Combating Prostate Cancer; Men: The Scientific Truth; Scientific American Presents; by Garnick, Fair; 6 Page(s)

The death rate from prostate cancer in the U.S. has declined for several of the last few years, but the disease still claims too many lives. It will strike an estimated 179,300 men this year and prove fatal in 37,000, making it the second leading cancer killer of men, behind lung cancer. For such reasons, we and others continue to seek ever better ways to manage this disorder, which is especially prevalent in those older than 65 years. We cannot claim that the ideal solution for every patient is at hand, but a spate of exciting recent discoveries deserves notice.

Some of the newer findings address a vexing flaw in the sole noninvasive screening test for detecting microscopic prostate cancer, the form most amenable to a cure. The test measures the level in the blood of prostate-specific antigen (PSA), a protein released by prostate cells. Both normal and malignant prostate cells secrete this substance, but when cancer is present, the levels in the circulation often rise. Elevated PSA levels can thus warn that the prostate gland harbors cancer even if the tumor is too minute for a doctor to feel. The other main screening test, the digital rectal exam, can identify only tumors that are no longer microscopic. In that procedure, a doctor inserts a finger into the rectum and, through its wall, feels the prostate for hardness or lumps.