YOUNGSTOWN, Ohio – Reluctance among men to undergo a prostate exam is sometimes the difference between life and death.
That’s especially important in the Mahoning Valley, where every year one in four men who do undergo screening is diagnosed with prostate cancer – among the higher rates across the state of Ohio. The good news is that when detected early, prostate cancer is among the most curable, specialists and data say.
And while the region is fortunate to have some of the latest technological advances and treatments for the disease, it is vital that men over the age of 40 take these exams seriously, says urologist Dr. Daniel J. Ricchiuti, a partner at N.E.O. Urology Associates Inc., Boardman.
“The biggest thing is to detect it early,” Ricchiuti says. This is commonly done through a routine checkup that combines a prostate-specific antigen, or PSA, test and a digital rectal examination. PSAs are proteins that are produced by cancerous and non-cancerous prostate cells. Since cancerous cells produce more of this protein, high levels found through a simple blood test could signal the presence of cancer.
“There’s nothing better out there right now and there’s no substitute for a PSA test and a digital rectal exam,” Ricchiuti says.
Yet some primary care doctors question the reliability of these tests, and studies have shown that elevated levels of PSAs have been caused by factors other than cancer. Moreover, these levels can rise and fall.
“Even though there are flaws, getting this test is still very necessary and it absolutely does save lives,” Ricchiuti says emphatically.
However, many men are reluctant to take these tests because early stages of prostate cancer are normally symptom-free and they feel that it’s unnecessary, he says. Moreover, some are apprehensive about undergoing a rectal exam, or the results of a simple blood test.
“There are a lot of guys who are deathly afraid of this exam,” Ricchiuti says. “It takes five seconds and it’s not a big deal.”
Should a screening detect the presence of cancer, the next step is for a patient to confer with his doctor about treatment, if treatment is required at all, Ricchiuti says.
That’s because there are different degrees of prostate cancer, Ricchiuti says. In some cases, the cancer might either grow very slowly or not at all, leaving specialists to monitor the patient’s condition through “active surveillance” instead of surgery or radiation treatments. “There are low-grade prostate cancers that aren’t life-threatening,” he says.
Those with more aggressive forms of prostate cancer typically require surgery or radiation, Ricchiuti says. “Typically, older men will undergo radiation,” he says.
Treating patients specifically with prostate and other urologic cancers was the idea behind Partners for Urology Health, a collaborative diagnostic and treatment center in Austintown among Mercy Health, Advanced Urology Inc. in Boardman and N.E.O.
“We’re fortunate in this area that we have the most up-to-date technologies and state-of-the art radiation care,” Ricchiuti says. “There aren’t a whole lot of places like this. It’s run very well with the input of everybody and provides optimal technology for treatment.”
Still, diagnosing the disease at its earliest stage is critical, Ricchiuti says, since symptoms often don’t appear until the cancer has progressed. This year, screenings and tests have fallen precipitously because of the COVID-19 pandemic.
“What we’ve seen nationwide is that people have quit going to the doctor, quit getting their heart checked, quit getting PSAs,” Ricchiuti says.
As a result of COVID, patients have postponed appointments with their physicians – coming in only when they feel it’s necessary. This could compromise early detection for prostate cancer, he says, noting he’s seen patients who have come in later than they should have – all because they were afraid of contracting COVID in a doctor’s office or hospital.
“The biggest threat today in my mind is that people are not going to get the care they need,” he says.
The most recent statistics from the Ohio Department of Health show that about 81% of prostate cancers diagnosed in 2017 across the state were caught at a local or regional stage, meaning the disease had not spread.
The five-year relative survival rate for these cancers is 100%. About 7% of cases had spread to distant parts of the body, for which the five-year relative survival rate is just 29%.
Ohio’s prostate cancer incident rate in 2017 stood at an average of 109.9 per 100,000 males, according to the Department of Health report. In Mahoning County, that incidence rate stood at 111.5, higher than the state average. Trumbull County registered an incident rate of 91.4, while Columbiana County stood at 74.9.
Mortality rates among the three counties resulting from prostate cancer are below the state average of 19.5 per 100,000, according to the 2020 report. Mahoning County’s rate in 2017 registered at 18.1 per 100,000, Trumbull County recorded a mortality rate of 12.4; Columbiana County stood at 7.5.
Overall, data show that prostate incidence rates in Ohio have fallen 25% between 2008 and 2017, while mortality rates have declined 19% during that period.
Yet Covid-19 has complicated screening efforts all across the Mahoning Valley, says Samantha Rivalsky, community outreach liaison for Mercy Health and coordinator of Man Up, a prostate cancer awareness program.
The initiative conducts free screenings for prostate cancer across the Mahoning Valley, providing access for those who cannot afford a test or lack a primary physician, Rivalsky says. “Our main goal is to provide it free to the community,” she says.
Unfortunately, the pandemic forced the cancellation of two major fundraising events this year that help to support these efforts, Rivalsky says.
Fuel the Fight, an annual car show, and a stand-up comedy show, Stand Up for Man Up, were both nixed because of COVID concerns, as was the annual African-American Wellness Walk.
Providing access to tests at no cost is important since the rate of prostate cancer in Mahoning County is higher than the state average, Rivalsky says. About one in four men screened in the Mahoning Valley is diagnosed with prostate cancer, she says, and it is the most common cancer among men in the region.
For example, the most recent screening sponsored by Mercy Health St. Joseph’s Hospital at the Eastwood Mall in Niles in July evaluated 15 white men. Four of those tests came back with elevated PSA levels, an unusually high concentration for Caucasian men.
“The statistics are even higher for African-Americans,” Rivalsky says, underscoring the importance of bringing access to an underserved population.
On average, the Man Up program hosts between 12 and 15 screening events every year. These were drastically reduced this year because of COVID, Rivalsky says. At the beginning of this year, the Man Up program set a goal of screening 400 men for prostate cancer; fewer than 25 have been tested thus far.
Still, the program has made a considerable difference in the fight against prostate cancer. “It’s been great,” Rivalsky says. “We’ve helped hundreds and hundreds of people over the years.”