Breakthroughs in Prostate Cancer Treatment and Diagnostics

Prostate cancer screening and treatment has seen a lot of controversy lately. Based on my experience screening for prostate cancer has benefits and should be something you ask about at your next doctor’s visit. Prostate cancer screening may be optional for some patients but in my opinion is a must if you have a family history or are African American.

Why is screening so important? Well, among men, prostate cancer is the second most commonly diagnosed form of cancer, behind skin cancer, with approximately one out of every six men expected to be diagnosed with it at some point in their lives. Prostate cancer is also the second deadliest form of cancer among men, behind lung cancer. Fortunately, if it’s detected early, prostate cancer is highly treatable. In fact, if diagnosed before the cancer spreads to other parts of the body, the five-year survival rate is 99 percent. And today as urologists we don’t treat everyone that is diagnosed with prostate cancer; not everyone needs surgery or radiation. We may decide to just watch the cancer through a process called “active surveillance.”

That said, prostate cancer has been notoriously difficult to diagnose with any certainty without performing a biopsy on the patient. Long-standing diagnostic screening procedures, such as blood screening and digital rectal exams, often yield false positives or don’t find tumors that actually exist. That may be about to change, however, as recent research could result in several new diagnostic tools and treatments.

Treatment

The standard curative treatments are still removing the prostate or radiation therapy. Clearly, the researchers involved with these studies have been attacking the issue from several angles, such as developing new medications, using the patient’s own immune system to attack tumors and customizing treatments based on each patient’s unique genetic profile.

Potential breakthroughs include:

• New drugs that inhibit the function of the checkpoints found in cancer cells, which block the immune system’s cancer-fighting response. This treatment is already being used to fight other types of cancer, with clinical trials currently in progress for prostate cancer.
• Immunotherapy strategies where a therapeutic vaccine is administered to turn on T cells so that they attack cancer cells. 
• Genetically reprogramming the patient’s immune system to recognize and kill cancer cells.
• Repurposing an androgen-depleting drug therapy – typically used for men who decide not to have surgery for their prostate cancer – as a complementary treatment when the cancer returns after surgery.
• Customized care based on genomics, which involves genetically testing the patient’s prostate cancer and creating therapies targeted to the cancer cells’ individual weaknesses.

Diagnostic Tools

As with many types of cancer, early detection and diagnosis offers the best chance for successful treatment and are recommended annually for men once they reach the age of 50. The two most common screening tools, which have been in long-standing use and are highly trusted by doctors, are the digital rectal exam and testing the blood for prostate-specific antigens (PSA). However, these are only screening tests and are not accurate enough to provide a confirmed diagnosis. In fact, the only way to diagnose prostate cancer conclusively is by performing a biopsy that extracts cells from multiple locations in the prostate.

With the recent research, however, there is promise for more accurate and less invasive ways to reach a confirmed diagnosis. Some of these breakthroughs include new imaging technologies that can help doctors locate tumors more accurately. This includes more advanced magnetic resonance imaging (MRI) and positron emission tomography (PET) tools that will be able to create 3D images of the prostate gland. With this more accurate data, doctors are hopeful that they might be able to confirm a diagnosis without a biopsy. Or, if a biopsy is required, they might be able to precisely pinpoint where the questionable area is and have to extract fewer cells for analysis.