Urologist urges prostate screening

Dr. Jonathan Mercer of Flathead Urology understands men's qualms about the dreaded DRE - digital rectal exam - used along with a blood test to screen for prostate cancer.

When faced with a nervous patient, he reaches into his black bag for a little humor to break the tension.

"I remind guys that it's not the favorite part of my day, either," Mercer said. "They usually laugh and say 'Go ahead.'"

A urologist and surgeon, Mercer practices in Kalispell and Whitefish and travels at least once a month to Libby and Eureka to see patients. With September deemed Prostate Awareness Month, Mercer agreed to share his background and expertise on prostate cancer, the number two cancer killer of men.

Mercer's screening advice echoes the most recent recommendation of the American Urological Association - have a baseline PSA (prostate-specific antigen) blood test and digital rectal exam beginning at age 40.

"Both are very important," he said.

Mercer said screening recommendations as well as treatment protocols continue to change and evolve, spurring lively debates within the field. He said the future holds exciting advancements with tests to sort deadly prostate cancers from the less aggressive, as well as new less-invasive treatments.

"The field is full of brilliant medical minds," he said "It's awe-inspiring how quickly new concepts develop."

Mercer, 45, said he was drawn to the medical profession from an early age. He had physicians in his family and his father was a "country veterinarian" who served on the local hospital board in Sunnyside, Wash.

"Growing up in that small town, the people with the most prestigious jobs were farmers and doctors," he said. "I always assumed eventually I would be a doctor."

After high school, Mercer attended the University of Washington where he played defensive back on the football team. He even had a brief stint at the Minnesota Vikings training camp.

"I knew I'd never make it [the team]," he said. "I played as well as I ever had at the training camp."

Mercer joined the Air Force, then attended medical school at George Washington University School of Medicine. As soon as he completed an internship in general surgery, he began active duty at Travis Air Force base in Northern California.

"I owed the Air Force four years but I decided to serve five and a half," he said.

Among his adventures in the service, Mercer attended flight school for the B-1 bomber and had a special operations assignment with a squadron in Okinawa, Japan. He spent a lot of time in Korea and traveled extensively in Southeast Asia.

"One of my primary missions was maintaining a hidden medical cache in Korea," Mercer said.

His final assignment was at Edwards Air Force Base in Southern California where, in 1998, he said he decided to leave the military and continue his medical education. He ended up in a residency in urology at Harvard Medical School in Boston.

Also in the late 1990s, Mercer got married to Paula, a lawyer from Northern California whom he dated long-distance before tying the knot. The couple now have three children with a fourth due to arrive within days.

After his Harvard residency, Mercer stayed in Boston to complete a fellowship in multi-organ transplant at Massachusetts General Hospital working with the liver, pancreas, small bowel and kidneys.

Mercer and his family moved west after eight years in Boston. They made a short list of areas in the northern Rockies, finally settling on Whitefish as a favorite in late 2005. They now live west of Whitefish.

"We're doughnut dwellers," Mercer said with a laugh.

He began his medical career working at Kalispell Regional Medical Center as part of Urology Associates. He went solo as Flathead Urology in January 2007.

Along with dividing his time between Kalispell and Whitefish with monthly trips to Libby and Eureka, Mercer does house calls for immobile elderly patients.

"A week doesn't go by that I don't make one or two" house calls, he said.

Along with prostate problems, Mercer's urology practice covers renal, bladder and testicular issues, including cancers. He deals with continence difficulties, "a smattering" of pediatric urology, vasectomies and their reversal and much more.

"A lot of emergent practice in urology is stone disease," he said.

Prostate problems account for a significant part of his practice. He spends a lot of time talking about the prostate with his patients, sorting fact from opinion and explaining PSA test results.

According to Mercer, some have an amazing command of prostate issues from researching credible sources.

"I've got patients who quote the latest information from the New England Journal of Medicine and the Journal of Urology," he said.

Prostate cancer presents a challenge because it comes in many forms - some aggressive and some not. In one autopsy study, 75 to 85 percent of the men in their 80s had non-aggressive prostate cancer but never knew it and did not die from it.

"Not all cancers require treatment," Mercer said. "That's what we're struggling with - when to treat it and when to ignore it."

Mercer said he presents the facts as he knows them to patients to help them decide whether to proceed to a biopsy (tissue sample) when a PSA blood test result and digital rectal exam indicate potential cancer - and then to choose what treatment option, if any, to follow if cancer is found.

Factors such as age, ethnicity, family history and overall health play into assessing risk posed by the prostate cancer discovered. Mercer said the difficulty comes with men in the middle of the risk continuum.

He said a certain segment of patients want him as the doctor to tell them what to do.

"I almost never do that," he said. "A lot of decisions are not black and white but shades of gray. They have to sleep at night with their decision."

The majority of patients opt for treatment when they hear they have prostate cancer, Mercer said. They face decisions about options from surgery to radiation to freezing therapy.

Surgery has the best 30-year track record for men remaining disease-free. But Mercer pointed out that the newer therapies don't have 30-year statistics yet.

On the negative side, surgery may bring side effects such as incontinence and impotence.

"Surgery techniques have improved," Mercer said. "The incidence is a lot lower than it used to be but it's still higher with surgery."

Surgery offers the benefit of final pathology to reveal how big the tumor was, how much of the prostate was involved and whether it spread. Mercer said final pathology gives him better information to recommend if more therapy, such as radiation, is needed.

He said the future holds exciting less invasive treatments such as high-intensity focused ultrasound now under review but not yet approved by the FDA.

"As you get less invasive, you get fewer side effects," he said.

Mercer said the most important point to remember is that screening with the PSA test and digital rectal exam gives a man the best opportunity to find prostate cancer before it spreads to other parts of the body.

"The problem with prostate cancer is, by the time you have symptoms, you're way behind the curve," Mercer said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com