Closing September with a Spotlight on Prostate Cancer Awareness Month
By this time next week, it’s likely we’ll be seeing lots of pink in honor of breast cancer awareness month in October. Our culture has done a great job of highlighting the need for women to attend to their annual mammograms and address their preventive health needs, but the men in our lives could certainly benefit from a heightened awareness of the importance of prostate health.
So says Dr. John Banerji, who joined Penn Highlands Healthcare in January 2019 following a tenure at UPMC after a urological cancer fellowship at Virginia Mason Medical Center in Seattle. Banerji is a leading specialist in the field of urology who notes an interesting trend among the patients in our area when it comes to urological health. “When it comes to cancer … I think a lot of patients here leave decision-making in their doctors’ hands.” That may be because many of Banerji’s patients we hear from trust so heavily in his expertise.
A particular point he’s passionate about is about the debate over the prostate-specific antigen test, which looks for the presence of prostate-specific antigen (PSA) in the blood primarily among men ages 55 to 74 with at least 15 years of life expectancy. PSA is a protein that incrementally increases in men each decade and in elevated amounts can indicate prostate cancer.
However, in 2012, the U.S. Preventive Services Task Force asserted that the PSA test is not safe. Four years later in 2016, Banerji published his clinical research findings in the prestigious Journal of Urology to argue that skipping the PSA test as a widespread approach “might be doing a disservice to men,” he says, adding that because prostate cancer “is asymptomatic, 65 percent of detection occurs thanks to an abnormal PSA test.” This is why preventive care related to men’s health “should be patient-involved and in a setting of shared decision making.” That means patients need to be sure to see their primary care physician annually. “PCPs are the first echelon patients come to,” Banerji says. “It’s our prerogative to keep the primary care provider involved.”
Most male patients should be aware that the best thing that may come from a PSA test is peace of mind. “The most important part patients should understand is that thankfully, a majority of prostate cancer is low-risk and low-grade.” Banerji explains that 65 to 70 percent of prostate cancer patients will have a type of cancer that will not cause problems in their lifetime and most of the time won’t even require treatment. However, those remaining patients will need treatment for aggressive prostate cancer. “Men who are diagnosed with prostate cancer shouldn’t be scared of the cancer word because the majority don’t require treatment, and those who do have good results. Our job is to weed out which are the bad actors,” he says.
As for the symptoms that 30 to 35 percent of patients could experience that may indicate a need to be seen, Banerji lists urgency, frequency of urination, or blood in urine (“Thankfully we don’t see that often anymore,” he notes). He also mentions bone pain or swelling of legs as possible indications of late-presentation of prostate cancer; but, “With the advent of PSA, we don’t see those as frequently—less than five percent,” Banerji says.
He’s careful to acknowledge that the PSA test can be controversial because it isn’t perfect. The PSA protein can be falsely elevated for reasons like a urinary tract infection, stones in the bladder or prostate, or urinary retention. “But irrespective of that,” says Banerji, “still, the PSA is probably the best we have. We do use variants of PSA test like PSA velocity, PSA density, isoforms of PSA and other adjuncts.” The moral of the story? See your PCP and ask about your male wellness.
Banerji sees patients as part of Penn Highlands Urology at Penn Highlands Clearfield, Penn Highlands DuBois, and Penn Highlands Elk. For a referral, contact your PCP. To learn more about urological care and prostate health, visit www.phhealthcare.org/urology.
