Augusta, Ga. (WJBF) - Prostate cancer is described as the most common, non-skin cancer in America. It is also the second leading cause of cancer death. 1 out of every 9 men will be diagnosed with prostate cancer in his lifetime. We take a look at the causes, symptoms, screenings, and treatments for this deadly disease.
Brad Means: We are going to move on to our discussion of prostate cancer. To talk about the impact that it has on not just the patient's life but the life of his family we wanna talk about what's going on with that disease as far as treatment. Not only the physical side of it, but the mental side as well and I can't think of a better person to do that than Dr. Zach Klaassen. He's a urologic oncologist at the Georgia Cancer Center right here in Augusta. Dr. Klaassen thanks for the work you do and thanks for being here.
Dr. Zach Klaassen: Brad, thanks for having us. Good to be here.
Brad Means: You look at the stats on prostate cancer and you come to the conclusion, and this is a little bit of an overstatement, boy if you live long enough you're gonna get it.
Dr. Zach Klaassen: Yeah, absolutely right Brad. So one in seven men will get prostate cancer. One in 38 men will die of prostate cancer. So you can see there's a high incidence of people getting it. But also high prevalence. So not everybody that gets prostate cancer dies of it, thankfully. But we have a lot of men in the community that are living with prostate cancer.
Brad Means: There are, if you again look at the charts, more people who get it as you get older so my question is at what age should we start that screening?
Dr. Zach Klaassen: That's a great question. So there's been a lot of debate in the lay media about when we should start screening. As the American Urological Association Company and a program that we're part of we recommend that men should think about getting screened usually between the ages of 55 and 69. Now there's a little variety of that in the sense that if you have a family history we may screen you a little bit earlier but that's that really sweet spot where we think about screening men.
Brad Means: And you say screening you mean the full on PSA test.
Dr. Zach Klaassen: Yeah, so there's two ways that we screen for prostate cancer. One way is the PSA blood test like you mentioned. The other way, and this may sound a little bit more because we do a rectal exam where we actually feel the prostate, and this is important because some men may have a normal PSA but their rectal exam will have a nodule and that will lead us towards suspicion of possible prostate cancer.
Brad Means: Is there something we can feel or detect that might let us know something is wrong? Sometimes if you have trouble urinating you think, oh my goodness I definitely have it.
Dr. Zach Klaassen: Right, and thankfully most men that have difficulty urinating, and that happens in a lot of men as we start to collect birthdays. These men typically don't have prostate cancer they have what's called BPH. This is a growth of the prostate, a benign growth. So for asymptomatic prostate cancer is the most common presentation. So that's why we have to detect it on the PSA blood test or the rectal exam.
Brad Means: If you detect prostate cancer early enough can you cure it?
Dr. Zach Klaassen: Yes we can. So there's a process that we go through, we call it shared decision making, so we usually get men that are referred to us with a PSA and maybe a little bit elevated. At that point we may repeat the PSA to make sure that it is truly elevated. If we think that there's an indication for a biopsy then we'll have a discussion with the patient, their family and we'll decide if a biopsy's warranted and what that entails. So at that point in time when we do the biopsy if men are diagnosed with localized prostate cancer there's treatments that we can do and we can cure them of prostate cancer.
Brad Means: And how long does that usually take? From that first scary news in your office to I can't believe it's all gone?
Dr. Zach Klaassen: So, we try to get men in as soon as we can. So when we get a referral at the Georgia Cancer Center we try to get them in as quickly as we can so that we can alleviate concern not only of the patient but also their family. And we try to make a treatment plan initially. So if we see somebody in week one we try to schedule the biopsy usually within a week or two, and then if we unfortunately have a positive biopsy then we discuss treatment options. This may include surgery. We do these surgeries typically with a robot so we're controlling the robot and this helps us take the prostate out minimally invasively. The other option is, and some men choose to do radiation therapy which is also very good treatment for localized prostate cancer.
Brad Means: Where you just trying to zap the tumor?
Dr. Zach Klaassen: Exactly, so you treat the whole prostate but you basically treat it by zapping it.
Brad Means: What about the involvement of the family? How key is that when it comes to helping a man get through this whole process because it is scary.
Dr. Zach Klaassen: For sure, it's a huge, huge aspect. At the Georgia Cancer Center we're big on the family aspect. When we're talking to patients we're not just talking to the patient. We're talking to their wife, their child, their nephew, their grandma. We try to get everybody involved who wants to be involved and I think we see that men, they can take time to make a decision. So the nice thing about, I shouldn't say the nice thing, the fortunate thing about prostate cancer is we don't have to make a treatment decision that day. It's important to talk to your family members, to your church members, people that have gone through the treatment before to see what the side effects are of the treatment.
Brad Means: Is my fist stop my urologist or my oncologist? Should I go straight to the oncologist to try to expedite this whole thing or must you go urologist first?
Dr. Zach Klaassen: That's a good question so we have great relationships with our medical oncologists. We love them at Georgia Cancer Center. Typically when it's a localized prostate cancer they come and see us first. And most of the time if it stays localized we'll continue to see them, typically for the rest of their life. If unfortunately patients progress to where the disease spreads or becomes metastatic at that point we'll usually get our medical oncology colleagues involved.
Brad Means: Is there anything I can do if I'm not genetically predisposed to prostate cancer to ward it off? Lifestyle changes or habits?
Dr. Zach Klaassen: It's a good question. We've been looking at diet, we've been looking at obesity factors and there appears to be some association between these but there's no concrete evidence at this point. I always tell men that even though there's a high chance of getting prostate cancer there's still a greater risk you're gonna die of heart disease. So anything you're doing that's good for your heart, exercise, diet, not smoking, et cetera. Those things are also good for your prostate because that's still the number one killer in men. So we talk about the whole health plan.
Brad Means: You know we talked a lot about our servicemen and women in our fist segment. Are you still seeing veterans come in who may have been exposed to something out in the field, in the trenches that's led to prostate cancer?
Dr. Zach Klaassen: Sure, the Augusta VA, which is just across the street from the Georgia Cancer Center. We were pioneers, well the people before me I should say, were pioneers of doing research looking at a possible link between Agent Orange and prostate cancer. Agent orange was very common, as most of our viewers probably know in Vietnam and so there was some initial studies that suggested that there may be a risk associated with prostate cancer after Agent Orange exposure. These studies are still ongoing. It's hard to always prove a causal association between one thing and another but there appears to maybe something to that story.
Brad Means: What about some of the fears that are out there? And you're hitting on a part of the body that can generate a ton of anxiety and fear in men and the people who love those men. So what about fears like, I won't ever urinate the same again. My sex life is gone, what do you say?
Dr. Zach Klaassen: These are great questions and great points. And we discuss this in detail when we're talking about the treatment options for men. So, we can cure prostate cancer with this localized treatment most of the time. In the men that we cure it there is side effects to these treatments and these are important. As you mentioned, sexual disfunction, urinary incontinence where you leak urine unexpectedly. Usually with surgery these are more drastic up front and then they progressively get better and sometimes we have to give medications to help with sexual function. With radiation usually this function is okay upfront and typically it does deteriorate a little bit over time. So these are very important issues and we're active in treating them and we have partners in our Georgia Cancer Center group that also treat these patients specifically as well.
Brad Means: And one of the great things that you do and that the folks at the Georgia Cancer Center do is address the mental health aspect of all of this. So, what is that approach? What does it entail when you're treating the whole person?
Dr. Zach Klaassen: Yeah, that's a great point. This is a passion of mine. I really think that it's an understudied topic and risk factor. Not only in prostate cancer but all types of cancer. Bladder cancer, lung cancer. This is is a really important topic because it's only recently over the last 10 or 15 years become kosher to talk about these sorts of things. So we're finding that, not surprisingly, men that are doing well in their 50s and 60s, sometimes their 40s are diagnosed with prostate cancer and they're probably gonna live with this prostate cancer for the rest of their lives. They may need treatment, they may not. However, this is the mental fatigue and this is what we're focusing on. So we've done a couple of studies using big data bases in the United States looking at patients that had a prostate cancer diagnosis and their suicide risk going forward. Unfortunately it is elevated all the way through this process, even after 15 years. So that tells us that, sure the suicide risk increases as men get older but also there's probably something related to the side effects of treatment or just the burden of that cancer diagnosis.
Brad Means: And so do you try to link them with mental health professionals at that point to get them through that we hope?
Dr. Zach Klaassen: Absolutely, we're trying to certainly increase our associations with our psycho oncologists and this is important for sure. We're even trying to get some of these patients the first time they see us. We're trying to get an initiative where we can get them in to see the psycho oncologist early.
Brad Means: Psycho oncologist, somebody who knows everything about cancer and the brain.
Dr. Zach Klaassen: Exactly, so these are excellent colleagues that we have that will talk to the patient really get to the root of how they're feeling. You know, we're urological oncologists, we treat the prostate cancer. But there's so many other things associated with this. So working with our colleagues in psycho oncology they're gonna ask about depression, they're gonna ask about suicidality. They're gonna have the family involved and these are all important aspects to sort of treat that whole patient specifically from a mental health standpoint.
Brad Means: Well, Dr. Klaassen you've seen this whole process unfold, probably daily if not monthly in your life. What can you say to offer people hope? What if they're in that dark place that is the initial diagnosis? You've seen somebody come out of that dark spot, right?
Dr. Zach Klaassen: Absolutely. So the prostate cancer diagnosis is something that, A, we will walk through the process with you explaining what this means. There's a large spectrum of patients that get prostate cancer. Some men have local low grade prostate cancer. We'll watch it carefully. They may never need treatment and we'll continue to follow them carefully. Some men are in that medium box where they're gonna need treatment. They may have side effects, we're gonna treat them as well. Some men are gonna present with aggressive disease. Those are the ones that are the tough ones. We're really active in getting them in clinical trials and getting them as much treatment as we can upfront. So to answer your question, yes we can work with you no matter where you are in that spectrum. We'll take care of you. We will be able to cure some people, unfortunately we can't cure the ones that present with advanced really aggressive disease. But the treatments that are coming out, especially for these patients over the last 10 years has really improved. Not just quantity of life, but also quality of life.
Brad Means: Yeah, the advancements have just been incredible. Thank you for what you do. You do change men's lives and take them out of that darkness and I appreciate that.
Dr. Zach Klaassen: Thanks for having us.
Brad Means: Absolutely, Dr. Zach Klaassen, Georgia Cancer Center, go see him. Go see your doctor and take that first step. You heard him say at the beginning of the interview the earlier the better.
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