Advancements In Prostate Cancer Treatment: A Patient’s Guide

September is Prostate Cancer Awareness month. Are you aware of how your prostate is doing?

Just four in 10 men know where their prostate gland is even located, let alone it’s health. (Answer: your prostate sits beneath the bladder and in front of the rectum). If your prostate gland has cancer, do you know how to detect the symptoms, let alone how it will be treated?

Turns out, early prostate cancer often doesn’t even present symptoms, a fact that 80% of men do not know. And when symptoms do arise, many men might not recognize them. For example, most men are unaware that sexual dysfunction can be a sign of prostate cancer.

Download Prostate Cancer Patient Guide

Our goal during Prostate Cancer Awareness month is to get men thinking about their health and schedule their annual exam. Finding prostate cancer early means better odds for a successful recovery. Thanks to clinical studies, medical researchers have developed many advancements in prostate cancer treatment, so you have a greater number of options to discuss with your urologists.

Your Risks of Prostate Cancer, and How to Know the Signs

Every 90 seconds, a man finds out he has prostate cancer. However, some men are at higher risk than others. These include men older than 65, Black men, men with a family history of the disease, and military veterans exposed to toxic chemicals, according to the nonprofit ZERO Prostate Cancer.

Despite the odds of developing the disease (it is the second most common cancer among men after skin cancer), you have better chances of surviving it. The five-year survival rate is 99%, thanks to early detection.

However, detection takes awareness.

Because prostate cancer tends not to show symptoms until it spreads outside the prostate, regular screenings are necessary to reveal early-stage disease.

However, these symptoms should warrant a call to your urologist if for no other reason than to rule out prostate cancer:

• The immediate and frequent need to urinate (often at night)
• Trouble starting and stopping urine (and dribbling when done)
• A weak stream
• Pain or burning during urination
• Pain in the upper thighs, hips, and lower back
• Pain and/or strain when ejaculating
• Blood in the urine or semen
• Difficulty getting an erection, or erectile dysfunction (in advanced prostate cancer)

Screening – Who, When, and How

Early screenings, typically performed through a blood test called a prostate-specific antigen test, can establish the baseline of cancer-marking antigens in your blood (your PSA score). Generally, a “normal” PSA reading is 4 nanograms of antigen per a milliliter of blood, although variables apply. Having a urinary tract infection (UTI) or enlarged prostate can elevate your PSA levels, for example.

The American Cancer Society recommends men at high risk of prostate cancer ask their doctors about getting screened at as young as 40 to 45, and men of average risk at 50.

• Age – Rare at 40 or younger; increases after 50
• Ethnicity – More common in African American men; less common in Asian/Pacific Islander and American Indian/Alaskan Native men
• Family history – Having a father or brother with prostate cancer more than doubles a man’s risk of developing prostate cancer
• Obesity (very overweight)
• Diet

Genetic and Genomic Testing

Family history matters for more than just risk assessment. New research on gene changes linked to prostate cancer helps scientists better understand how the cancer develops and has led to medicines that target those changes.

Testing can:

• Help identify your risk for certain cancers
• Help with early detection or prevention
• Guide treatment decisions

Genetic testing looks at individual genes and how they’re passed down from one generation to another. 10% of prostate cancer  caused by inherited mutations, yet family history increases your risk for prostate cancer by 60%.* Genomic testing, on the other hand, looks at genes within your cancerous tumors, to look for mutations that may drive cancer growth. These gene mutations exist only in the tumor itself. 90% of prostate cancer are due to non-inherited, acquired mutations.**

Ask your doctor whether genetic or genomic testing is right for you, especially if prostate, breast, or ovarian cancer runs in your family.

Prostate Cancer Treatment Today: What You Can Expect

If you experience signs of prostate cancer, you should contact a urologist for testing to rule out cancer.

Standard approaches for detecting prostate cancer include the PSA blood test and a digital rectal exam. However, men older than 50 with PSA readings higher than 4 ng/mL can ask their doctor about an advanced test called IsoPSA, which breaks down the structures of the antigen proteins to specify if the elevated reading is due to cancer or something else.

Many patients benefit from pairing a biomarker test, such as IsoPSA, with a prostate MRI. A prostate MRI provides a detailed picture of the gland, helping physicians identify suspicious areas before recommending next steps. Used together, a biomarker result and MRI imaging help your doctor determine whether a biopsy is truly warranted, sparing many patients from an unnecessary procedure while helping others get to an accurate diagnosis faster.

If cancer is detected, you have options today for more targeted, effective treatments. The Urology Group offers a combination of diagnostic and treatment options for men with protate cancer:

• PSMA PET/CT Scan – This advanced imaging combines the technologies of different types of scans to gain a cellular and cross-sectional view of your prostate tissue. A PET scan (positron emission tomography) reveals how your tissue functions on a cellular level using dye with tracers that bind to prostate-specific membrane antigens (PSMA). A CT scan processes X-rays taken from various angles with computer software, to detailed “slices” of the area.Used together, these technologies can precisely locate cancer cells and their activity throughout the body – including small growths that other imaging tests might miss. Armed with such knowledge, your physician can make better-informed recommendations about treatment. The Urology Group care team now provides this scan at our Norwood facility. Read an overview of our PSMA PET/CT scan here.
• SpaceOAR Hydrogel – Men who undergo radiation therapy for prostate cancer should ask their doctors about this procedure to limit side effects to the rectum, which sits directly behind the prostate. SpaceOAR is an absorbable gel that creates a temporary space between the rectum and the prostate, essentially pushing them apart during treatment to protect the rectum from radiation exposure. Clinical results include fewer complications of the bowel, the urinary system, and sexual function.SpaceOAR is injected before radiation therapy begins, and might involve local or general anesthesia, so prepare to have someone take you home. The gel is made of water and polyethylene glycol (PEG), a compound used in most implants and is naturally absorbed by the body.
• Adaptive radiation therapy (ART) – This highly advanced form of radiation therapy calibrates each treatment based on changes in the patient’s body from one visit to the next, for more precise results. The technology relies on sophisticated imaging and artificial intelligence that reveal even subtle changes, enabling the oncology team to adjust the therapy before each session. The enhanced accuracy can ensure more direct and effective treatment of the cancer, while limiting radiation exposure to nearby tissue.Patients eligible for ART will undergo a few preparatory sessions, which include imaging and planning. Once therapy begins, daily sessions take 20 to 25 minutes, with the treatments themselves taking 10 to 15 minutes. Learn more about ART therapy here.
• Robotic Prostatectomy – For patients whose cancer requires surgical removal of the prostate, The Urology Group has several fellowship-trained surgeons experienced in robotic-assisted prostatectomy. This minimally invasive approach uses a robotic surgical system to give surgeons enhanced precision, visualization, and control compared to traditional open surgery, which can translate to less pain, less blood loss, and a faster recovery for many patients.

Some of our surgeons also perform single-port prostatectomy, an advanced robotic technique that uses just one small incision, rather than the several incisions required in traditional robotic surgery. This approach can further reduce scarring and may offer a quicker return to daily activities. Your surgeon can help you understand whether a robotic or single-port approach is right for your specific case.

Be Aware: Your Prostate Is Counting on You

You have access to other prostate cancer treatment approaches, depending on the stage. These include hormone therapy, immunotherapy, and prostate removal. Ask your doctor about these options. After cancer treatment, your doctor will advise follow-up appointments that include further PSA testing, possible imaging, and discussions about symptoms and side effects.

September may be Prostate Cancer Awareness month, but you should make awareness a daily ritual. This could help you prevent prostate cancer from developing, or, if caught, choose a treatment approach with greater confidence.

If you are at high risk of prostate cancer or suspect you have symptoms, request a consultation with one of The Urology Group’s cancer specialists. Patients with progressive prostate cancer can learn about our Advanced Prostate Cancer Clinic here.