By Dr. George Privett
Take your time; know your options; get several opinions
I am a physician who is living with prostate “cancer.” Since September is Prostate Cancer Awareness Month, I thought it might be of interest to share my knowledge and experience with other men and their families.
Prostate “cancer” is a very common disease of men; in fact if a man lives long enough he will likely have it and not even know it. I use the term “cancer” in quotes because in over 90% of cases, men who have an elevated screening PSA and a prostate biopsy showing low grade “cancer” (Gleason Grade 6) will have non-malignant disease that needs no treatment and certainly does not need immediate life altering surgery, or radiation. (I used active surveillance 10 years until my PSA got to 36 before having radiation treatments.)
Traditional prostate biopsies involve blindly inserting 12 to 15 random biopsy needles into the prostate through the rectum. Prostate biopsy has the risks of serious infections, bleeding and even death.
A new plan of attack for evaluating an elevated PSA is the use of 3 Tesla Multi-parametric MRI of the prostate. This can determine if there is a tumor, where it is, its size and the likelihood of its being malignant. If an area is identified that looks suspicious, then a more targeted biopsy can be performed and a rational treatment plan designed. If no tumor is identified in the MRI or if a biopsy suggests low or medium grade tumor, then watchful waiting or active surveillance can be the best choice and will completely avoid any complications.
If high grade tumor or cancer is detected, the more definitive treatments of external radiation and/or radioactive seeds are good options, with or without hormone treatment or chemotherapy. Research shows that there is no difference in outcomes comparing Radiation and Surgery; and Radiation has fewer side effects. For low grade disease, watchful waiting or active surveillance is recommended and has no side effects.
A source of information I found helpful is the Prostate Cancer Research Institute (PCRI), whose founder and CEO is Mark Scholz, MD. Dr. Scholz is a Medical Oncologist in the Los Angeles area, specializing in Prostate Cancer diagnosis and treatment. His book co-written with Ralph Blum, “Invasion of the Prostate Snatchers” was most informative to me.
Dr. George Privett received his medical degree from Baylor University College of Medicine. He later moved to Kentucky where he completed an internship and residency in Internal Medicine and Neurology at the University of Kentucky Chandler Medical Center. Dr. Privett served as Chief of Neurology at Womac Army Hospital in Fort Bragg, North Carolina. He is a member of American Academy of Neurology, American Society of Neuroimaging, American Medical Association, Kentucky Medical Association and Lexington Medical Society. He practiced Clinical Neurology and Neuroimaging from 1974-1998 and currently practices Neuroimaging and is the Medical Director and owner of Lexington Diagnostic Center & OPEN MRI.
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