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Military Health News

Raising Awareness about Prostate Cancer


By Bernard S. Little

WRNMMC Command Communications

September is National Prostate Cancer Awareness Month, observed each year to increase the public’s knowledge about the most common cancer in men in the United States, after skin cancer. Prostate cancer is also the second leading cause of cancer death in men, after lung cancer, according to the National Institutes of Health’s National Cancer Institute.
One of the leading federal agencies in the battle against prostate cancer is the Department of Defense Center for Prostate Disease Research, located at Walter Reed National Military Medical Center. The CPDR is celebrating 25 years of innovative basic science and clinical research to develop promising detection techniques and treatments for prostate cancer.
“We see men for all prostate-related problems,” said CPDR Director Army Col. (Dr.) Inger Rosner. “A good majority of the active duty population is male, and we serve those on active duty and retirees. [Prostate disease is] something that can affect all men, and I think we improve the quality of life of men [we serve],” she added.
Retired Army Col. Jane Hudak, Ph.D., is a registered nurse and the CPDR patient educator. She explained one in six men will develop prostate cancer during their lifetime. “The risk of being diagnosed with prostate cancer increases to one in five men for African Americans, and one in three men if there is a family history of the disease,” she added.
Hudak stated the exact reasons why men develop prostate cancer remain unknown. “Certain factors may increase the chances of developing the disease, and these factors may be genetics, diet, advancing age or a combination of any of the factors.
“Strategies to prevent prostate cancer have not been proven,” Hudak continued. “Nevertheless, it is generally agreed that eating a healthy diet (limited animal fats and high consumption of fruits, vegetables and grains), exercising regularly, and maintaining a healthy body weight may be helpful in reducing men’s chances of developing this disease.”
Hudak further explained that detection for prostate cancer can include a rectal exam and/or a blood test for PSA or prostate specific antigen. “The PSA test measures the level of PSA, a substance produced by the normal prostate, in the blood. The PSA levels tend to be elevated in most prostate tumors. All men have some PSA in their blood, but an elevated PSA does not necessarily mean that a man has prostate cancer. A prostate biopsy (tissue sample) confirms the presence of prostate cancer.”
According to the American Urological Association, men ages 55 to 69 should be screened annually for prostate cancer. The AUA recommends men younger than 55 or older than 69 who are concerned about their personal risk factors should talk with their physician about their need to be screened. Men who are at risk for prostate cancer (such as men with a family history of the disease, especially if the disease was diagnosed before age 60, and African American men), or men who have any concerns about developing prostate cancer, are encouraged to talk with their physician, regardless of age.
For men who are diagnosed with prostate cancer, the CPDR conducts “a unique and comprehensive, team-focused Multi-Disciplinary Prostate Cancer Clinic,” Hudak said. “This clinic is an all-day forum of physician consultations and educational sessions that provide men and their families with information about their prostate cancer so they can make an informed decision on the best treatment for them. Patients are seen by urologic oncologists, radiation oncologists, an andrologist (a urologist who specializes in male sexual health), social workers/clinical psychologists and nurses to discuss treatment options, management strategies for side effects of the treatments and coping mechanisms to assist with the physical and emotional effects of prostate cancer.
Hudak added that treatment for prostate cancer can take a number of different forms, depending on the patient’s age, stage and grade of cancer and the presence of other clinical conditions. Treatment options for prostate cancer include, but are not limited to active surveillance, surgery and various types of radiation therapy. Hormone therapy may also be used in conjunction with radiation and as a treatment option for more advanced disease found to be outside the prostate. Chemotherapy can also be offered for patients with metastatic disease.
A Survivor’s Perspective
Retired Army Col. Richard E. Talley was diagnosed with prostate cancer in November 2015.
“In July of 2002, while working at the Pentagon, I took my annual flight physical at the clinic there. My PSA result jumped from the previous year at something like 2.0 up to 3.6. [My provider] sent me to the old Walter Reed Army Medical Center where I met then Captain Rosner.  She performed a biopsy which showed normal results, so we went into the ‘watch-and-wait’ mode for several years. My PSA remained in the 3.5 area for the following years,” Talley explained. 
“In 2007 when I retired, I had my annual physical and my PSA bumped up a little,” the retired colonel added. “I saw a urologist at Fort Belvoir, Virginia, and he performed my second biopsy. Results were normal again. This was starting to concern me as it didn’t make any sense that my numbers were jumping around and yet the biopsies were clear. 
“The next year I met with another urologist at Fort Belvoir because my PSA jumped above 5.0,” Talley continued.  She performed a third biopsy and the results continued to be negative. We continued with the “wait and watch” and I began taking the PSA every six months.  At one point, my PSA jumped to something like 14, I think.  I decided to get a second opinion and asked my primary care physician at then-Fort Myer [Virginia] to refer me to Walter Reed Bethesda.
“In 2015, I went there to meet with a urologist and had the best surprise. My ‘new’ urologist was Colonel Rosner. I was really happy and comfortable finding this out as she was the doctor who did the first biopsy 13 years earlier.  She had me take a special MRI [for a biopsy].  She called me three days before Thanksgiving while I was at my parents in Atlanta to let me know that one of the samples came out positive [for prostate disease],” Talley explained.
The retired colonel added that his treatment included brachytherapy, also called seed implant, which is a form of radiotherapy where a sealed radiation source is placed inside or next to the area requiring treatment. He said “nerves” was the most difficult part of his treatment at Walter Reed Bethesda.
“I was really pleased with the first class treatment,” Talley continued. “I had two urologists in there, including Colonel Rosner; two radio-oncologists; two technicians and two anesthesiologists. I felt like a rock star,” he added.
He described his treatment as, “pretty simple. [It] only took me out of work a day.  The staff was absolutely awesome. Army Maj. (Dr.) Jeremy Karlin, my radio-oncologist was the best. He has a fantastic bedside manner; easily approachable; always there for me if I had questions, and he remains so to this day, one and a half years after the procedure.”
Talley offered this bit of advice to other men concerning their prostate health: “Don’t play games with this. I was lucky that I was an aviator and thus had to have a flight physical annually which included labs and PSA testing. Most other men don’t get annual physicals at all; they only see the doctor when they have to. That might be too late. The one thing that I didn’t want to happen is to ignore my numbers and then find out one day that the cancer spread outside of the prostate. Then things go in another direction.”
Another Survivor’s Story
James William Ruest, diagnosed with prostate cancer in November 2016, agrees with Talley that men should stay on top of their prostate health. “If you notice anything out of the ordinary with regard to the urinary process, get with your primary care physician right away and get your PSA checked. Get your PSA checked annually and take appropriate action if it is elevated above your normal reading. There are possibilities for false positives and false negatives, but let the doctors figure that out.  Get your PSA checked on a regular basis.”
Ruest, who served in the Air Force, was also diagnosed at Walter Reed Beth. He said he noticed blood in his urine, which led him to inform his doctor.
“I sort of expected [prostate cancer] but was a little concerned for my future and a little scared,” Ruest said. He added his treatment included hormone treatment followed by radiation. He was also part of an immunotherapy clinical trial.
Ruest described his treatment as “painless.” He added his goal is to “get back to normal or as close to normal as is possible as soon as possible.
“Don't be afraid to take care of this problem, and do it as soon as possible after it is diagnosed,” Ruest furthered. “You may not be everything you were before treatment, but with today's methods and equipment, there will be very little impact on your physical well-being,” he added.
From the White House
“We have good reason to be hopeful about overcoming prostate cancer,” said President Donald Trump in a statement released Sept. 1. “The rate of new prostate cancer cases in the United States has fallen nearly 6 percent on average each year over the past decade. During this same time, the rate of deaths due to prostate cancer has also fallen by more than 3 percent on average each year.  Men diagnosed with prostate cancer are living longer lives than ever thanks to innovative research and improvements in cancer treatment.  Our Nation applauds these ongoing efforts to enhance the lives of Americans and provide comfort and support in the fight against cancer. Nonetheless, in fighting prostate cancer, we are still mindful that it remains the second leading cause of cancer deaths among men,” he added.
“This month, I encourage men to talk with their health-care providers about their risk for prostate cancer,” Trump continued. “I also call upon all Americans to do their part in raising awareness of this disease. We pray for Americans currently fighting prostate cancer and recognize the progress yet to be made in finding its cure,” he concluded.
The Center for Prostate Disease Research is located on the third floor of the America Building at Walter Reed National Military Medical Center. Appointments are available by calling 301-319-2900. A referral is not required. For more information, please contact Jane Hudak at 301-319-2918 or email jane.l.hudak.ctr@mail.mil.