Raising Awareness About Prostate Cancer With Stamford Health

STAMFORD, CT — With the calendar flipped to September, it's time to observe National Prostate Cancer Awareness Month.

According to the Prostate Cancer Foundation, prostate cancer is the most common non-skin cancer in men in the U.S., and the fourth most common tumor diagnosed worldwide.

In 2021, almost 250,000 U.S. men will be diagnosed with prostate cancer, and more than 34,000 will die from the disease. It's estimated that more than 3 million U.S. men are living with prostate cancer.

Additionally, black men are over 75 percent more likely to develop prostate cancer than caucasian men, and are more than twice as likely to die from the disease.

According to Dr. Michael Karellas, Chief of the Division of Urology with Stamford Health, family history plays a big role in determining risk factors. For example, if someone has a father who was diagnosed at an early age — in their 50s or 60s — with prostate cancer, they should get screened in their 40s.

Also, if someone has a first-degree relative, a mother or sister, who had breast cancer at a young age and they were tested for the BRCA gene, there is some overlap between that mutation and prostate cancer development.

"The general guidelines are to get a baseline PSA test (prostate-specific antigen) in your 40s, somewhere between age 45-49. If your PSA is low, less than three, you're probably OK for a while. Then it's more getting checked periodically after that," Karellas said. "The issue of PSA testing is there's a fair level of interpretation that has to be involved in looking at PSAs. In the past, some men would fear if their PSA was elevated they'd be rushed into a biopsy and a procedure, and that's not what we do anymore necessarily."

The PSA test in general has been controversial.

"The PSA test is a flawed test," said Karellas. "In the urology community we recognize the PSA is not a perfect test, but it's a starting point into the potential diagnosis of prostate cancer."

Karellas noted that most prostate cancers are not symptomatic when they're detected. Trouble urinating or having blood in the urine could be a sign of advanced disease, Karellas said.

"We have a very good understanding of prostate cancer these days," Karellas added. "Overall, the chances of someone dying from prostate cancer are approximately three percent. One, we're very good at treating it, and if we catch it early it's very curable. The other reason why there's such a low death rate from prostate cancer is there are some cancers we know are not lethal."

Surgery to remove the cancer using robotics is an option, as is an open procedure which is more uncommon in 2021. There are also multiple types of radiation. But Karellas said just because someone has been diagnosed with prostate cancer, doesn't mean they need aggressive treatment or any treatment at all.

"There are many men who have prostate cancer who don't need treatment and we watch them carefully. We have data to support that. It's called active surveillance, and it does require some follow up," he said. "If you meet certain criteria, we can watch you."

Stamford Health remains at the ready to treat and test for prostate cancer, Karellas stressed.

"We have everything available at Stamford Hospital that the major centers in the city or Yale have," Karellas said, mentioning a partnership with the Dana-Farber Brigham Cancer Center Collaborative. "One of my goals coming to Stamford was to be able to provide that level of care so people didn't have to go anywhere else if they didn't want to go anywhere."

Getting cancer screenings or medical treatment in general is critical especially during COVID-19. Many people have been hesitant about going to medical facilities because of the virus.

"Unfortunately during the pandemic, a lot of people were skipping routine checkups. As a reflection of that, I've had a handful of men this year who I've operated on that had basically more advanced cancers than they probably would have had last year. Because of that, their cancer outcome was compromised," Karellas said. "Do your regular health maintenance which includes getting a baseline PSA. If your PSA is elevated or more concerning than you think it should be, there are other tests we can do."

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