Colon cancer, also called colorectal cancer, this is a cancer that  begins in the colon (large intestine) or the rectum. Colorectal cancer is the third most common cancer in the United States and the second leading cause of cancer-related deaths. Most colorectal cancers start as abnormal growths in the lining of the colon or rectum called polyps. Over time, some polyps can turn into cancer.

“Colorectal cancer is a largely a preventable type of cancer,” says Brennan Scott, M.D., Chair of Gastroenterology at the Palo Alto Medical Foundation. “We have tests that detect many different types of cancer, but colon cancer can be prevented by doing a screening test to find polyps and removing them before they have a chance to become cancerous.”

According to the Centers for Disease Control and Prevention (CDC), at least 60 percent of deaths from colorectal cancer could be avoided by regular screening tests. At PAMF, the odds may be even better. New outcomes studies show that Dr. Scott and his team have surpassed national benchmarks for early tumor detection.

In this blog post, Dr. Scott answers common questions about colorectal cancer and explains how you can reduce your risk.

Who is at risk?

Colorectal cancer is most common in people over the age of 50 and the risk increases with age. Because of this, regular screening tests are recommended for average-risk people starting at age 50. People with a personal or family history of colorectal cancer or polyps, inflammatory bowel disease, or certain inherited genetic mutations may be at higher risk and should begin screening earlier. If you fit this description, talk to your doctor about when and how often to be tested, and what type of test is best for you.

What are the symptoms of colorectal cancer?

Precancerous polyps and the early stages of colorectal cancer often have no symptoms at all. This is why screening tests are so important. Signs and symptoms of later-stage colorectal cancer include:

• Altered bowel habits – including a change in stool consistency or frequency
• Blood in the stool
• Unexplained abdominal pain
• Unexplained weight loss
• Loss of appetite
• Anemia

What are the most common screening tests and how do they differ?

There are two general categories of screening tests: preventive tests that find both polyps and cancer and detection tests that primarily find cancer that has already formed.

Preventive tests include:

• Colonoscopy: The doctor uses a thin, flexible tube with a camera to examine the entire colon and remove any polyps that are detected. The procedure (which takes about 30 minutes) is usually performed under moderate sedation. Because colon must be empty so the doctor can see well, patients must “prep” by drinking a laxative before the test. The prep is generally considered the most unpleasant part of the test. However, if no polyps are found, colonoscopy typically needs to be performed only once every ten years.

• Sigmoidoscopy: Similar to a colonoscopy, but the doctor examines the only rectum and the lower third of the colon. Some bowel prep is required, and sedation is not routinely needed. It is used in conjunction with stool blood testing.

• CT Colonography: Also called a virtual colonoscopy, this a special type of CT scan. This test can detect larger polyps as well as cancer, although it may not detect smaller polyps. It is non-invasive, but a bowel prep must be still performed before the test, and the patient is exposed to some radiation.

Detection tests include:

• Stool Blood Tests: These tests look for tiny amounts of blood shed by colon tumors or large precancerous polyps. There are two types, one that uses a chemical to detect blood (FOBT or fecal occult blood test), and one that uses antibodies (FIT or fecal immunochemical test).  Both tests work on stool samples taken at home, and no prep is required. However, they need to be repeated yearly, and can miss many polyps and some cancers.

• Stool DNA Test. This test looks for genetic material shed by cancer or polyp cells. It should be repeated every three years, and also can miss many polyps and some cancers.

How do I know which screening test is right for me?

A colonoscopy is the only test that can detect and remove the abnormal growths and has been proven to prevent colon cancer. However, if you have concerns, your gastroenterologist may individualize a screening program for you that may combine several testing methods. If any of those tests indicate the presence of polyps or cancer, your doctor will schedule a colonoscopy.

Is there anything I can do to reduce my risk of colorectal cancer?

The most effective way to reduce your risk is by having regular screening tests. However, certain lifestyle factors may also help decrease your risk, such as:

• Be physically active
• Maintain a healthy weight
• Eat a diet that is high in fiber and low in fat, especially animal fat
• Avoid tobacco and limit alcohol consumption.

The CDC estimates that as many as one-third of adults age 50 or older have not been screened as recommended. Colon cancer is a cancer you can prevent. Talk to your doctor today about high quality colonoscopy screening at PAMF.

 Brennan Scott, M.D., is Chair of Gastroenterology at the Palo Alto Medical Foundation.  

Whether or not a person develops cancer during his or her lifetime is influenced by a number of factors, including genetics, the environment, lifestyle and aging. While some of these factors are easier to control than others, understanding your personal risk can help you take preventative action, whether that means talking to your doctor about genetic testing, or simply making healthful changes to your diet. In this blog post, Frank dela Rama, R.N., MSN, AOCNS, AGN-BC, a board-certified advanced genetic nurse in the Palo Alto Medical Foundation’s Cancer Genetics Program, explains how these factors can cause cancer, and what you can do to reduce your risk. 

Genetic risk factors for cancer  
Our genes make us who we are. Genes are sequences of DNA that tell each of our cells what to do by providing the instructions to make specific proteins. Mutations in genes that are inherited from our parents can predispose people to cancer.

Diseases related to just one gene are rare. Normally, it takes changes in both copies of a gene to affect the way the gene is supposed to function. People with a mutation, or DNA change, in one copy of one of these genes have a higher risk of getting cancer because they are starting with only one healthy copy of the gene.

Some of the most well-known inherited mutations that predispose a person to cancer involve the BRCA1 and BRCA2 genes. The lifetime breast cancer risk for a carrier of a BRCA mutation is between 45 and 65 percent. In the general population, the lifetime breast cancer rate is 12 percent. Other inherited genetic mutations have been linked to elevated risks of specific cancers as well.

Inherited gene mutations play a major role in 5 to 10 percent of all cancers.

Other risk factors
The process of living exposes us to many factors that can damage our cellular DNA. When the damage affects the production of proteins that regulate cell growth and division, or repair damaged DNA, cancer can occur. The affected cells essentially “lose the brakes” – without these proteins, damaged cells survive and keep dividing, resulting in the rapid, uncontrolled cell growth of cancer. Moreover, because these mutated cells are more fragile than healthy cells, pieces of them are prone to breaking off and traveling elsewhere in the body, causing metastasis, or the spread of the cancer. Some of the other factors that can harm our DNA and increase the risk of cancer include:

• Environment: DNA changes can result from exposure to environmental factors like tobacco smoke and ultraviolet radiation.
• Diet: Your diet can affect your cancer risk. Numerous foods, including red and processed meats, have been linked to the development of certain cancers. Vegetables, especially colorful ones, are high in dietary fiber and antioxidants which helps prevent cancer.
• Alcohol: Drinking alcohol can raise your cancer risk. The risk increases with the amount of alcohol you consume.
• Exercise: Exercise is important too. According to the American Cancer Society, maintaining a healthy weight is one of the most important ways to protect yourself from cancer.
• Aging: Aging is the most significant risk factor for developing cancer. Aging is accompanied by numerous biologic changes, including the shortening of our telomeres. Telomeres are segments of DNA at each end of our chromosomes that help protect us from random changes in our DNA. Each time a cell divides, the telomeres get shorter, a process linked to aging and cancer.

What steps can I take to reduce my cancer risk?   
If you have family history of cancer, or a known genetic mutation linked to cancer, genetic counseling and testing can help assess your risk. Then, based upon results (positive or negative for mutations), you and your doctor can tailor a cancer prevention plan. To learn more about genetic testing and find out if it’s right for you, see Genetic Research and Cancer – A Promising Future.

And remember, there are simple things everyone can do to get and stay healthy and lower their risk of cancer, including eating the right foods, getting enough exercise, avoiding tobacco and limiting exposure to the sun’s harmful ultraviolet rays.

In honor of Breast Cancer Awareness Month, throughout October we’ll be posting a series of stories about breast cancer prevention, treatment and survivors.

Angelina Jolie surprised the world when she had a preventative double mastectomy. Yet she had strong reasons to do so. She inherited the rare BRCA1 gene, which her doctors estimated gave her an 87 percent chance of developing breast cancer. By having surgery, she minimized her risk of developing the disease.

While this course of action is relatively new in the fight against breast cancer, it’s not the only one changing the way experts treat and prevent the disease. Doctors at Sutter Health affiliates Palo Alto Medical Foundation and Mills-Peninsula Health Services say key developments in recent years are reshaping the course of treatment for women who have breast cancer, or who are at risk for breast cancer.

“The whole way in which we manage, treat and take care of breast cancer patients today is hugely different,” says Harriet Borofsky, M.D., medical director of the Mills-Peninsula Women’s Center. Here are some of the latest advances in breast cancer care.

Shorter Radiation Treatments

For some women – typically those with early stage breast cancer that hasn’t spread – high-dose, short-term radiation can shorten the course of therapy.

• Hypofractionated radiation therapy gives higher doses every day for three to four weeks, instead of lower doses over six weeks.
• Brachytherapy inserts radioactive seeds in a woman’s breast, changing them twice a day for five days. It takes just 10 treatments.
• Intraoperative radiation therapy (IORT) radiates breast tissue at the time of surgery. After a lumpectomy, radiation is inserted into the cavity during surgery, completing all the treatment at once.
  

  Pauling Chang, M.D.

While these advances in radiation therapy sound like improvements, PAMF radiation oncologist Pauling Chang, M.D., warns that doctors need long-term data before they are sure these new radiation therapies work as well as standard, lower-dose external beam radiation.

“We still need large-scale, randomized studies with long-term follow-up,” he says. But some day, he hopes, “this will become the standard of care for women with breast cancer, so treatment times can be much shorter, with fewer side effects.”

Genomic Testing of Early Stage Breast Tumors

Two tests – Oncotype DX and MammaPrint – can examine a breast tumor’s genetic structure to help determine if chemotherapy will work well, and whether the cancer will likely come back after treatment. The tests can spare some women from having to undergo difficult chemotherapy that wouldn’t benefit them.

Today, genomic tests help women with very early and limited forms of breast cancer: estrogen-positive tumors that have not spread to lymph nodes, and DCIS (ductal carcinoma in situ), which is the earliest, noninvasive form of breast cancer.

But the field of personalized medicine – treatment based on your own genetic profile – is growing rapidly. Eventually, genomic tests may help shape the best treatment for many women with breast cancer.

Chemoprevention for Women at Risk

About 35 years ago, the drug tamoxifen was approved to treat women with the type of breast cancer fueled by the female hormone estrogen. Today, women who are at high risk of developing estrogen-positive breast cancer can take tamoxifen or a similar drug, raloxifene, to help prevent disease.

Both of these drugs block estrogen’s effect in the breast and in other tissue. Other drugs are being studied for chemoprevention.

“As we better understand the role of genetics and family history, it’s important to offer women at risk a way to lower their risk,” Dr. Borofsky says.

Still, about 80 percent of women who are diagnosed with breast cancer have no family history of the disease, she says. So the best protection for women remains early detection.

Early Detection Is Still the Key

Today, about 90 percent of women who discover breast cancer on mammograms catch it so early that the cancer has not spread to lymph nodes, Dr. Borofsky says.  And early detection leads to “better treatment options and outcomes,” she says, helping reshape the fight against breast cancer.

Karen Harrington, M.D., and her husband Stephen

Karen Harrington, M.D., a family medicine doctor at the Palo Alto Medical Foundation’s Aptos Office, knows first-hand that anyone can receive a breast cancer diagnosis.

“I never thought I’d be the one to get cancer,” says Dr. Harrington. “I exercise regularly, eat well, live in the Santa Cruz mountains and I got breast cancer.”

Watch her story in this video:

Apart from skin cancers, breast cancer is the most common cancer among women in the United States. It is also the second leading cause of cancer death, after lung cancer.

Knowing Your Risk

Breast cancer is caused by changes in our DNA that make healthy breast cells become cancerous. Although we know that there are many factors that can increase your risk for getting breast cancer, it’s currently unknown how each risk factor effects cells and causes them to become cancerous.

There are some factors that can increase your risk of getting breast cancer, including:

• Having a mother, sister or daughter who had breast cancer
• Inherited gene defects such as the Breast Cancer (BRACA) 1 and 2 genes
• Prior biopsies showing precancerous findings
• Dense breast tissue, as shown on a mammogram
• Being overweight or obese after menopause
• Heavy alcohol consumption
• Hormone replacement treatment for longer than five years

Taking Preventative Action

“The highest risk factors for developing breast cancer are being a woman and aging,” says Dr. Harrington. “While all breast cancers cannot be prevented, I advise women to get screened regularly. If you have a family history or are high-risk, you should talk to your doctor to see if you need additional screening or need to start screening early.”

Currently the U.S. Preventive Services Task Force does not recommend routine annual mammograms for women over 40 but advises all women of that age to discuss screenings yearly with their doctor. Learn more in PAMF’s Health Maintenance Guidelines.

“The best day on my cancer journey was when I had my six-month check up with my surgeon. I didn’t realize how nervous I’d be as he examined me to look for any recurrence of my cancer,” says Dr. Harrington. “When he told me that I was cancer-free, we went out and celebrated with a hike in the Santa Cruz mountains.”

Edna Shochat

In honor of Breast Cancer Awareness Month, throughout October we’ll be posting a series of stories about breast cancer prevention, treatment and survivors.

When Edna Shochat discovered a lump in her breast in 2010, she was about to go on a long-anticipated trip to Israel with her husband. She had already postponed this special trip for a full year to recover from a serious break to her leg and the resulting surgery.

“It was a painful dilemma,” says Shochat, a vibrant 71 year old. “I agonized over whether I should change my plans and give up what might be our last perfect vacation.”

She decided to keep her discovery secret and went ahead with the month-long trip.

“Everyone was so pleased to see how my broken leg had healed and kept telling me how well I looked,” says Shochat. “They didn’t know that I could barely sleep, worrying about the lump. I was counting down the days, trying to hold on to each hour and keep my ‘vacation from reality’ from coming to an end.”

Going Through Treatment

Once home, Shochat underwent an ultrasound-guided needle biopsy at the Palo Alto Medical Foundation‘s (PAMF) Breast Imaging Center. The biopsy showed she had cancer in both breasts.

Genetic testing, part of PAMF’s Cancer Care Program, revealed that Shochat carries the Breast Cancer Gene 1, which indicates that she is at a higher risk of developing ovarian cancer as well as breast cancer.

So, in January, 2011, Shochat had a double mastectomy. She also had her ovaries and fallopian tubes removed. The surgery lasted more than six hours and was performed by three PAMF surgeons. Under the care of the Oncology Department she then underwent eight chemotherapy sessions at PAMF’s Infusion Center.

“I give so much credit to the doctors and staff at PAMF for helping me through my cancer journey,” says Shochat. “The most valuable support came from my nurse educator, Jennifer Glover, R.N., who, from diagnosis on, helped me prepare for and navigate through the battle to reclaim my life.”

Coping with Humor 

“As soon as I woke up from surgery and saw the worried faces of my husband and children, I knew I had to reassure them,” says Shochat. “I said faintly, ‘I think I’m beginning to experience Empty Breasts Syndrome.’ As soon as they heard those words, they smiled and looked relieved.”

Shochat ‘s pastel “Two Sisters” is displayed at Deborah’s Palm, a non-profit women’s center in Palo Alto.

Shochat, who enjoyed a successful career as a graphic designer, coupled her playful sense of humor with photography and writing to document her cancer journey. (One of her poems is below.)

At a Breast Cancer Connections workshop, she designed a fashion line called “My Cup ‘o’ Tees: T-shirts for women who may have lost (one or two) precious body parts but not their sense of style,” and displayed them at the closing event.

Shochat is now cancer-free and enjoying immersing herself in all the things she loves, from art and poetry to “babysitting” her teenage grandsons.

“Several of my friends wondered how I could keep in such high spirits during my cancer diagnosis and treatment,” says Shochat. “One of them even suggested I should give lessons on how to go through breast cancer. My response was, ‘May the day arrive when there are no women eligible to sign up for that class.’

Closure

By Edna Shochat

Today I clean out the closet.

Close the final chapter in my “Book of Boobs,”

End the saga “Breasts, Interrupted.”

The last remaining brassieres in my chest of drawers,

still in perfect shape, head to Goodwill.

May the lovely cups find a good home,

and a new B-size pair to have and to hold.

An estimated 1,660,290 new cases of cancer will be diagnosed in 2013. You can prevent many of these cancers, and many others are much easier to treat if detected early.

Just consider these 2013 predictions from the American Cancer Society:

• 2 million new cases of skin cancer will be diagnosed by year end. Many could have been prevented with simple sunscreen.
• 174,100 Americans will die from cancers caused by cigarettes, cigars and chewing tobacco.

Overall, the World Cancer Research Fund estimates that 25 percent to 33 percent of all cancers in the United States are related to being overweight, inactive or having poor nutrition.

At the same time, cancer treatment is more effective than ever before – the 5-year survival rate is about 68 percent for all cancers combined, compared to 49 percent in 1979.

Learn More at the Celebration of Life Event Oct. 5 in Capitola:

The key to cancer prevention and successful treatment is to become well informed. Get started by attending Celebration of Life: Cancer Prevention and Survivorship, a free program dedicated to increasing awareness about cancer, prevention and survivorship on Saturday, October 5 in Capitola. The event is open to the community, cancer patients, survivors and families.

The program will be held from 9 a.m. to 1 p.m. at the Mid-County Senior Center, 829 Bay Ave., in Capitola. It’s sponsored by Palo Alto Medical Foundation (PAMF) and the Sutter Maternity & Surgery Center in Santa Cruz.

For men, PAMF urologist Steven Roberts, M.D., will go over the pros and cons of PSA testing in his talk Prostate Cancer: To Screen or Not to Screen at 9 a.m. Dr. Roberts will share new information to help you make your decision, and will discuss how to approach treatment rationally.

For women, PAMF surgeon Isaac Chankai, M.D., will discuss breast health and overall concerns, as well as treatment for breast cancer in his talk Breast Health for Life at 10 a.m.

Acupuncturist Katayoon Hakim from the Hakim Acupuncture & Herbal Clinic will discuss how this ancient eastern practice can ease the side effects of cancer treatment in her talk The Benefits of Acupuncture at 11 a.m.

Lastly, at 11:30 a.m., chef David Wells will present Fresh Foods and Simple Culinary Principles. Learn how to make easy and delicious meals from healthy foods in this live cooking demonstration. Wells is a personal chef to celebrities and an instructor at the California Culinary Academy.

Plus, many local support organizations and resources will be there to answer your questions.

“The technology allows us to track the patient’s position in real time – so we can be sure we’re hitting the target every single time,” said Pauling Chang, M.D., a radiation oncologist at the Palo Alto Medical Foundation. Another benefit for patients, Dr. Chang says, is the convenience of one-day treatment. “I had a patient who had radiosurgery in the morning, and was able to attend a dinner party that same night.”

PAMF is an early adopter of innovative technology – and was the first health care organization in the world to offer this new, precise, radiosurgery technology as part of its comprehensive Cancer Care Program. Learn more about radiosurgery and take a virtual tour with Dr. Chang in this video.

Watch Dr. Chang’s philosophy of care video.

Learn More About Radiosurgery:

What is Radiosurgery?

How is Radiosurgery performed?

Benefits of Radiosurgery Treatment

Overview of Radiosurgery on the International Radiosurgery Association Website

Although Gordon Ray, M.D., medical director of the Palo Alto Center’s Radiation Oncology Department, had read about the benefits of pet therapy for cancer patients in scientific journals, it was a real live dog visit to his department that inspired him to start PAMF’s Animal Assisted Therapy Program.

“One of our patients had his service dog with him during an appointment,” says Dr. Ray who launched the program together with Tina Pierce, administrative director of PAMF’s Programs of Excellence; Inger Saxe, a director of  risk management and quality improvement; and Jan van Boeschoten, director of the Palo Alto Center Radiation Oncology Department. “I noticed the positive effect the dog’s presence had on patients in the waiting room. Patients were talking to each other more and the atmosphere seemed lighter and more relaxed.”

Wallie

Wallie, a cute-as-a-button poodle mix and the department’s first therapy dog, has been working his magic on patients for a couple of weeks now.

“We have seen a strong attachment grow between some of our patients who specially request to see Wallie when they come in for treatment,” says Dr. Ray. “There’s also a real sense of joy when he is present during their follow up exams.”

Furry colleagues Sparky (beagle), Sunny (golden retriever) and Wallie currently hang out in the department’s patient waiting room several hours a week on Mondays, Wednesdays and Fridays ready to be stroked and petted. These specially certified pet therapy dogs come from the Peninsula Humane Society (SPCA) and Furry Friends who also train and provide the handlers who accompany the dogs to work.

“These are all quiet, well-behaved dogs,” says van Boeschoten. “They don’t jump up or lick, are very friendly and always happy to be touched and petted. Our department is very high-tech with big machines and serious treatments – the dogs offer a welcome distraction and help make the whole treatment experience less frightening.”

The department provides two waiting rooms so patients can choose a dog-free environment if they prefer. Staff also note in each patient’s record if they prefer the therapy dogs’ presence or not.

Sparky shares the love with a patient

Sunny brings his mellow disposition to work

The Animal Assisted Therapy Program will be offered in the Mountain View Center Oncology Department next month and at the new Sunnyvale Center when it opens in 2013.

The program was named after longtime PAMF patient Irene Davidson. Davidson was a radiation therapist and a strong believer in the positive role that animals can play in promoting wellness among cancer patients. She dedicated funds in her will to PAMF’s Animal Assisted Therapy Program.

Carla Gomez, PAMF Healthy Breast Program Coordinator, reaching out to community at Safeway stores in Santa Cruz

Carla Gomez, PAMF’s Healthy Breast Campaign coordinator in Santa Cruz, is working at a table set up at various Safeway store locations throughout Santa Cruz this month (October) to let people know about our Healthy Breast Program and resources.

This PAMF Healthy Breast Program reaches out to uninsured women to educate them on the importance of breast cancer screenings, and to connect them to resources that are available. Since its inception this past February, we have reached out to more than 3,400 individuals and have provided follow up treatment for 32 women, 5 of whom had surgical removal including 1 breast cancer diagnosis.

“The Safeway staff and shoppers have been really friendly and happy to have me there,” Gomez said. “I spoke with people, talked to a few survivors – and even got the name of someone who needs an appointment! I think it’s really great to build that relationship. People also liked knowing that donations went to local programs.”

Each October, Safeway stores collect donations for breast cancer and donate the proceeds to local organizations. Last year, the Safeway Foundation chose PAMF’s Healthy Breast Campaign as the recipient of the $20,000 raised in Santa Cruz County.

PAMF Healthy Breast Program Patient Stories

Self-determination and Community Support Help Breast Cancer Patient

Young Mother Gets Timely Treatment

Not able to visit Safeway in Santa Cruz this October? You can make an online donation to the Health Breast Campaign in Santa Cruz, using a secure form. All donations go to local breast health programs.

Frank delaRama, R.N., M.S., AOCSN, Oncology Nurse Specialist and Prostate Cancer Nurse Navigator

Recent buzz on PSA screening is up again, thanks to the U.S. Preventive Services Task Force (USPSTF) draft recommendations to be published soon, which plan to downgrade PSA screening from “I – inconclusive” to “D – no benefit” for men younger than 75.

My first gut-level feeling as a health care provider is fear that men will flat out avoid PSA screening based upon this recommendation. On the other hand, perhaps this news will uncover an opportune teaching moment, for men to have a thorough discussion with their physician about the actual pros and cons of PSA screening, as well as prostate cancer screening in general.

Many of my physician colleagues at the Palo Alto Medical Foundation (PAMF) share similar perspectives:

“PSA screening should be a discussion between patient and physician that takes into account life expectancy, family history, patient’s acceptance for more invasive testing and present health issues,” says Andrew Epstein, M.D., urologist at the Palo Alto Medical Foundation (PAMF).

David Leibowitz, M.D., FACP, medical oncologist and director of innovation/informatics at the Palo Alto Medical Foundation, states, “This is like the mammogram recommendation from the same group. It may be that not everyone should have PSA testing, but the important point is that the physician needs to talk with the patient about the benefits and risks before they even order the test. Then the physician can help him make an informed decision, with an understanding of the good and the bad possible consequences.”

The decision whether or not to have PSA Screening is clearly a complex issue, and health care providers today do not depend upon just one set of guidelines to direct prostate cancer screening.

Pauling Chang, M.D., a radiation oncologist at the Palo Alto Medical Foundation, reinforces that prostate cancer screening, “…should also be consistent with the American Cancer Society recommendations and the American Urology Association recommendations on prostate cancer screening, which differ from what the Task Force recommends.”

Ultimately, the decision to test is your own. Don’t skip the discussion.

When considering whether or not to have a PSA test (or any health related test), if you would do something differently with your care, if the result shows something critical needing follow up or even treatment, then testing is right for you. If, even with a critical result, you would not do anything differently related to a test result, then testing is less useful to you. The important thing here is to understand all the “what if’s,” with the help of your physicians and nurses, so you can figure out the “to do’s” now.

Most often in prostate cancer, the options are so diverse (even including active surveillance) that men who have PSA screening appropriately have at least one, if not several, valid “what ifs” from which to choose.

Given the USPSTF statement downgrading PSA screening, men should take this opportunity, not to simply skip the test, but to have a thorough discussion with their physician about all the issues in prostate cancer early detection.

See my recent blog posts “A PSA on PSA” and “40-45-50,” for further details on prostate cancer screening and strategies for health care decision making.

More recommendations for prostate cancer early detection and reaction to the USPSTF announcement on prostate screenings:

TIME’s Healthland review of USPSTF recommendation & Prostate Cancer Screening

American Cancer Society Recommendations for Prostate Cancer Early Detection.�

American Urology Association Responds to New Recommendations on Prostate Cancer Screening

This blog post is contributed by Frank delaRama R.N., M.S., AOCNS,  Oncology Clinical Nurse Specialist at the Palo Alto Medical Foundation and prostate cancer nurse navigator – a role he created at PAMF in 2004, contributed to this blog post.  Frank created PAMF’s Prostate Cancer Buddy Program and is the chair of PAMF’s Cancer Patient Advisory Council. He has helped many men and their families along the cancer care journey, from diagnosis, through treatment, and into survivorship. You can follow Frank on Twitter at @fdelarama.