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FirstHealth of the Carolinas
The cancers of men By Dick Broom

But if the test shows that the level of PSA (prostate specific antigen) in your blood is high, don’t panic. Chances are better than two to one that you don’t have cancer.

Given those odds, you might well ask, “If the test is so unreliable, what’s the point of having it?”

The answer is that, as imperfect as it is, the PSA test is the best we’ve got. And it definitely does lead to the diagnosis of prostate cancers that wouldn’t otherwise be detected until it’s too late.

“Because of the PSA test, prostate cancer is commonly found much sooner, so people who have it are much more likely to get successful treatment,” says Greg Griewe, M.D., a urologist with Pinehurst Surgical.

A high PSA level—unless it is extremely high—simply tells your doctor to keep an eye on it.

“I always check it again, and the second test is often normal,” says Robert Chamberlain, M.D., also a Pinehurst Surgical urologist. “Then I’ll do the test again in three to six months. Low-grade prostate infections, urinary infections and various other things can change the PSA.”

Another method of checking for prostate cancer is the digital rectal exam. If the physician feels a bump or nodule on the prostate, there is a possibility that it is cancer. Like PSA tests, digital rectal exams should be done once a year.

A killer of men
Prostate cancer is one of the leading killers of men. Out of every 100,000 male deaths in North Carolina, 25 white men and 67 minority men die of prostate cancer.

“African-American men tend to come in with a more aggressive disease and in a more advanced stage,” Dr. Chamberlain says. “So they need to start having annual digital rectal exams and PSA tests at age 40, especially if they have a family history of prostate cancer.”

If cancer is suspected, either because of a bump on the prostate or a high PSA level, the next step is usually a biopsy. The urologist will make a tiny incision and remove small samples of tissue from the prostate for laboratory analysis.

The most common treatments for prostate cancer are radiation therapy and removal of the prostate, either by traditional surgery or a relatively new minimally invasive procedure. (See the accompanying story.)

Bernard Stanfield, M.D., another Pinehurst Surgical urologist, has begun treating selected patients with cryotherapy, which uses extreme cold to kill the cancer.

It isn’t known what causes prostate cancer. It is one of the few cancers for which smoking isn’t a prime suspect.

Testicular cancer
Cancer of the testicles is another male cancer whose cause is unknown. It is rare, striking only about eight of every 100,000 men. It can develop at any age, but is most common in younger men.

“Just as women are supposed to do monthly breast self-exams, guys in their mid- to late teens should do monthly testicular self-exams to feel for lumps,” Dr. Griewe says.

The treatment for testicular cancer is removal of the testicle, often followed by radiation therapy and, sometimes, chemotherapy.

Urologists who use the da Vinci Surgical System (as shown at FirstHealth Moore Regional Hospital) predict that it will be the standard of care for prostate surgery within a few years.
da Vinci Prostate Surgery

The urologists who use a robot system to perform prostate surgery at FirstHealth Moore Regional Hospital predict that it will be the standard of care nationwide within the next couple of years.

More and more urologists around the country are using the robot, called the da Vinci Surgical System, which allows them to perform a minimally invasive procedure through a few tiny incisions instead of one large incision.

The benefits for most patients include less blood loss and a shorter hospital stay.

“Patients are generally going home from the hospital sooner and recovering more quickly and with less pain,” says Greg Griewe, M.D., one of the Pinehurst Surgical urologists who use the da Vinci system.

With traditional prostate surgery, many patients experience urinary incontinence for many months following the operation. Patients who have the da Vinci procedure generally regain their bladder control much faster.

Another disadvantage of large-incision prostate surgery is the high risk for nerve damage that results in sexual dysfunction. That risk is smaller with robot-assisted surgery, according to Robert Chamberlain, M.D., the other Pinehurst Surgical urologist who uses the da Vinci system.

“We have found that both sexual potency and continence are significantly better than with open surgery, and all the national studies support that,” he says. “I see guys who I thought would not retain their potency, and they do.”

The da Vinci system’s robot has two arms with tiny surgical instruments on the ends and one arm with a camera that relays three-dimensional video images to a monitor in front of the surgeon. The surgeon uses hand and foot controls to manipulate the instruments. The 3-D imaging allows surgeons to see much more and to operate with greater precision.

“It’s like you’re a little man standing on top of the prostate while you’re operating,” Dr. Griewe says.

Moore Regional was among the first 200 hospitals in the country to acquire a da Vinci Surgical System. Now other hospitals are scrambling to catch up.

“If you have prostate cancer and you choose to have your prostate surgically removed, this is definitely the way to go for most men,” Dr. Chamberlain says. “In another year or two, I can’t imagine anybody will be having their prostate taken out any other way.”

For more information on da Vinci robotic surgery, call toll-free (800) 213-3284.

Brachytherapy treatment

Physicians at FirstHealth Moore Regional Hospital were the first in North Carolina to routinely use a type of radiation therapy called “high dose rate brachytherapy” to treat prostate cancer. Thin wires with radioactive tips are run through catheters to the target tumor. After a few minutes, the wires are pulled back out. Because the radiation source remains inside the patient for such a short time, a more concentrated dose can be given.

“We can very precisely control the shape and intensity of the dose and, thereby, minimize the effects on the normal tissues nearby,” says Stephen King, M.D., medical director of Radiation Oncology at Moore Regional. “Studies have shown that high dose rate brachytherapy is particularly beneficial for men with more advanced or aggressive prostate cancer.”

For men with early stage prostate cancer, both surgery and high dose rate brachytherapy have a five-year cure rate of about 90 percent. The major risks with both treatments are urinary incontinence and impotence.

Men and breast cancer

Joel Shriberg, breast cancer survivor

It sounded like a practical joke, but the surgeon wasn’t kidding when he told Joel Shriberg, a member of the FirstHealth Moore Regional Hospital Board of Trustees, that he needed to have a mammogram.

That was two and a half years ago, when Shriberg was 64.

For two or three months, he had felt an occasional itch on the side of his chest under his left arm. A friend of his, an orthopaedic surgeon from Boston who had come to Pinehurst to play golf, had noticed him scratching. After feeling under the arm, the friend urged Shriberg to see a general surgeon, who immediately suspected cancer. A mammogram and ultrasound showed that Shriberg probably did have breast cancer, and a biopsy confirmed the diagnosis.

After the tumor was removed, Shriberg had both chemotherapy and radiation therapy to make sure all the malignancy was gone. He says he has felt great ever since.

About 1 percent of diagnosed breast cancers are in men.

“Breast cancer is thought to be an estrogen- driven disease, and since men have very little estrogen, male breast cancer is really a rarity,” says Dennis Devereux, M.D., a general surgeon in Troy.

Dr. Devereux says he has operated on fewer than a dozen men for breast cancer in more than 30 years of practice. Most men have much less breast tissue than most women, and men’s breasts don’t have milk-producing glands and ducts. Otherwise, the structure of the tissue is the same, and the type of cancer that can affect that tissue is the same. “It can spread to lymph nodes and to other organs the same way,” Dr. Devereux says.

Breast cancer is usually not diagnosed as early in men as in women. That is because men don’t have mammograms to screen for cancer, so the disease usually isn’t discovered until the man feels a lump. By then, there is a greater chance that the cancer has spread to nearby lymph nodes and perhaps farther.

Shriberg calls his encounter with breast cancer “about as good as a bad experience could be.”

“I am absolutely astounded at the quality of care we have here and the amount of concern shown by the doctors, nurses and volunteers,” he says. “For a community this size to have a hospital of this quality and with such a strong culture of caring is just fabulous.”

Now, in addition to serving on the hospital board, Shriberg volunteers at the FirstHealth Outpatient Cancer Center, where patients receive chemotherapy.

“It’s nice to be able to share with somebody and help alleviate their fears,” he says.