serious, there is also a lighter side in that as a urologist, we deal with sometimes awkward and what may be considered embarrassing situations. So patients have to feel comfortable with you and that takes a certain type of person. It’s a good fit for my personality. But one of the most rewarding and satisfying parts of being a urologist is the ability to help a patient overcome a health challenge. And many times, the change in their life can be seen immediately after treatment.
To see a urologist at City of Hope | Pasadena or to learn more about the services there, call 626-396-2900.
Also, learn more about prostate cancer clinical trials at City of Hope.