Frequently asked questions about PSA and prostate cancer

Shared by

What is the prostate? The prostate is a gland that is a part of the reproductive organs and lies below the urinary bladder in men. It serves to produce fluids that are a component of the man’s ejaculate.

What is prostate cancer? Prostate cancer is a cancer that develops from the cells lining the duct structure of the prostate. Most cancers are called adenocarcinomas.

Who is at risk of prostate cancer? All men are at risk. About 17 percent of U.S. men will be diagnosed with prostate cancer during their lifetime, making about one man in six at risk. More than 200,000 men annually in the United States are diagnosed with prostate cancer and about 30,000 men each year die from this disease. Risk factors for developing prostate cancer include:

  • Age – prostate cancer is unusual before age 50 but increases in frequency with age.
  • Ethnicity/race – Black men have a higher risk for prostate cancer.
  • Family history – men with one or more close male relatives with prostate cancer have a higher risk of the disease. In general, the more relatives affected, the greater a man’s risk.

What are the symptoms of prostate cancer? In general, prostate cancer is silent. By the time symptoms develop, such as bone pain, urinary symptoms, blood in urine or weight loss, the prostate cancer has spread and cure is unlikely. While urinary symptoms (arising at night to urinate, slower stream) are common in aging men, these symptoms generally are not related to prostate cancer. Because prostate cancer develops without symptoms, early detection is necessary for cure of the disease.

How is prostate cancer diagnosed? Traditionally, two tests have been used to detect prostate cancer – digital rectal examination (DRE) and prostate-specific antigen (PSA). DRE involves the physician using the gloved finger to examine the prostate through the rectum. The physician is examining for bumps or irregularities in the prostate that can indicate the presence of cancer. The PSA test measures a protein that is made generally only by the prostate and that is increased in men with prostate cancer.

What is a prostate biopsy? If either the DRE or PSA is suspicious for prostate cancer, the physician may recommend a prostate biopsy. The biopsy is performed on an outpatient basis and generally involves use of an ultrasound unit to guide a biopsy needle. Several needle biopsies are obtained, removing tissue for analysis. A pathologist examines the tissue removed to determine if prostate cancer is present.

What is an abnormal PSA reading? Over the past two decades, many physicians have used a PSA level of 4.0 ng/ml (nanograms per milliliter) to separate men who may have prostate cancer from men with a low risk of prostate cancer. Men with a value over 4.0 ng/ml have often been offered a prostate biopsy to determine if prostate cancer is present. For men with a PSA between 4.0 and 10.0 ng/ml, it is frequently cited that the risk of cancer if a biopsy is performed is about 25 percent. (For values over 10.0 ng/ml, the risk increases further.) However, with some exceptions, many men with PSA levels less than 4.0 ng/ml have not been offered a prostate biopsy. While there have been some small groups of men with these ‘normal’ values of PSA who have had a biopsy, very few series have examined this group.

How does this report change what we know about PSA? The Prostate Cancer Prevention Trial, a study funded by the National Cancer Institute and coordinated by the Southwest Oncology Group, reported its conclusions in June 2003. The study enrolled 18,882 men, half receiving the drug finasteride (Proscar) and half receiving an inactive agent (a placebo). Over seven years, men had DRE and PSA testing. If either were abnormal, a prostate biopsy was recommended. At the end of seven years, to ensure that prostate cancer had not developed, all men, even those with a normal DRE and PSA, were recommended to have a prostate biopsy.

In the 2,950 men who had received placebo and who had never had an elevated PSA or abnormal DRE (and who met several other rigorous criteria for this analysis), prostate cancer was detected in 15 percent. The risk of prostate cancer in men with PSA in the ranges of < 0.5, 0.6 to 1.0, 1.1 to 2.0, 2.1 to 3.0, and 3.1 to 4.0 ng/ml was 6.6, 10.1, 17.0, 23.9 and 26.9 percent, respectively. While high-grade (aggressive) prostate cancer increased with higher levels of PSA, there was no level of PSA below which such aggressive cancer did not occur.

How can this information be used? First, it is important to recognize that PSA continues to be an important blood test for the detection of prostate cancer. The risk of both cancer itself and of aggressive disease increases with higher levels of PSA.

For a man with a normal PSA, it must be understood that prostate cancer may be present. For some, the prostate cancer will be of no consequence and could be followed until a PSA level increased. For some men, however, cure of aggressive prostate cancer may be best achieved by detecting the cancer while the PSA level is less than 4.0 ng/ml.

Individuals with a PSA less than 4.0 ng/ml who may consider undergoing a prostate biopsy could include (1) a man with a strong history of prostate cancer, including one or more relatives who developed the disease at a young age, (2) a black man. Both of these groups have a significantly higher risk of prostate cancer and are at risk of developing the disease at a younger age.

Because prostate cancer, even aggressive prostate cancer, can develop in men with no risk factors at all for the disease, a man with a normal level of PSA may want to examine the prostate cancer detection risk for his own level of PSA, using the results from this study. Different men will have different levels of risk that will lead them to select a prostate biopsy.

What is the future of prostate cancer detection?

Work is ongoing to examine improved methods of prostate cancer detection. The PSA test measures only one of more than 100,000 proteins in the blood, and there is evidence to suggest that other substances may help to find those men with prostate cancer. The University of Texas Health Science Center at San Antonio’s SABOR program, the San Antonio Center For Biomarkers Of Risk Of Prostate Cancer, is a member of the National Cancer Institute’s Early Detection Research Network and is working to identify a group of tests and risk factors.

A panel of genetic markers, dietary factors and other measures are being examined to determine if they can improve prostate cancer detection. The ultimate goal of this program is to identify not just the man with prostate cancer (because in some men, the cancer will never cause him problems in his lifetime), but to identify those men whose prostate cancers are destined to cause problems and to detect them sufficiently early to allow treatment for cure.

Who can participate in SABOR? Currently, more than 3,000 men from San Antonio and South Texas are enrolled in the study. Of these men, more than half are either Hispanic or black. This is a major feature of the SABOR study, as evidence suggests that risk factors and blood tests may work differently in men of different ethnic and racial backgrounds. While men over age 40 generally enter in the SABOR study, some men at younger ages have enrolled due to strong family history of prostate cancer or other factors that increase their risk.

What is involved in SABOR visits? Men who are interested in SABOR are given information to read and have an opportunity to ask questions about the study. Because this is a research study, an informed consent is required and the study is overseen by The University of Texas Health Science Center at San Antonio’s Institutional Review Board. At the first visit, in addition to a prostate examination and blood tests, questions are asked about family history of cancer and personal medical history, as well as any urinary symptoms. Men are asked to take home and complete questionnaires regarding their diet and use of dietary supplements. The next time SABOR participants cut their toenails, they are requested to send in the clippings, as these can help to examine dietary selenium, a possible prostate cancer preventive factor. On an annual basis, men in SABOR have a prostate examination and a blood test and are asked to update their medical and family history.

Complete information regarding SABOR can be obtained by calling (210) 567-0214 or (800) 335-4594. SABOR clinics are held in a number of locations around San Antonio, in Laredo and in McAllen.

Are there any other options other than early detection of prostate cancer? The results of the Prostate Cancer Prevention Trial demonstrated that a man who took finasteride, a drug that is used for enlarge of the prostate – both to treat urinary symptoms as well as to reduce the risk of progression of urinary symptoms – lowered his risk of prostate cancer by 25 percent. The side effects of finasteride include a risk of sexual problems and a possibility of development of a more aggressive prostate cancer. The additional benefit of this medication is the improvement in urinary function and reduction in long-term risk of urinary problems. A smaller dose of finasteride (1mg) is used to treat male pattern baldness.

 

‘Out of the 4.0 box thinking’ benefited South Texas patient

Shared by

San Antonio (May 27, 2004) – Like many Americans, Edgar Smith loathes the words “prostate cancer.” His father had it, he had it, and his two brothers had it. That’s why he strongly encourages men to have themselves checked and to understand their options.

“My youngest brother, Harry, passed away March 6 and he died very sadly,” Smith said. “He was in hospice care. I remember it was bad, and it was so sad. I have that picture in my mind. I told myself, this doesn’t have to happen with early detection.”

Early detection of prostate cancer includes a digital rectal exam (during which the physician feels for prostate abnormalities), the prostate-specific antigen or PSA test, and prostate biopsy. The PSA test measures the level of one protein in the blood. Physicians often consider that if a man has a PSA of 4.0 nanograms per milliliter (ng/ml) or lower, he does not need a prostate biopsy, during which tissue is taken from the prostate to be examined for cancer by a pathologist.

Smith said he benefited from “out of the 4.0 box thinking” on the part of his physician, Dr. Javier Hernandez, and his surgeon, Dr. Ian M. Thompson, professor and deputy chair of the department of surgery and chief of urology at The University of Texas Health Science Center at San Antonio. Smith had a 0.9 ng/ml reading for two years, but because of his family history Dr. Hernandez suggested a biopsy, which was positive for prostate cancer. “It looked like I was doing really well, but I wasn’t,” Smith said.

His cancer was of the aggressive variety but had not spread. Dr. Thompson performed a prostatectomy on Smith at University Hospital, the Health Science Center’s teaching hospital. “If I had not seen the docs, I would not be in as great a shape,” Smith said.

Smith, 69, is retired from the Texas Workforce Commission and lives in Floresville near San Antonio. He said he has already told his two sons about the importance of checkups for prostate cancer.

Study finds 15 percent of men with ‘normal’ PSA had prostate cancer

Shared by

ThompsonPC1_BODY
Ian M. Thompson Jr., M.D., professor of surgery and chief of urology at The University of Texas Health Science Center at San Antonio, discusses the results of the Prostate Cancer Prevention Trial with reporters. Dr. Thompson was interviewed by local and national media regarding the trial’s results, which were published in the May 27 issue of “The New England Journal of Medicine.”

San Antonio (June 8, 2004) – Some men who have received good marks on the prostate-specific antigen (PSA) test from their physicians may be getting a false sense of confidence about not having prostate cancer, according to a study released May 27 in The New England Journal of Medicine.

The results of the Prostate Cancer Prevention Trial (PCPT) were announced last June in Washington, D.C. Additional information gleaned from this study has enabled researchers to study the risk of prostate cancer in men who had what physicians consider “normal” PSA scores – under 4.0 nanograms per milliliter (ng/ml). Of 2,950 men who throughout the trial always had PSA scores below 4.0, a surprising 15 percent (449 men) had prostate cancer. Not only that, 67 of the men had high-grade cancers, the type of cancer that poses the greatest risk.

“There are many men who have been told that, based on their PSA score, they don’t have prostate cancer,” said lead author Ian M. Thompson Jr., M.D., professor of surgery and chief of urology at The University of Texas Health Science Center at San Antonio, one of the institutions that participated in the PCPT. “Based on this study, we now know they have a substantial risk of cancer and some can have high-grade disease. Waiting for a PSA level to go above 4.0 may be too late in some men.”

The number of U.S. men who have been told they have “normal” PSA readings is estimated at 25 million to 35 million, researchers said.

“There is no PSA value below which a man can be assured that he has no risk of prostate cancer,” wrote the authors, who include Leslie G. Ford, M.D., of the National Cancer Institute (NCI) and Charles A. Coltman Jr., M.D., chairman of the Southwest Oncology Group, one of the largest NCI-supported cancer clinical trials cooperative groups in the United States.

The results suggest that men as young as 40 with a strong family history of prostate cancer and a PSA level even lower than 2.0 should seek consultation with their physicians. “I am familiar with a family in which every man had prostate cancer in his 40s,” Dr. Thompson said at a briefing at the Cancer Therapy and Research Center, the clinical partner with the Health Science Center in the San Antonio Cancer Institute, an NCI Clinical Cancer Center.

“The bad prostate cancers in the men with normal PSA scores may be more numerous than all the prostate cancers we are currently detecting,” Dr. Thompson added. “It calls into question whether our definition of prostate cancer risk is correct.”

The new study reveals the need for a more specific test for prostate cancer, Dr. Thompson said. “Very clearly, we can’t tell for sure which prostate cancers are slow growing and which are aggressive and we need a screening test that doesn’t just find cancer – it finds only those cancers that will cause problems in an individual man. Certainly, a man who is at risk of prostate cancer should think about the use of finasteride, the agent we demonstrated last year that can reduce the risk of prostate cancer by 25 percent. If you don’t ever get prostate cancer, you don’t have to worry about whether it is aggressive or not. From a philosophical standpoint, what we need to do is a ‘Manhattan Project’ of prostate cancer, an intensive, large-scale study of men who are characterized by family history, medications, diet and genes, and follow them for 20 years. Then we would have a much clearer picture.”

Men should speak with their physicians about the possibility of a prostate biopsy, which can be done on an outpatient basis in the doctor’s office, Dr. Thompson said.

Dr. Coltman, in his role as director of the Southwest Oncology Group, served as principal investigator on the study and Dr. Thompson served as clinical coordinator. The Fred Hutchinson Cancer Research Center at The University of Washington, Seattle, provided statistical support. Other co-authors are from The University of Texas M.D. Anderson Cancer Center and The University of Colorado Health Sciences Center.

Medrano receives 2004 Medical School Distinguished Alumnus Award

Shared by

MedranoM_BODY
Medrano

San Antonio (May 25, 2004) – Martha Medrano, M.D., M.P.H., assistant dean for continuing medical education and director of the School of Medicine’s Hispanic Center of Excellence at The University of Texas Health Science Center at San Antonio, has received the 2004 Medical School Distinguished Alumnus Award.

“We are honored to present this award to Dr. Medrano, who stands out among her peers,” said Wei-Ann Bay, M.D., president of the Health Science Center’s Medical School Alumni Association. “She has truly taken the opportunity to give back to the School of Medicine. She shares her enthusiasm and love of medicine with her students and has been an incredible force in promoting health and education in the Hispanic community.”

Dr. Medrano, who graduated from the Health Science Center’s School of Medicine in 1981, received her award at the school’s commencement on Saturday, May 22.

One outstanding alumnus is selected each year to receive the award by the school’s alumni association. Candidates are selected based on their impact on, and accomplishments in, the profession of medicine, and the extent to which they have impacted their community through leadership and activities. Nominees are also judged on their efforts to promote the school and its students and their actions or involvement in reflecting the mission of the alumni association and the School of Medicine.

Dr. Medrano is also a medical staff member at the Southwest Neuropsychiatric Institute and works in psychiatry services at the Audie L. Murphy Division, South Texas Veterans Health Care System. She is a medical staff member of the University Health System and an Advisory Council Member for the National Institutes of Health in the Office on Research on Women’s Health.

The recruitment, retention and promotion of Hispanic medical students and faculty is the focus of Dr. Medrano’s work at the Medical Hispanic Center of Excellence. She is working to include cultural competence in the medical school curriculum, increase Hispanic health information resources at the Dolph Briscoe Library and to expand the center’s medical student summer research program.

As a co-investigator of the major nationwide initiative, Redes En Acción, she is working to create a national and regional infrastructure for collaboration among grassroots leaders, local communities, researchers and public health professionals to stimulate cancer control research, training and awareness for Hispanics/Latinos. Redes En Acción recently released a report stating that inadequate access to cancer screening and care is the number one cancer issue for the nation’s 38 million Hispanics/Latinos. The report also includes a series of research recommendations for cancer prevention and control education, training and outreach.

She is also the principal investigator of the U.S. Mexico Border Center of Excellence Consortium that is developing a strategic plan for increasing the health care delivery and research workforce along the United States and Mexico border.

Some of her other projects include studying the relationship between childhood trauma and drug injection behaviors, and training health professionals and staff in appropriate techniques when providing medical interpretation. She is the principal investigator of the Eisenhower Professional Development Program that is implementing an educational intervention with middle and high school teachers to integrate simple medical equipment into science classes.

In 2003, Dr. Medrano received a Recognition Award from The United States Border Health Initiative and the Latina Women in Action Award from the La Prensa Foundation. She also received the National Advisory Board Recognition Award from the National Hispanic Medical Association and the United Latin American Medical Student Association Appreciation Award.

Although she has written and has been cited in many articles, she has most recently been included as a physician leader in the September 2003 issue of San Antonio Medicine and was cited in the April 2003 issue of Latina. In the September 2002 issue of San Antonio Medicine, she wrote an article titled, “Minority Women in Medicine.”

She is an active member of the Bexar County Medical Society, the Hispanic American Biomedical Association and the Hispanic Faculty Association. She is also an active member in the National Hispanic Medical Association, the National Hispanic Science Network on Drug Abuse and the National Hispanic Medical Association Board of Advisers. She was a founding member and former president of the Hispanic Faculty Association at the Health Science Center.

An El Paso native, she earned a bachelor of science in biology degree from The University of Texas at El Paso in 1977. In 1997, she earned a master’s of public health from The University of Texas Health Science Center at Houston. She completed her residencies and a fellowship at the Health Science Center in the departments of psychiatry and pediatrics.

Putting the proverbial brakes on aging

Shared by

StrongNelson3_BODY
Aging Intervention Testing Center lead investigators Drs. Randy Strong (left) and Jim Nelson joined the Health Science Center in 1993 and 1990, respectively.

San Antonio (May 18, 2004) – The University of Texas Health Science Center at San Antonio has received a $2.5 million grant for a National Institute on Aging (NIA) Intervention Testing Center, one of three such U.S. centers established by the NIA to test potential therapeutic interventions to slow the aging process.

The new center, which is part of the Health Science Center’s Sam and Ann Barshop Center for Longevity and Aging Studies, will test compounds that may slow the aging process and extend life span or “health span” – the continuation of good health throughout life. The San Antonio Aging Intervention Testing Center will interact closely with the two other NIA-designated centers at the University of Michigan and Jackson Laboratories, Bar Harbor, Maine.

The San Antonio center is headed by Randy Strong, Ph.D., associate professor of pharmacology at the Health Science Center and research career scientist with the South Texas Veterans Health Care System, and Jim Nelson, Ph.D., professor of physiology at the Health Science Center.

“Ten years ago, the only intervention known to increase life span in mammals was caloric restriction,” Dr. Strong said. “Since that time, rapid advances in gene technology have led to the discovery of a number of genetic manipulations or mutations that extend life span in both invertebrates (flies and worms) and mammals (mice and rats).

“In addition, epidemiological and clinical studies point to anti-inflammatory medications as having positive effects in preventing cancer and in delaying the progression of neurodegenerative diseases, and these medications are under clinical trials in Alzheimer’s disease and chemoprevention studies of colorectal cancer. Thus, a number of therapeutic targets are now identified and that is why the NIA funded a program to test potential interventions in aging processes. We are honored to be part of this new program.”

Dr. Strong said the genetic alterations studied by scientists have included manipulations of the insulin-like growth factor 1 (IGF-1) and insulin receptor genes; mutations in a gene that governs growth hormone and targeted deletion of the growth hormone receptor gene; targeted deletion of signaling molecules in the IGF-1 and insulin signaling pathways; and engineering animals to make high levels of anti-oxidant enzyme.

The first four interventions to be tested starting this summer are anti-oxidant and anti-inflammatory compounds. Four to five studies will be added each year to study other interventions.

“Biomedical aging research is in an exciting phase of rapid growth,” Dr. Nelson said. “The growing number of genes that are being found to play a role in aging provides a growing number of targets for drug therapy and interventions suitable for our center to test. My own studies, which show that anti-inflammatory mechanisms are associated with the longevity effects of calorie restriction, support the anti-inflammatory interventions being undertaken in these trials.”

Barshop Center Director Arlan Richardson, Ph.D., said, “This Intervention Testing Center will contribute to the Barshop Center’s emp

Meyers make sure there is always a doctor in Hondo’s house

Shared by

MeyerE_BODY
Meyer

The Meyer family has practiced family medicine in Hondo for nearly a century, and that won’t end any time soon. Emily Sullivan Meyer, the first woman in the family to attend medical school, will receive her M.D. from The University of Texas Health Science Center at San Antonio School of Medicine at 1 p.m. Saturday, May 22, at Laurie Auditorium, Trinity University. And, you guessed it, after residency she hopes to be the fourth generation of Meyers to practice family medicine in Hondo.

“I’m so lucky to be from Hondo,” Emily said. “The community has always been supportive and wonderful, and I hope I can give something back.”

Meyer is the daughter of Dr. John and Gail Meyer of Hondo. She was valedictorian of the Hondo High School Class of 1995 and received a bachelor of arts degree, with honors, in theater and dance from The University of Texas at Austin in 2000. She excelled in medical school and the Alamo Chapter of the Texas Association of Family Physicians awarded her the S. Perry Post, M.D., Medical Student Scholarship, which is for a graduating senior who plans a career in family practice. Emily also received the John S. Primomo, M.D., Award for Exemplary Family Practice and the Leonard Tow Humanism in Medicine Award in recognition of exemplary compassion, competence and respect in the delivery of care.

Although Emily is the first woman in her family to attend medical school, she is not the first doctor in her family. She comes from a long line of physicians, who have served as outstanding role models and mentors for her.

Emily’s great-grandfather, Henry J. Meyer, M.D., attended Tulane Medical School in New Orleans and moved to Hondo in 1906 to begin general practice. He served on the Hondo school board from 1928 to 1946 and was president of the board for 15 years. Meyer Elementary School in Hondo is named for him.

Emily’s grandfather, Walter B. Meyer, M.D., graduated from Tulane and practiced medicine in Hondo from 1937 to 1977. He served on the school board from 1947-1965 and was board president for 17 years.

Emily’s uncle, Parker H. Meyer, M.D., graduated from Tulane in 1965, practiced in Hondo until 1991 and now sees patients in the Dallas suburb of DeSoto. Another uncle, James R. Meyer, M.D., graduated from Tulane in 1975, specializes in obstetrics and gynecology in The Woodlands, and returns to Hondo once a month to perform gynecological surgery.

Emily’s father, John W. Meyer, M.D., graduated from Tulane in 1974 and has been practicing medicine in Hondo for 28 years. He served on the Hondo school board from 1983 to 1998 and was board president for nine years. He served on the Texas Medical Foundation Executive Board from 1987 to 2003 and was president from 1995 to 1999. He currently serves on the Texas Medical Association Rural Health Committee and other panels.

Emily spent two months of her fourth year rotating with her dad at his office in Hondo. While there, she met several people who have been patients of the Meyer family for many years.

One such patient is the town optometrist, 82-year-old Dr. John Jennings, who was delivered by Emily’s great-grandfather. In fact, Dr. Jennings has been a patient of Emily’s great-grandfather, grandfather, one of her uncles and now her dad. Dr. Jennings, who still sees patients, told Emily that he would wait for her to come to practice in Hondo so that he could be seen by four generations of the Meyer family.

“My dad has been my role model and hero, and I can’t wait to practice with him,” Emily said. “I know this wouldn’t be happening without the support of my family, friends and the people of Hondo. It’s such a special place.”

Emily will begin her family practice residency at CHRISTUS Santa Rosa Hospital July 1. And just like her father, uncles, grandfather and great-grandfather before her, Emily will no doubt leave her mark on Hondo – and may someday inspire a fifth generation of Meyer family physicians to serve their hometown.