WRNMMC, Bethesda, Md.  –   September is Prostate Cancer Awareness Month, and for Military Health System beneficiaries, “Walter Reed offers the full range of state-of-the-art screening, diagnostics, and treatment options,” says U.S. Navy Cmdr. (Dr.) Gregory Chestnut, director of the Center for Prostate Disease Research, located at the medical center.

Chestnut also serves as director of Urologic Oncology at Walter Reed. “Our multi-disciplinary prostate cancer clinic allows for each patient with a prostate cancer diagnosis to meet with our surgery team, radiation oncology team, and clinical trials team, as well as with case managers, social workers, sexual health providers, and patient-volunteers who are walking through their own prostate cancer journey with us. Our advanced prostate cancer patients have access to the best medical oncology treatments available, as well as clinical trial enrollments, if possible,” he added.

Surgically, we offer minimally invasive radio prostatectomy using the DaVinci Xi and SP robots. Our radiation oncology service offers traditional external beam radiation therapy, ultra-hypofractionation, known as ‘cyber-knife’ treatments, and high-dose-rate and low-dose-rate brachytherapy ‘seeds’ for treatment of localized prostate cancer. Our radiology services use the most advanced MRI technology to image the prostate and to guide prostate biopsies. We also use the recently approved PSMA PET scan for evaluation of disease and offer PSMA-directed therapy for certain patients with advanced, metastatic disease,” Chestnut shared.

He emphasized that “prostate cancer can be treated most effectively if it is discovered early and treated in a manner appropriate for the risk category of the disease.” He explained that not all prostate cancer needs to be treated with surgery, medicines, or radiation therapy. “Some prostate cancer can be actively monitored and treated only if more aggressive features are found during surveillance. However, prostate cancer can spread outside the prostate and can be lethal once distance metastasis develops.”

Chestnut added that the good news is across all stages, prostate cancer has a 97 percent five-year relative survival rate because of early screen-detected cancers, which can be effectively treated with several different treatment modalities.

“That fact is that 27 percent of cancers found in American men are prostate cancers, and prostate cancer accounts for 11 percent of cancer deaths among American men,” Chestnut continued. “For this reason, early detection, informed guideline-endorsed treatment and regular follow-up is important for all men at risk for prostate cancer,” he added.

All men are at risk for prostate cancer as they age, Chestnut said. “Certain men are at greater risk of developing prostate cancer. African American men are more likely to get prostate cancer, are commonly diagnosed at a younger age and with more advanced disease and are more than twice as likely to die from prostate cancer than other men. There are genetic risk factors for prostate cancer as well.”

He added that in the United States, 1 in 8 men will be diagnosed with prostate cancer during their lifetime. “That diagnosis rate increases to 1 in 6 for African American men to 1 in 5 for men with a family history of prostate cancer.

Chestnut explained that most prostate cancers do not have an inheritable genetic cause, “but up to 10 percent of screened men have certain inherited mutations, which make prostate cancer diagnosis more likely. If a patient’s father or brother has prostate cancer, particularly at a young age, there is a higher likelihood of that person being diagnosed with prostate cancer. Some studies show up to a two to three times greater risk of prostate cancer if a father or brother has prostate cancer than if they do not.

Increasing numbers of men with prostate cancer in the immediate family further increases this risk. Additionally, any close family member having breast cancer, ovarian cancer, or pancreatic cancer may increase a man’s prostate cancer risk. I urge all patients with a family history of prostate, breast or ovarian cancer to talk with their medical provider to discuss prostate cancer screening early – in their 40s.”

He encourages men to talk to relatives about prostate cancer, which may be uncomfortable but can identify family history risk features.

“Diets high in processed meats, such as ham, bacon, sausages, and hot dogs have been shown to increase risk for prostate and other cancers,” Chestnut added. “Plant-based diets, and diets rich in fruits, vegetables and fiber can help protect against diet-related cancer risks,” he said.

Chestnut explained that most men are diagnosed with prostate cancer without having any signs of the disease other than an elevated PSA blood test or an abnormal digital rectal exam. “To make matters more confusing to patients, there are common signs of benign prostatic hyperplasia (BPH), or enlarged prostate, which can be common in men as they age. These symptoms can be many of the same ones present with prostate cancer. I urge all men to seek medical advice if they have trouble starting or maintaining their urine stream; if their urinary stream is weak; if they experience frequent urination, especially at night; if they have trouble completely emptying their bladders; if there is any pain or burning during urination; or if there is any blood in the urine or semen. It’s important to note that these symptoms can exist in the absence of cancer as well and that a simple medical exam can help determine the cause.”

He added that, in some cases, if prostate cancer has grown without diagnosis or treatment and metastasized, men may have new bone pain, weight loss without trying to lose weight, numbness or weakness in their lower extremities, or changes in bowel habits.

The American Urological Association recommends men begin PSA screening at age 55 for those at average risk of prostate cancer. “However, men at higher risk for prostate cancer, including African American men and any man with a family history of prostate cancer, breast cancer, ovarian cancer, and pancreatic cancer, earlier screening is recommended,” Chestnut added.

“For these men, I recommend a ‘mid-life PSA’ at age 40 and discussing the role of more regular screenings to begin in their 40s. Screening typically consists of a blood test for prostate-specific antigen, or PSA, and a digital rectal examination to feel the prostate. If the PSA is elevated or if the rectal examination is concerning, other tests to determine prostate cancer risk are often conducted. These may include other blood or urine tests, MRI imaging, and prostate biopsy,” Chestnut added.

In his proclamation for National Prostate Cancer Awareness Month 2023, President Joe Biden states, “This year alone, more than 280,000 Americans will be diagnosed with prostate cancer. During National Prostate Cancer Awareness Month, we honor the lives ended too soon, and all those we can still save by redoubling our efforts to end cancer as we know it.”

“We are also working to make sure prevention, detection, and treatment procedures are available to patients of all communities and backgrounds,” the president added. “And we know that screening matters. To all those caring for loved ones with prostate cancer and all those facing it themselves, we stand with you.”