"Ask The Doctor": Prostate Cancer

March 27, 2000

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JazzyTaco: Is there a difference between screening for prostate cancer and early detection of prostate cancer?

Dr. Brian Miles: Strictly speaking, yes. Screening means that men are tested for the disease almost in the same fashion as vaccinations are given to children, which is routinely and without discussion. That is currently not being done. What we are engaged in is early detection, which is the evaluation of men who are in the appropriate age group, generally over the age of 50. Or if they have a family history of prostate cancer, in which case we test them earlier, or if they are African-American, a group that is at extremely high risk for developing the disease. All of these men are tested with their knowledge and with their permission.

Sez0007: Is prostate testing generally a good idea?

Dr. Brian Miles: As I just outlined, yes. It is indicated for all men over the age of 50, and for men with a family history or African-Americans, beginning at age 40. Prostate cancer is very curable if detected early.

Sfcarl: How often should I be tested?

Dr. Brian Miles: Testing is recommended every year. If, however, your tests are routinely normal, then testing, after an initial three to four year period, can be done every other year, and this is believed by some investigators.

Tribbian: What is your feeling on second opinions? Why should I get one? When should I get one?

Dr. Brian Miles: Well, second opinions can be very valuable. If the diagnosis of cancer is made, you will want to get as much information as possible. And sometimes, you will be more comfortable if you have an opinion that validates the first, or at least gives you the information that the consulting physician has given you all the data. However, this is not absolutely necessary. If you are comfortable with your physician and with what he or she has presented to you in the way of discussions regarding the aggressiveness and stage of your disease, and, of course, its treatment, then you should proceed based on that physician's recommendations. Interestingly, in most studies, and in one I've done myself nationally, 88 percent of men who actually sought a second opinion ended up doing what the first opinion recommended, anyhow. So second opinions can be valuable, but they usually only validate the first opinion.

Ami: Have there been any studies on using alcohol for the treatment of enlarged prostate or prostate cancer

Dr. Brian Miles: Not really. Alcohol has been tried in laboratory animals. It certainly will kill the prostate, or that portion of the prostate exposed to it, but it can be extremely uncomfortable, and has never been used in any substantive way in clinical trials for either cancer or benign prosthetic growth.

RiGHtCLiC: What are the odds today in treating this disease?

Dr. Brian Miles: Well, the odds of curing the disease are based on its aggressiveness, which is called its grade, and, its stage. That is, whether it is localized or not localized to the prostate. The more aggressive the cancer and the bigger its volume, the lower the likelihood of cure. However, overall, at least here at Baylor, we are able to cure 80 percent of our patients, all comers. Happily, the groups with the very aggressive cancers, or the larger volume cancers, make up a minority of cases due to our early detection efforts. And in those men, we are curing only 40 to 50 percent, those with the high-grade, aggressive, large volume cancers.

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