A myth is an imagined but UNREAL event.
As prostate cancer is a major health issue and not all prostate cancers are the same, it is vitally important that men and their spouses deal with FACTUAL information only.
- Myth: if you don’t have urinary symptoms, you do not have prostate cancer
FACT. Most men that are diagnosed with prostate cancer these days have no urinary symptoms or findings on examination and are picked up with an abnormal prostatic specific antigen (PSA) and therefore have a stage T1c disease.
- Myth: prostate health is enhanced by frequent sex and ejaculation.
FACT. There is NO evidence to support frequent ejaculation for improved prostate health and lower cancer rates.
- Myth: supplements keep my prostate healthy.
FACT. Despite media, infomercials and industry spin there is absolutely NO scientific evidence to show that supplements, nutritional support or increased water intake, keep the prostate healthy or lower the incidence of cancer.
There may be some support for maintaining an ideal weight, a lean diet and undertaking moderate exercise.
- Myth: I can pass my prostate cancer to my spouse.
FACT. Prostate cancer is not spread through sexual activity.
- Myth: having a big prostate or a high PSA means that I will eventually get prostate cancer.
FACT. there is no hard data to support this notion.
- Myth: a vasectomy will increase my chances for prostate cancer.
FACT. There is NO increased incidence for prostate cancer after a vasectomy.
- Myth: prostate screening is valueless
FACT. Although the current method of prostate screening with the total PSA only may not be cost effective, evaluation of individual men with the PSA as well as the %free PSA may be. Especially men in certain risk groups such as those with a family history of prostate cancer or those men with an African heritage.
Furthermore, prostate cancer is found in all age groups from the 30′s on but becomes progressively more common as well as more aggressive with age.
- Myth: PSA is sensitive for diagnosing prostate cancer.
FACT. The total PSA on its own lacks specificity and sensitivity for diagnosing prostate cancer. An elevated PSA does not make a diagnosis of prostate cancer and although 70% of men with a PSA of 4-10ng/ml have benign pathology on their prostate biopsy, the PSA can be made more meaningful by assaying the other PSA components of free PSA and %free PSA with the PSA test. Other ways to determine whether a prostate biopsy may be necessary can be through monitoring certain PSA parameters. Following PSA velocity may be meaningful if the PSA rises over 0.75 ng/ml/year (doubling of the PSA in 6 months may be more meaningful) or, monitoring the PSA density of PSA to prostate gland volume and a level of 0.12ng/ml/g or greater may be abnormal and suggest the need for a biopsy.
However, some very aggressive prostate cancers may show only marginal increases in PSA if at all.
- Myth: a PSA of 4ng/ml or less is normal and means no prostate cancer.
FACT. 15-20% of men with a normal total PSA of 4ng/ml or less have clinically significant prostate cancer.
This fact simply underscores the importance of checking the %free PSA and doing a digital rectal examination (DRE), especially when the total PSA is normal.
- Myth: my pathology report indicates a cancer so I must have it.
FACT. The diagnosis of prostate cancer involves considerable subjectivity on the part of the pathologists. This is despite the incorporation of special stains to improve the diagnosis. The importance of having your prostate biopsy slides validated by a prostate pathology reference laboratory can not be understated.
In addition, not all prostate cancers demand treatment. For example, those men in whom one microfocus (<5% Gleason 6 in one needle biopsy specimen only) of cancer was found should be especially wary of being rushed to treatment.
Men with one microfocus only should undergo a repeat biopsy 2-3 months or so later, and preferably a saturation biopsy to confirm whether a cancer can be detected. This process will also identify the very odd patient in whom prostate cancer was under estimated at the first biopsy and will need treatment. Often however, the repeat biopsy will not reveal any cancer. If this is the case, or even if another microfocus is found, treatment should be held up and active surveillance only should be undertaken.
- Myth: lowering my PSA means I lower my risk for prostate cancer.
FACT. For the most part this process simply gives you a false sense of security and may not give any protection from developing prostate cancer.
Although there is a suggestion that 5 alpha reductase inhibitors such as proscar and avodart lower the PSA and may also provide some protective value, it is unclear if the two issues are related. In addition, other researchers contest the possible benefits of using these medicines as a prophylaxis against prostate cancer. As well, there are 3 other classes of drugs that will lower your PSA but not necessarily bring about a lowered risk for prostate cancer, ie STATINS, THIAZIDES and NSAIDS. Checking your %free PSA is important and a rising PSA while on these medications may be significant.
- Myth: a high PSA means prostate cancer
FACT. only about 30% of men with an elevated PSA will have prostate cancer
- Myth: my DRE was normal so I do not have prostate cancer.
FACT. Although the DRE has about a 50% accuracy for detecting a cancer based on induration or a prostatic nodule, the exam still provides useful information as to abnormalities in texture, prostate size and tenderness, especially if the total PSA is normal.
- Myth: an MRI study of your prostate can do away with a prostate biopsy.
FACT. A 3T MRI or any other imaging study such as a CAT scan or ultrasound can NEVER establish a diagnosis of prostate cancer.
Imaging studies may show suspicious areas that can then be targeted for biopsy as well as performing systematic random biopsies of the prostate. This process is fundamentally important as imaging studies often misinterpret benign areas as being cancerous while other areas are interpreted as being normal when in fact they harbor cancer. Furthermore, these imaging studies are unable to accurately predict the grade or Gleason score of the prostate cancer.
- Myth: prostate needle biopsies damage the prostate.
FACT. for the right indications and with the correct pre biopsy patient preparation, there is NO “damage” to the prostate from the 18 gauge spring loaded biopsy needle. There are low incidences of infections and urinary issues. Minor temporary small amounts of blood in the urine , stool, and semen are normal while some men may also have temporary erection issues. These will all resolve.
- Myth: needle biopsies of the prostate can spread the cancer
FACT. there is absolutely NO evidence to support metastatic spread being caused by a prostate needle biopsy.
Furthermore,the 18g spring loaded biopsy needle has already taken it’s sample stored within the trocar before the trocar is even removed from the prostate. In this way, the specimen is never dragged through any other tissue layers.
- Myth: needle biopsies of the prostate cause needle tracking with prostate cancer forming along the needle path or track.
FACT. Prostate cancer needle tracking has never been documented in men with the clinical T1c stage prostate cancer. Currently,this is the most common stage of presentation for men. Rare examples of needle tracking have only ever been recorded in a few men who had bulky locally advanced prostate cancer and were biopsied. This issue did not impact their response to treatment in any way as the tracking was subclinical and microscopic only and never lead to development of any clinically evident prostate nodule or disease.
- Myth: prostate cancer is slow growing and does not need treatment.
FACT. Prostate cancer is the second leading cause of male cancer deaths after lung cancer and therefore needs to be reckoned with. Prostate cancer has a very varied biological behavior from slow growing to very aggressive so each man needs to be individualized. Each man can only be counselled effectively based upon a well performed needle biopsy of his prostate to determine the tumor volumes, the Gleason scores and the regions of the prostate involved.
- Myth: all men will eventually get prostate cancer and die from it.
FACT. This information is based on post mortem studies where the clinical and prognostic significance of these lesions is unknown. Men can only be counselled effectively on the basis of their prostate needle biopsy results.
- Myth: all prostate cancers should be cut out
FACT. The survival benefits for prostate cancer after HIFU, cryoablation, radiation and surgery are similar, underscoring the fact that prostate cancer does not need to be removed surgically.
However, the quality of life (QoL) issues that result from these treatments can be quite different. Surgical options are usually associated with the biggest negative impact on QoL with increased risks for incontinence, impotence, shortened penis and positive margins, usually requiring additional treatments.
- Myth: a treatment option undergoing an FDA trial can’t be good
FACT. revolutionary technologies such as HIFU are performed all over the world but are undergoing FDA trials here in the US.
Confusion over FDA trials has arisen since none of the other prostate cancer treatment options for localized prostate cancer such as cryo, radiation and robotic prostatectomy have ever enjoyed FDA scrutiny with double blind studies and independently validated prostate pathology.
- Myth: recurrences after a therapy such as radiation are best treated with long term androgen deprivation therapy (ADT) such as lupron.
FACT. A rising PSA after any definitive treatment option for localized prostate cancer demands a prostate biopsy to detect a possible recurrence. Depending upon the mans age and co-morbidities, he may be considered for a minimally invasive treatment option such as HIFU or cryo to treat a localized prostate cancer recurrence rather than being placed on long term ADT and the associated problems of metabolic syndrome and bone thinning.
- Myth: it is easy to compare cure rates between treatment options for localized prostate cancer.
FACT. Comparing the data between various prostate cancer treatment studies for cure rates involves a lot of assumptions and is invalid for the following reasons:
1) few if any studies include independently validated prostate pathology.
2) men with prostate cancers of the same clinical stage actually include individuals with very different tumor volumes, Gleason scores, as well as cancers involving very different regions of the prostate.
3) constant evolution and refinement of a particular technology makes comparisons of cure rates with other treatment options, or even with the same but earlier versions of that technology, spurious.