Advances in Prostate Cancer Care: A Comprehensive Update on Screening, Diagnosis, and Management
Why should we be paying attention to prostate cancer?
Dr. Robert Mordkin, the featured panelist, is a highly experienced urologist specializing in prostate cancer care and the director of urology at the VA Hospital Center. Prostate cancer deserves more attention, he says. It’s the second leading cause of cancer-related deaths in men. Despite its lethality, the public does not always treat it with the same urgency as other cancers due to its prolonged period from diagnosis to fatality. Approximately 1 out of 35 men die from prostate cancer, illuminating the importance of effective screening methods.
What are the screening challenges?
There are many challenges associated with prostate cancer screening, which relies primarily on the PSA (prostate-specific antigen) test. PSA is a protein formed by both cancerous and noncancerous prostate cells, so it does not provide a clear-cut cancer diagnosis. The thresholds for “normal” or “abnormal” often don’t distinctly indicate the presence or absence of cancer. Acceptable PSA ranges also vary widely for younger vs. older men because prostate size naturally increases with age. However, the advent of PSA testing in the late 1980s is still considered a significant advancement in the field. Screening in earlier years depended largely on rectal exams and noticeable symptoms. Symptom onset only occurs in later stages of the disease when successful treatment is far less likely. Thus, there is a critical need for early detection while the cancer remains localized within the prostate.
PSA screening considerations
How do we approach PSA testing, given its many limitations? Dr. Mordkin advocates for a balanced approach, asserting that while the test itself doesn’t cause harm, the disease certainly does. He recommends regular testing between ages 50 to 75, with variations based on family history and ethnicity. African American men in particular face a higher risk of more virulent prostate cancer. Practitioners should assess individual health status and needs rather than relying on rough age-based guidelines. In cases of elevated PSA levels, Dr. Mordkin explains that prostate biopsies can be very helpful, but practitioners should use them selectively. In the past, biopsies were used aggressively, but over the past decade, the field of urology has transitioned towards a more judicious approach. Advanced techniques like prostate MRI can be helpful in assessing the need for further evaluation.
Treatment approaches differ based on the cancer’s aggressiveness and the patient’s overall health. “The devil is in the details,” Dr. Mordkin explains. Active surveillance is recommended for less aggressive cases, while treatments such as radiation or radical prostatectomy are suggested for more aggressive forms. Radiation uses high-energy particles to kill cancer cells, while radical prostatectomy removes the prostate entirely. Alternative forms of treatment include cryotherapy and high-intensity focused ultrasound, but neither of the treatments is widely endorsed by the medical field.
- Are there preventative methods for prostate cancer? There are controversies over the use of supplements to prevent this disease. However, it is clear that various lifestyle factors contribute to prostate health, and a holistic approach to health is key. What is beneficial for heart health is generally beneficial for prostate health. People should focus on getting a balanced diet (omega-3s from fish and vitamins from vegetables, for example) and avoiding harmful habits like smoking and excessive drinking.
- What are the side effects, particularly around sexual functioning? While early recovery often restores some sexual functionality and patients can use other interventions to boost sexual functioning, they can expect negative effects over time. It is important to thoroughly discuss potential consequences with healthcare providers before opting for any specific route.