Contributed By Debbe Geiger, Duke Medicine News & Communications

Bob Crutchfield, of Cary, says an annual physical and two conscientious doctors saved his life. It was during his annual exam seven years ago that a routine screening for elevated blood levels of prostate-specific antigen indicated Crutchfield was at risk for prostate cancer. A biopsy confirmed the diagnosis.

“We were sitting at the kitchen table when we received the call,” said Gloria, Crutchfield’s wife of 17 years. “We sat silent for only a minute, but it felt like an eternity. Then I said, ‘We’ll deal with this. We’ll beat this together.’”

After undergoing surgery to remove the cancer, Crutchfield, now 75, is cancer-free. He says the credit goes to his family practitioner and his surgeon at the Duke Prostate Center in Durham.

“I probably wouldn’t be here today if it wasn’t for those two,” Crutchfield added.

What is Prostate Cancer
Prostate cancer occurs in the walnut-sized gland located in front of the rectum and underneath the urinary bladder. It is one of the most common types of cancer in American men. According to the American Cancer Society, more than 200,000 new cases of prostate cancer are diagnosed in the U.S each year.

It is also the second leading cause of cancer death in men with about 30,000 men dying from prostate cancer each year.

While the disease can strike at any age, the older you are, the higher your risk, says Cary Robertson, MD, Crutchfield’s urologist at Duke. “Two out of three prostate cancers are found in men over the age of 65,” he said.

Family history, nationality and race are also risk factors. Prostate cancer occurs more frequently among African-Americans. It is also more common in North America, northwestern Europe, Australia and on Caribbean islands.

Eating right, exercise and avoiding unhealthy lifestyle habits like smoking will go a long way toward improving one’s overall health. But Robertson says, “There’s no definitive conclusions on how much of a role they play in actually preventing prostate cancer.”

Rather, the best defense against the disease is regular screening, early diagnosis and the right treatment. That’s what gives patients like Crutchfield the best odds for becoming survivors.

Diagnosing and Treating Prostate Cancer
The PSA test and digital rectal exam are typically performed during annual physicals and can detect the presence of prostate cancer. Studies show that cancers found through these means are more often treatable.

“Neither test is 100 percent accurate, but there’s no question that they help spot prostate cancers early,” Robertson said. A biopsy will confirm the diagnosis, and imaging in the form of a bone scan, CT or MRI is used to determine the stage of the cancer.

Armed with that information, doctors counsel patients on the treatment that is right for them. In some cases, that may mean taking a wait and see approach, which doctors like Robertson refer to as “active surveillance.”

“If someone has low or moderate risk prostate cancer — and 75 percent of patients do — we may suggest simply watching the cancer to see how fast it grows,” says Robertson. “This lets us delay definitive therapy until it is absolutely necessary.”

Doctors review a patient’s age and health status when considering active surveillance. “If a patient is young, we don’t want to miss treating a cancer at a less aggressive stage,” he said. “But there is a growing awareness that older men, typically over the age of 70, do quite well over time. They may never be threatened by that cancer.”

Duke is currently participating in a clinical trial comparing active surveillance with immediate therapy.

If active surveillance isn’t an option, several treatments are available. Crutchfield opted for surgery during which the entire prostate gland and additional tissue are removed. Radiation therapy kills cancer cells with localized high-energy rays from an external source, much like an X-ray, or internally via the placement of radioactive pellets or “seeds.” During cryosurgery, also called brachytherapy, doctors treat the prostate cancer by freezing it.

When cancer reaches more advanced stages, a new prostate cancer vaccine is offering hope to men for whom other treatments have failed. A new chemotherapy drug is also showing promise in late stages of the disease.

The Future Looks Bright
As the leading cancer researchers and clinicians in the nation, Robertson and his colleagues at Duke are involved in several trials to advance the screening, imaging and treatment of cancer.

One exciting yet still experimental treatment for which Duke was a clinical trial site is called high-intensity focused ultrasound. This technology kills the cancer with lethal heat rays. “It’s too early to say,” said Robertson, “but patients appear to tolerate the therapy well.”

Robertson says advances in imaging are also showing promise. “We’ve recently begun to employ better MRI techniques to evaluate the prostate and detect potential areas of cancer,” he added

The future for detecting and treating prostate cancer is bright, he says, and is likely to get better as imaging improves, as chemotherapy drugs develop and as vaccine strategies mature.

For more information, visit www.dukehealth.org.