Prostate Cancer Screenings: Early Detection Improves Outcomes
Courtney Carter
/ Categories: WELLNESS, 2024

Prostate Cancer Screenings: Early Detection Improves Outcomes

In the United States, 1 in 8 men will be diagnosed with prostate cancer in his lifetime. Despite the alarmingly high number of men who develop prostate cancer, there is good news: more than 80% of all prostate cancers are detected when the cancer is confined to the prostate or the region around it, making it highly treatable. In fact, the 5-year survival rate in the U.S. for men diagnosed with early-stage prostate cancer is greater than 99%.

However, that success rate doesn’t mean prostate cancer is never deadly. Every day, 94 men die from prostate cancer in the U.S., making it the second leading cause of cancer death among men in the country. The real tragedy in those numbers is how easy it is to screen for the disease.

The most common screening method is a simple blood test called prostate specific antigen (PSA).

PSA is a substance made by the prostate, which then becomes detectable in your blood. PSA levels tend to be higher in men who have prostate cancer. But because other factors can influence PSA levels, including age, benign prostate enlargement, and certain medications, it’s important to let your doctor interpret your PSA test results. If your levels are abnormal, your doctor may refer you to a urologist who may recommend other tests, including imaging or prostate biopsy. It’s important to note that the actual diagnosis of prostate cancer can only be made with a biopsy.

 

As for who should get a screening and when, the American Cancer Society recommends men discuss screening with their doctor at the following ages and risk levels:

  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age)

  • Age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years

If no prostate cancer is found, the timing for future screenings will be determined by the findings of the PSA test:

  • Men who have a PSA level of less than 2.5 ng/mL may only need to be retested every 2 years.

  • Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

 

WHEN TO SEE A DOCTOR

In most cases, early prostate cancer has very few or no symptoms. When they do appear, they may include:

  • Problems urinating, including a slow or weak urinary stream, or the need to urinate more often

  • Blood in the urine or semen

Symptoms of more advanced prostate cancer can include those noted above and:

  • Trouble getting an erection (erectile dysfunction or ED)

  • Pain in the hips, back (spine), chest (ribs), or other areas, from cancer that has spread to the bones

  • Weakness or numbness in the legs or feet, or even loss of bladder or bowel control, from cancer in the spine pressing on the spinal cord

  • Weight loss

  • Feeling very tired

In many cases, these symptoms are caused by something other than prostate cancer. However, it’s still important to tell your health care provider about your symptoms so they can determine the cause and treat it.

 

Matthew Vernon, MD, is a radiation oncologist at the Dartmouth Regional Cancer Center at Southwestern Vermont Medical Center 

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Emergency Department: Open, Ready, Safe. 

The last 3 months have been a uniquely challenging experience in the SVMC Emergency Department (ED) and emergency departments and hospitals all over the country and the world. I am very proud of all our staff has done and continues to do to ensure safe care for patients during this era of COVID-19. We are grateful that cases of COVID-19 in our area have been the lowest in the U.S. and have decreased even further over the past several weeks. We are also heartened to see that patients who had been avoiding the ED are now confident to return to get the care they need.

It may be surprising to hear that over the past few months, the sickest patients we have seen in the ER have not had COVID-19. Many people have refrained from seeking care for serious medical problems due to the fear of being exposed to the virus, assuming that the hospital was not a safe place to be and not recognizing the seriousness of their symptoms. The most challenging moments of the past several months have involved critically ill patients who tried to stay away for far too long due to fear of being exposed to COVID-19. We have had many sad moments trying to care for those who waited until it was too late for us to help with conditions that could have been easily treated if presented sooner.

One might expect that the greatest challenges related to the pandemic were those needed to adapt our facilities and procedures and the work of caring for sick COVID-19 patients. SVMC is fortunate to have built a strong foundation of safety and infection-prevention methods over many years, which made this transition much easier. Still, when it became apparent that we were going to see COVID-19 cases coming through our doors, we implemented many COVID-specific changes very quickly.

From day one our staff have all been fully trained to use protective equipment effectively, to focus on cleaning and disinfecting, and to move patients safely through the new areas created to keep them safe. We also spaced the waiting room chairs to allow for plenty of distance and initiated drive-by testing to keep potentially contagious people outside and away from other patients.

We immediately increased our standard of protective equipment we use. For example, all staff who relate with patients now wear both a mask and protective shield, which is a proven and effective strategy to prevent transmission. Those staff who work with patients with respiratory or other contagious symptoms also wear a gown and advanced respirators developed in cooperation with Mack Molding in Arlington. They look strange, but they help us deliver care safely.

We also quickly built special spaces and units in the hospital to treat and segregate patients with respiratory symptoms who might be contagious from those with other routine medical problems. Outpatients with symptoms that could be related to COVID-19 are directed to a spacious area called the Respiratory Evaluation Center. There they can be taken to a safe treatment space called a negative-pressure room without encountering any patients who are using the ED for other reasons or any staff who are not fully equipped with protective gear. There are similar, safe, negative-pressure units for those who require treatment in the ED or hospital.

Our hard work paid off. We have treated a number of COVID-19 patients in our ED and, as far as we know, not a single staff member was sickened in relation to their work here, and no patients have contracted COVID-19 while under our care. With our current procedures and drastically declining COVID numbers, we are confident that we can continue that trend. Furthermore, SVMC recently received a perfect score on a rigorous survey specifically designed to judge our ability to prevent transmission of COVID-19. At this time our ED is safer than just about any other public place you could go.

My goal in writing today is to communicate that SVMC’s Emergency Department is open, ready, and safe. If you need emergency care, we are here and we can care for you safely. Please do not defer emergency care until it is too late for us to help. While many symptoms can represent a serious medical problem, the most concerning are chest pain, difficulty breathing, fast heart rate, confusion, high fever, intense headache, drooping face, dehydration, or weakness. Of course, with any other symptom you feel indicates a serious problem, come in right away or call 9-1-1.

For us, spending time with patients and connecting on a personal level is the best part of our jobs. We take pride in our life-saving role in our communities and the work we have been able to do during the pandemic, but we cannot help if you do not come in. Please don’t hesitate to get the care you need when you need it.

Adam Cohen, MD, is a board-certified emergency medicine physician at Southwestern Vermont Medical Center. He also serves as the chair of the Department of Emergency Medicine and the medical director of SVMC’s Emergency Department.

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