Video title: Prostate Cancer — Nebraska Medicine [Nebraska Medicine logo appears from a red to a white screen.] [Music plays.] [Text appears on screen: "Cancer"] I think cancer is a really scary word [Speaker on camera: Charles Enke, MD, Radiation Oncologist, wearing a white physician's coat and navy polka-dot tie. He is seated at a desk with two computer monitors visible behind him, one displaying a prostate anatomy diagram.] and sometimes we try to put things in perspective from — yes, this is cancer by definition — but it's not one that we're going to recommend aggressive treatment for. And there are other times that we say, you know, this really is a serious diagnosis that we need to treat aggressively, and it may involve all three different kinds of team members being actively involved. [Text appears on screen: "How common is prostate cancer?"] Prostate cancer is common among men in the United States. In fact, it's the most common non-skin cancer diagnosed in men in the United States. But if you look, there are over three million men who are alive today who've been diagnosed with prostate cancer. Most of those were treated, so it is a cancer that is very treatable. [Text appears on screen: "When is prostate cancer typically diagnosed?"] Prostate cancer tends to develop slowly, and the vast majority of men who have prostate cancer — prostate cancer may be present, undiagnosed and asymptomatic in a man for potentially many years before it gets to the point where it can be detected. But if left untreated, and if it is a prostate cancer that has more aggressive tendencies, certainly it can spread. [Text appears on screen: "How does prostate cancer spread?"] And when we think of prostate cancer spreading, I think of it in three ways. [Text appears on screen: "1. May extend into surrounding areas"] It can continue to grow locally within the prostate until it breaks outside of the prostate and may extend into surrounding tissues, and that could include the bladder — more commonly into glands called the seminal vesicles, which are physically attached to the prostate but they're separate from the prostate. [Text appears on screen: "2. Can spread via lymph nodes"] It can spread via lymphatic vessels into lymph nodes. [Text appears on screen: "3. Via the bloodstream"] The last way that prostate cancer spreads is via the bloodstream, and that tends to occur late in the history of prostate cancer. [Text appears on screen: "At what age is a man most likely to be diagnosed with prostate cancer?"] Prostate cancer is definitely a cancer not of young adult males. About the youngest men that may have a diagnosis of prostate cancer — a very, very small percentage — may be in their early 40s. It certainly becomes more common in men as they proceed through their later forties, more commonly in their 50s, 60s, 70s, and 80s. And so it's not something that tends to just decrease once you get to a certain age. PSA stands for prostatic specific antigen, and it's nothing more than a blood test that can be done for the diagnosis of prostate cancer. And when I say diagnosis, you don't prove that somebody has cancer on the basis of the PSA — but at least it may help identify the man who has a higher PSA number, meaning we think you have a higher risk that you could have prostate cancer, and that could lead to additional evaluation, including perhaps a prostate biopsy, which is really the more definitive way to do that. [Text appears on screen: "Are PSA screenings recommended?"] I think the advice today that is recommended is: discuss the pros and cons of PSA screening with your primary care provider. But because of the fact that prostate cancer really can be a fatal cancer diagnosis — and it can be highly, highly curable when treated at earlier stages — I still recommend that men strongly consider screening for prostate cancer. And the other thing that men tried to avoid, but the other is just still having an examination of the prostate itself. If a doctor feels a lump that is suspicious in the prostate gland, those are rarely prostate cancers that we're going to ignore, and they usually need to be evaluated, staged, and usually those are cancers that require treatment. [Text appears on screen: 1. African-American men should consider starting screening at age 40. 2. Men with a genetic risk, such as BRCA 1 or 2 mutations, should consider starting screening at age 40. 3. Men in general should consider PSA screening at age 45.] So although men get squeamish about it, I still encourage them to do it. So at a minimum, you want to make certain that you're doing a PSA test. [Text appears on screen: "What is a multidisciplinary approach to care?"] I think since we started our multidisciplinary urology clinic — where we have the urologist, radiation oncologist, a medical oncologist — seeing potentially the patient may see all three of those physicians at the same office setting, we've seen a very significant increase in men coming for maybe second opinions, because they essentially can see three doctors if appropriate and get an opinion. Plus, we actually present those patients at a tumor board that is really geared for nothing more than patients with urologic cancers. The purpose there is not necessarily just to try to convince the patient to have their treatment done at Nebraska Medicine, but it really is an opportunity to give patients peace of mind, give another overview — another set or group of eyes looking at their cancer diagnosis and treatment options. And a lot of times a patient may just feel reassured that their original recommendations are consistent with what another group of physician specialists also feel, and it makes them feel that much more comfortable going forward. [Nebraska Medicine logo is shown on a white screen.] [Music plays.]