Joey Wahler (Host): It can make the difference between life and death. So, we're discussing prostate cancer screening. Our guest is Dr. Ronney Abaza, who's a urologist. This is Wellness in Reach, a Mount Carmel podcast. Thanks so much for joining us. I am Joey Wahler. Hi there, Doctor. Welcome.

Ronney Abaza, MD: Thanks, Joey. Good to be with you.

Host: Same here. We appreciate the time. So first, when should men begin prostate cancer screening? Because the age for that, the minimum suggested age, has changed in recent years, right?

Ronney Abaza, MD: Yeah. And it's a great question and men should really be aware of this, because I am seeing myself men being diagnosed with prostate cancer younger and younger. And my specialty is robotic surgery. So, most of the surgeries that I do are for prostate cancer, as a urologist who specializes in robotic surgery. And I've operated on men, believe it or not, in their 30s, who have been diagnosed with prostate cancer.

Now, why would somebody start getting screened in their 30s or their 40s? Well, usually, it's because of family history. And so, really, when we make the recommendation to an individual man on when he should start getting screened, we take into account multiple different factors, which include family history; race, because African Americans are at higher risk of prostate cancer.; and the family history is really a critical one because if a man has a first-degree relative, meaning father, brother, for example, who have had prostate cancer, their risk of having prostate cancer in their lifetime doubles. So, we typically will screen those men at a younger age and start screening them at a younger age compared to the general population who don't have any risk factors.

If a man doesn't have any risk factors, then he can start around the age of 50 or 55. Whereas if a man is African American or has a family history of prostate cancer, then we ask them to start getting screened around the age of 45. And if they're really motivated, like again, some of my patient's have been, again, I've had men diagnosed in their 30s, and so they can even get screened even earlier.

Host: And so, obviously crucial-- if you can-- to be aware of your family history or check if you don't know. The screening gold standard is of course a PSA blood test. Remind us, please, Doc, what does PSA stand for and what does that test actually look at?

Ronney Abaza, MD: Yes. And that's really important for men to understand is that the screening for prostate cancer is as simple as a blood test. Now, the most effective screening would also include the digital rectal exam, which is the finger test that men are always mortified by and don't want to do. But at the very least, a man can get their blood test done with their annual lab screening, their cholesterol checks and everything else that they do every year with their primary care doctor. That will catch the vast majority of prostate cancers.

So, in other words, you don't want to throw out the baby with the bath water and say, "Well, because I don't want to get the finger test, then I'm not going to be screened for prostate cancer. I'd rather not know," because you can just get the blood test and most prostate cancers will be caught that way.

 So, PSA stands for prostate specific antigen. It's not specific to prostate cancer. It's not prostate cancer specific antigen. It's prostate specific antigen, and that's where some of the uncertainty comes from with PSA and why some men will have a high PSA and not have prostate cancer, for example. They may just have a large prostate. And there are some men who might have a normal PSA and may have an early prostate cancer. And so, that's why it's so important to get the PSA checked on a regular basis because your PSA may be normal today and you may have an early prostate cancer, but if you're getting it checked on an annual basis, then over the course of the next few years, that PSA will be going up, and we'll be able to detect that cancer while it's still early enough to cure it.

Host: And speaking of which, as I alluded to at the top, how big a difference can that early detection make in a patient's prognosis? Because it can make all the difference, right?

Ronney Abaza, MD: It makes all the difference. Absolutely. So, prostate cancer, like most cancers, is only curable when it's still localized, meaning that it hasn't spread to the rest of the body. Once it's spread to the rest of the body, whether it's to lymph nodes, to the bone, to the liver, to other organs, unfortunately, it's no longer curable. And so, men really can't wait until they have symptoms because the symptoms don't come until it's already spread. And once it's already spread to other parts of the body, again, it's no longer curable. So, we can't wait until then. And that's why it's so important to do the screening so that we can catch it when it's still early and localized, And then, we can cure it with the standard treatments that we have.

Host: Following up on that-- you just touched on it-- typically, early on, there are no signs or symptoms that men can look for, right? Which makes it even more important to get that screening, if need be, early and later on often. Is there any sign that men can look for that maybe something is off?

Ronney Abaza, MD: That's exactly right, Joey. If you wait until you have symptoms, it's too late. And I see a lot of patient's who come to see me who have been diagnosed with prostate cancer, we know they have prostate cancer, and they say, "Doc, I don't understand. I don't have any trouble peeing. I don't wake up at night to go to the bathroom." And I say, "Well, those aren't symptoms of prostate cancer. Those are symptoms of enlarged prostate." And so again, if you're waiting until you start having trouble passing your urine as you get older as a man to get screened for prostate cancer, you're mixing two things that are completely different.

So, prostate cancer, again, in the vast majority of men, has no symptoms whatsoever, doesn't have blood in the urine, doesn't have trouble urinating, waking up at night to go. None of those are symptoms of prostate cancer. If we want to catch prostate cancer at its curable stages, when it's still localized in the prostate, we have to catch it before it's spread. In other words, we want to cure it, then the way to do that is with screening. And the screening again is as simple as a blood test, and there's really no excuse why a man can't get that blood test. You should be able to get that blood test again with your cholesterol check and all of the other tests that your primary care doctor is doing on an annual basis. Just ask your primary care doctor to add that on to your annual test. And that number, over time again, will detect the vast majority of prostate cancers and allow us to catch it at a time when it's still curable, so that those men who end up getting prostate cancer can have it cured and not worry about it spreading and causing symptoms, and eventually, God forbid, dying of the disease.

Host: Yeah, prostate cancer and an enlarged prostate is-- you know, better than anyone and just mentioned, Doc-- oftentimes men unfortunately get those things confused. So, what lifestyle choices could help lower the risk of developing prostate cancer, especially if you are higher risk, which you mentioned earlier?

Ronney Abaza, MD: Yeah. Unfortunately, there's nothing that a man can do in terms of changing his diet or staying away from smoking or alcohol. For example, we all know that smoking causes lung cancer. There's nothing like that that is directly linked to prostate cancer, where a man could say, "Well, I'm just going to change this or that in my diet or do this or that, and I don't have to worry about prostate cancer." No matter how healthy you are, you may be exercising every day and eating right and staying away from smoking and other risks, but unfortunately, you still are at-risk of getting prostate cancer, because the biggest risk of developing prostate cancer is age.

As we get older as men, our risk of prostate cancer is getting higher and higher, and that's why we need to get screened so that we can detect it. Because again, it can happen to anybody. Regardless of their family history, there are men who have prostate cancer who have told me, "Oh, I don't have anyone in my family who's ever had prostate cancer. Why did I get this?" I say, "Unfortunately, it happens." And then, we see men of all different races and backgrounds, healthy men, men who have a lot of other medical problems. It really doesn't make a difference. Prostate cancer can happen to anyone. And so, again, that's why it's so important to screen and why it's so important for men to ask for their doctors to screen them for prostate cancer so that it can be caught early.

Host: And so, to be clear, if you do get the PSA test on an annual basis and there happens to eventually be a PSA number that indicates cancer, if it's only been a year since your previous check, it should still be very treatable, right?

Ronney Abaza, MD: Yes. And that's one of the great things about prostate cancer. If you can say something good about cancer, compared to most other cancers, prostate cancer in general is a relatively slow-growing cancer. Now, yes, there are aggressive forms of prostate cancer that can grow very quickly and become lethal within a much shorter period of time. But the vast majority of prostate cancers have a very wide window of opportunity for cure, which is measured in, believe it or not, years. So from the time that a prostate cancer starts in a man to the time that it eventually spreads and becomes incurable is usually several years. So if a man is getting his PSA check on an annual basis, we will catch it before it has a chance to spread to other parts of the body and the vast majority of situations.

Host: So, it's interesting, it's almost ironic, isn't it, that as you've pointed out, lifestyle changes are not within a man's power to be less at-risk, but getting checked regularly to make sure that it doesn't become a runaway freight train, so to speak, that is within everyone's power.

Ronney Abaza, MD: Exactly. And like I said, there's really no excuse to not get screened for prostate cancer, because it's as simple as a blood test. As I said, if you want to be as thorough as possible, then yes, you would also get the prostate check, the finger check, which, you know, a lot of guys are not happy about. But if you really wanted to be thorough, and especially for example, if you have a family history and you've had several guys in your family who've had prostate cancer and you really want to know whether or not you have prostate cancer, and you really want to be vigilant because you're worried about getting it, then you would do both the blood test and the finger test on an annual basis. But if a guy is nervous about the finger test, doesn't really want to do it, well then, again, don't throw the baby out with the bath water. At the very least, do the blood test because that will catch the vast majority of prostate cancer.

Host: Now, if it is found, what treatment options are available for prostate cancer these days? What are the best ones and how do men know which approach is best for them?

Ronney Abaza, MD: That's a great question, Joey. And before we even talk about treatment, we also want to let men know that not all prostate cancers need to be treated. There are forms of prostate cancer that are so slow-growing and not aggressive and unlikely to spread, that we can do what we call active surveillance.

So, a prostate cancer diagnosis doesn't always mean either a death sentence or having to have some type of treatment, because a lot of these cancers we can just follow. And men can live many, many years and never have to do anything. So especially for an older man who maybe has a lot of medical problems and maybe he's not diagnosed with prostate cancer until he is 75 or 80, well, obviously, we want to be aggressive and subject that man to surgery or radiation. If it's a cancer, that would take 20 years to cause trouble. We can just watch that cancer and, most likely, he'll pass away of natural causes and never even know that he had the cancer, other than the fact that we were watching it and making sure that it didn't progress and get worse.

For those men who have prostate cancers that need to be treated, the two major treatment options are surgery and radiation. So, those are the standard treatments that we use. And there are some newer therapies that we use on a somewhat experimental basis or sometimes used to kind of slow the cancer down rather than definitively treating it and curing it. But the two major treatments are surgery and radiation. So, you're either removing the cancer from the body with surgery or using radiation to kill the cancer in the prostate without removing it. And those two treatments work extremely well. So if prostate cancer is caught at a time that it's still localized, the vast majority of the time, it can be cured with surgery or radiation.

Fortunately, the cure rate for prostate cancer is very, very high, as long as we catch it early. So, it's not like some cancers that, God forbid, if a person gets a really aggressive breast cancer, or a person gets a really aggressive pancreatic cancer, the cure rates can be less than 50%. Well, with prostate cancer, fortunately, the cure rate is above 90% as long as you catch it when it's localized. If you wait until it's spread to other parts of the body, unfortunately, it's not curable at all.

Host: And then, in summary here, doctor, what would you say is the most important step for men to protect or maintain their overall long-term prostate health? Because generally, it's really a matter of doing the things that we all should do just to stay healthy in general, right?

Ronney Abaza, MD: Oh yes, of course. Prostate cancer is only one part of a man's overall health. So although prostate cancer is the leading cause of cancer death right after skin cancer, a lot of men, unfortunately, in the US die of prostate cancer. But fortunately, it's much lower number than something like heart attacks.

So as men, we need to take care of our bodies holistically, not just focus on one thing and forget about everything else. So yes, we need to be screened for prostate cancer on an annual basis, but the most important thing that we can do for our health is really to take care of our hearts, because that's the really the biggest killer, even before any other cancer, is heart disease.

So to prevent heart disease and stroke, we need to stay away from smoking, eat right, exercise, all of the things that everyone should be doing. Those are important to do. And then, we add that extra layer of prostate cancer screening just to make sure that, yes, we're living a healthy life, minimizing our risk of heart disease, stroke, and other kinds of things. But then if we were to develop prostate cancer, that we can catch it when it's curable, and then live out our natural life with a good quality of life as well.

Host: Yeah, it's definitely a message that can't be repeated enough. Folks, we trust you're now more familiar indeed with prostate cancer screening. Dr. Abaza, keep up all your great work and thanks so much again.

Ronney Abaza, MD: My pleasure.

Host: Same here. And a reminder to talk to your doctor about those risks and benefits of prostate cancer screening. Now, to learn more, please visit mountcarmelhealth.com/cancer. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of Wellness in Reach, a Mount Carmel podcast.