Prostate Cancer Detection & Management

Over the past decade, there has been a dramatic shift in prostate cancer detection and management. This can be attributed to a number of factors:

• Recognition that PSA screening SAVES LIVES
Despite what the US Preventative Services Task Force (USPSTF) initially suggested, PSA screening DOES, in fact, save lives in men ages 55-69. We know now that the USPSTF based their recommendations on the results of the US-based PLCO study, which was greatly flawed.

Most of the men (nearly 90%!) in the control ‘no screening’ arm who were supposed to NOT be screened actually DID in fact have screening. The results of the study have thus been rendered meaningless.

A large multicenter European trial and one from Göteborg, Sweden BOTH demonstrated a significant reduction in prostate cancer mortality with PSA screening.

• Significant improvement in prostate MRI technology
Multiparametric prostate MRI provides impressive details of the internal architecture and anatomy of the prostate. This can reveal ‘lesions’ or abnormalities within the prostate that are suspicious for cancer and provide a roadmap for targeted prostate biopsy. We no longer need to (nor should we) perform random ultrasound-guided prostate biopsy with the inherent 30-50% chance of MISSING the cancer. What other organ have we continued to randomly stick needles into HOPING to hit the cancer if it is present? Answer: None.

• Development of MRI/Ultrasound 3-D Fusion Prostate Biopsy Technology
This technology creates 3-D renderings of the prostate using MRI images and ultrasound images and then merges the two together. This provides real-time 3-D imaging of suspicious lesions within the prostate and enables accurate sampling.
Several large studies have documented a significant improvement in prostate cancer detection with this approach compared to standard ultrasound-guided biopsy. This can also have a tremendous impact on how we treat prostate cancer.
Prostate MRI along with MRI/US fusion biopsy provide very specific anatomic detail about prostate cancers that enables better consideration for potential less-invasive treatment options such as focal therapy.

• Acceptance of active surveillance as a safe, reasonable approach for men with low-grade prostate cancer.
This was formerly referred to as “watchful waiting” but we now monitor cancers more actively. We (urologists as a community) have been over-treating low grade prostate cancer for a long time, subjecting patients to the unnecessary side effects and morbidity of treatment with minimal impact on their long-term survival. We need to provide individualized treatment, tailored to each patient’s particular disease and situation.

• Development of genomic-based biomarkers.
Biomarkers are novel blood and urine tests use to better assess patients’ risk of aggressive prostate cancer. Some of these tests, including 4K score, phi test, and PCA-3 are useful for men with an elevated PSA to determine those who should undergo prostate biopsy or prostate MRI and fusion biopsy as described above. Others such as Decipher, Prolaris, and GPS score, are performed on the prostate biopsy tissue to better classify the aggressiveness of prostate cancer. The Decipher test is also used after radical prostatectomy to assess the patient’s risk of developing subsequent recurrence.

• FDA approval of HIFU (High Intensity Focused Ultrasound)
HIFU is a non-invasive treatment for prostate cancer that utilizes an ultrasound probe to precisely focus high-energy ultrasound beams into the prostate. The innovative, breakthrough treatment provides cancer outcomes similar to surgery or radiation but with minimal side effects such as ED or urinary incontinence.
HIFU has been performed around the world since the mid-1990’s. In September of 2015, the FDA cleared the Sonablate HIFU device for prostate treatment here in the US.

For additional information on available diagnostic tools and treatment options for prostate cancer, please visit SarasotaProstate.com.