Prostate cancer is not just an older man's disease - By Dr. David Samadi

Prostate cancer, the second most common cancer among men in the U.S., has always been known as an older man's disease, but more and more that is changing.

Peter was my patient, and I'm telling his story today in hopes that you, or somebody you know, will understand the importance of diagnostic screenings that can detect prostate cancer early, when its cure rate is virtually perfect.

The average age of diagnosis is about 66, and about six in 10 prostate cancer cases are diagnosed in men age 65 or older, according to the American Cancer Society.

It will kill roughly one in 38 men, making it the second leading cause of death among American men as well.

What many people are unaware of, though, is that prostate cancer is not just an older man's disease. Men younger than 50 — and as young as 40, sometimes younger — can get prostate cancer, too.

Did you know that the number of younger men diagnosed with prostate cancer has increased nearly six-fold in the last 20 years? Today, more than 10% of new prostate cancer diagnoses in the U.S. occur in men younger than 55.

What's more alarming is that for younger men, the disease is often much more aggressive. When prostate cancer affects men in their 60s, 70s and older, it is typically slow-growing.

Older men diagnosed with prostate cancer are more likely to die of other causes, but when it strikes a younger man, it is likely they have developed a tumor that is growing quickly and aggressively.

Peter Latos first came to my office after he was diagnosed with prostate cancer at age 42. His story is heartbreakingly tragic — all the more so, I believe, because it could have been prevented.

Peter actively monitored his health, and he sought to have a PSA test at age 40, only to be told that it was not recommended because he was simply too young.

At one point, he went for a routine stress test and his cardiologist ran a series of blood tests including a PSA test.

Peter's PSA level was about 14 ng/ml, far higher than the 1 to 4 ng/ml that is typical for the average healthy man.

He was referred to a urologist, who initially diagnosed him with prostatitis and treated with a course of antibiotics. That slightly reduced his PSA, but the level was still very high. He should have been given a biopsy at that point, but he never was.

Peter had his PSA level re-tested, about one year later, and by that time, it had shot up to 60 ng/ml. A prostate biopsy confirmed that he had stage 4 prostate cancer, meaning the prostate cancer had already spread to the lymph nodes, his other organs and bones.

Doctors told him that his treatment options included chemotherapy, radiation and hormones, and told him that he had roughly six months to live.

That wasn't good enough for Peter. He came to me to have his prostate removed, and I performed a radical robotic prostatectomy just one week later.

Many doctors may have advised against this, given his advanced disease, but Peter wanted to put up a fight against this disease and I wanted to help him do that. He fought his prostate cancer successfully for five years, but his illness later took a turn for the worse and Peter died on June 29, 2013 at just 47 years old.

(Disclosure: The Peter Latos Prostate Cancer Foundation, established by Peter's family, in his memory, to save lives through early detection, is honoring me next month at its annual gala.)

Peter's story is just one of many examples of young men who are diagnosed with aggressive prostate cancer. Not all of those men will lose their life as a result, but the risk is much higher because of the nature of the disease in younger men. Had Peter been tested just a few years earlier, he may still be alive.

The current PSA guidelines, established by governmental agencies like the U.S. Preventive Services Task Force, discourage doctors or urologists from giving PSA tests until a man is in his 50s. In fact, the USPSTF recommends against PSA screening completely, claiming there is not enough evidence to support the benefits of the test.

Other agencies or organizations recommend that men begin testing their PSA at age 50 or 55. This is simply not good enough.

I'm going to say this, and I want to be crystal clear: The concern expressed in recent years about the potential harm that can be caused by reliance on PSA screening is wrongheaded. Period. Putting our head in the sand — and forsaking the only diagnostic tools we have at our disposal, be it a PSA, colonoscopy or mammogram — will only result in aggressive cancers and needless metastasis.

The PSA is one of the few tumor markers that can help us to detect prostate cancer. There is an art to monitoring the PSA, and it must be done by cancer experts. It is detective work, and any good sleuth will tell you that it's only one of numerous factors to consider when deciding whether to recommend a biopsy.

Furthermore, not every positive biopsy means the patient needs to have surgery or radiation. Further, the outcome after any treatment has as much to do with the experience and skill of the surgeon, so patients need to choose wisely and be sure to get a second opinion.

Surgeons need to step up their own game, too, and make sure they are performing the highest quality procedures with the most up-to-date techniques. Continence and sexual function will both improve with time, and there is excellent quality of life after treatment for prostate cancer. For those who need treatment and don't get it until the cancer has spread, however, the ending can be far different.

I will be working with the Peter Latos Prostate Cancer Foundation this Saturday, May 9, giving free PSA screenings. The event is being held at Cavo, 42-18 31st Ave. in Astoria from 9 a.m. until 1 p.m. To ensure a spot, call my office at (212) 365-5000.

It brings tears to my eyes every time I look at this picture of Peter Latos and me, taken after Peter's prostatectomy. At the time of diagnosis they told him he had less than a year to live but Peter waged a valiant five-year fight.

What I want men to know:

1. Get a baseline PSA test at age 40.

There is no harm in knowing your numbers. PSA results should be discussed with an experienced specialist who can guide you in the right direction, advise you how to follow up and let you know what to be aware of.

2. Know your family's medical history

Men who have a brother or father with a history of prostate cancer are twice as likely to be diagnosed with the disease. For younger men, the risk is even higher if they have multiple relatives with a history of prostate cancer. This should also be discussed with the same experienced specialist who checks your PSA level.

3. African-American men are at greatest risk

African-American men are 60% more likely to develop prostate cancer, and 2.5 times more likely to die from it. African-American men are also diagnosed at a younger age (about 3 years younger, on average) and are more likely to have high-grade or aggressive tumors.

Take note of the trends:

Men should also educate themselves on the PSA trend and the PSA velocity. It's important to track the PSA level and note whether it remains stagnant or continues to rise over time. A Northwestern University research study found that about 70% of men who had rising PSA levels and negative biopsies were eventually diagnosed with prostate cancer.

The PSA velocity is the rate of change, or speed, at which the PSA rises over a number of years. The speed at which the PSA rises is helpful in predicting whether prostate cancer is present. For example, if the PSA doubles within a year, as opposed to remaining stagnant over two years, there is a higher chance that cancer is present.

Prostate cancer truly can be a silent killer. There are usually no symptoms present until the disease is in an advanced stage; that's why early detection is key.

Until recently, men were encouraged to get routine PSA tests to help their doctors detect prostate cancer. Medical guidelines changed, though, and now men are dissuaded from having the test before age 50.

Until recently, men were encouraged to get routine PSA tests to help their doctors detect prostate cancer. Medical guidelines changed, though, and now men are dissuaded from having the test before age 50.

Screening is essential in order to find the disease early. Detecting prostate cancer early allows men to have more treatment options and more effective treatment in general. When prostate cancer is discovered in the early stages, when it is still confined to the prostate gland, the cure rate is almost 100%.

Early detection methods :

• PSA (prostate-specific antigen) blood test: The primary test used to screen for prostate cancer, measures the amount of prostate-specific antigen in the blood. PSA is a protein produced in the prostate, a walnut-sized gland that sits directly beneath the bladder. A high PSA level may indicate prostate cancer, though the test is not specific to prostate cancer. A high PSA may also indicate other prostate conditions, including an enlarged prostate (BPH) or infected prostate (prostatitis).

•Digital rectal exam: Usually done in conjunction with the PSA test. Checks for abnormal growths or tumors on the prostate gland.

•Prostate biopsies:

— Trans-rectal ultrasound: Trans-rectal ultrasound uses high-frequency waves to produce images of the prostate gland, which helps the urologist isolate suspicious areas for tissue collection.

— MRI-guided: A urologist uses MRI to produce images of the prostate gland, which helps him directly target suspicious lesions on the prostate from which tissue samples are collected. MRI-guided prostate biopsies are more accurate in detecting prostate cancer and can help reduce repeat biopsies in patient who have high PSAs and negative biopsies.

•PCA3 urine test: This is a newer test and is to be used as a supplement, not by itself nor as a replacement for the PSA test. The higher the PCA3 level, the likelier it is that prostate cancer is present.

On a mobile device? Watch the video here and Dr. Samadi's interview here.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery, and an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team and the chief medical correspondent for am970 in New York City, where he is heard Sundays at 10 a.m.

Learn more at roboticoncology.com and SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.

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