Doctor outlines treatment for prostate cancer

Photo by Barry Levine

Photo by Barry Levine

ALBANY -- Not getting regular blood screenings can turn a treatable condition into a silent killer.

Dr. Charles Mendenhall, a radiation oncologist with Phoebe Putney Memorial Hospital, made an address to the Dougherty Rotary Club Tuesday for the purpose of educating the public on prostate cancer -- specifically how the disease is detected in its earlier stages and the treatment options that are available.

The best way of detecting the condition early is through the prostate-specific antigen (PSA) blood test. High levels of the antigen, or a level that rises over time, can be an indication of cancer.

"The PSA is the best measurement on how the cancer is behaving," Mendenhall said.

A PSA level is typically considered high when it gets above four nanograms per milliliter.

After the PSA test, the next thing to consider is the Gleason score, or grade -- which measures the aggressiveness of the cancer on a scale of two to 10.

"Eighty percent of the patients I see have a grade-6 cancer," Mendenhall said.

Before treatment begins, a physician also has to take into account the ethical implications of putting a patient through a procedure from which he or she may not benefit much, Mendenhall said.

"If I have an 80-year-old who has had two strokes, from an ethical standpoint, I may decide I'm not going to treat him," he said.

The best hope of curing prostate cancer is either through surgery to remove the prostate or radiation therapy.

On radiation therapy, Mendenhall discussed TomoTherapy. Phoebe's TomoTherapy unit, installed about 18 months ago, allows physicians to use an image-guided approach to map out a specific area of the body in order to administer a more targeted dose of radiation.

"We can map the radiation dose in a 3- to 5-millimeter margin," Mendenhall explained. "It's all about treating what you have to treat (and avoiding what you don't need to treat)."

For prostate cancer treatment, such an approach can allow doctors to better protect other organs in the pelvic region.

"We want to avoid the bladder and the rectum as much as possible," Mendenhall said.

Brachytherapy, a procedure in which radioactive seeds are implanted through needles using ultrasound for guidance into the prostate where they can irradiate the cancer from within, is also a common method of treating the condition, Mendenhall said.

The survival rate for prostate cancer over a five-year period is 100 percent for localized disease, 100 percent for regional disease and 31 percent for distant (or advanced) disease -- numbers that experts say can be misleading.

"Those that are (treated) for prostate cancer and get a recurrence aren't going to die in five years," Mendenhall said. "Plus, some of these guys are going to drop dead of a heart attack."

Incidence rates tend to be higher in the African-American population, which may be an indicator of how common the condition is in Southwest Georgia compared to other regions.

"The incidence rate may be higher here than, say, Leesburg, Pa.," Mendenhall said.