Dr. William Tester discusses who's at risk for prostate and colon cancer and what screening procedures to follow.
June Is Men’s Health Month
With Dr. William Tester, Medical Oncology, Director, Einstein Cancer Center
Prostate cancer is common, but usually not deadly.
According to the American Cancer Society, one in six men will be diagnosed with prostate cancer. It is the most common cancer among men. The American Cancer Society estimates that 238,590 new cases of prostate cancer will be diagnosed in 2013 and 29,720 men will die of it. But more than 2.5 million men diagnosed with prostate cancer are still alive.
Most men do not die from prostate cancer, says Dr. William Tester, a medical oncologist with Einstein Healthcare Network. “Prostate cancer is a slow-growing cancer,” Tester explains. “It is most commonly diagnosed in men who are age 65 and older. Because it’s slow-growing, we look at the stage of the cancer and the men’s other health factors — which can be significant at that age — then evaluate their risk and decide if they need treatment and what kind. That raises a third issue, which is that prostate cancer is very treatable if we catch it.”
Who is at risk for prostate cancer? What is the screening process?
“Unfortunately, we don’t have a good genetic screening test for prostate cancer and that leaves us with family history and race as the two predictors,” Tester explains. “African-American men have an increased risk for prostate cancer as do men whose fathers or brothers have it.”
Screening for prostate cancer is done through a digital rectal exam and a blood test to check PSA (prostate-specific antigen) levels. If abnormalities are found, doctors proceed with a biopsy. “The blood test is actually a bigger indicator of a problem and it is a simple test to do,” Tester says. “For men at average risk, we recommend they get tested at age 50.” The testing should start at age 45 for men who have one first-degree relative with prostate cancer and age 40 for those with two.
Colon cancer is just as common as prostate cancer, but more people die from it because fewer people get tested for it.
The American Cancer Society estimates that 142,820 people will be diagnosed in 2013 and that 50,830 will die from colon cancer. It is the second leading cause of cancer death in men and women in the United States.
What is the best way to screen for it? “Colonoscopy is the gold standard and it should be done every 10 years,” Tester explains, “but there are other options. Annual stool testing is an acceptable alternative. A sigmoidoscopy, which uses a shorter scope than a colonoscopy, could be done once every five years. You could get a virtual colonoscopy, which is basically an X-ray of the colon. That should be done once every five years. The best test is the one that gets done.”
Why is colonoscopy the gold standard?
“Physicians favor colonoscopy because we can find pre-cancerous polyps and remove them during the procedure,” Tester explains. “If other tests find pre-cancerous polyps, the patient has to have a colonoscopy anyway. So, colonoscopy is screening and prevention.
“I’d like to repeat that: prevention,” Tester states. “With many other cancers, there aren’t things that we can do for prevention. This works. It has been proven. On the other hand, if we don’t remove those polyps, the cancer will advance. The more colon cancer advances, the more lethal it becomes.”
While preparation for colonoscopies is uncomfortable, that is nothing compared to the treatment for colon cancer. “Would you rather have one day of uneasy bowels?” Tester asks. “Or one year of surgery and chemotherapy?”