Why screen for prostate cancer?
Screening for prostate cancer is a controversial topic and various opinions exist depending on the source. Prostate cancer is the second most common cancer (300,000 men/yr in the U.S..) and the second highest cause of cancer-related deaths in American men (35,000). Introduction of prostate cancer screening in the 1990s decreased deaths from prostate cancer by 50%, but it was not without consequences.
Guidelines from cancer experts recommend considering PSA screening after a careful discussion of risks and benefits in men:
- Age 55 to 69
- Between age 40 and 54 if there are high risk factors (a family member with prostate cancer or African-American)
- Over age 70 only if excellent health
What is PSA?
PSA stands for ‘prostate specific antigen.’ It is a protein made exclusively by prostate tissue. A simple blood test can detect your level and evaluate what your risk for prostate cancer may be.
What is PSA Screening?
Prostate cancer commonly causes no symptoms while contained within the prostate, and this window is the best opportunity for cure. Therefore, PSA screening allows detection of these cancers early before they causes symptoms or have spread beyond the prostate.
What if my PSA level is high?
The first thing to know is that PSA can be elevated from benign causes, and there are also falsely positive elevations. However, if your primary care doctor or urologist determines that your PSA truly is elevated, consultation and examination with a specialist at Fore River Urology is often the next step.
Do I need an MRI?
In some cases, depending on your PSA level, health, age, PSA trajectory, examination, family history, it may be in your best interest to get a specialized 3T prostate MRI. This focused imaging takes high resolution images of your prostate which can measure the size of your prostate and identify concerning areas within your prostate. Should a concerning spot be identified, your urologist will review the imaging and determine the next course of action.
In other situations, your specialist may determine that proceeding directly to a prostate biopsy is most prudent.
What is a Prostate Biopsy?
Prostate cancer is typically diagnosed with an ultrasound-guided biopsy of the prostate. This is a procedure performed most commonly in the urologist’s office under local anesthesia and/or conscious sedation (Nitrous / “Laughing gas”).
Transrectal prostate biopsies involve the patient lying on their side and an ultrasound probe is gently inserted into the rectum for imaging guidance. The prostate nerves are then numbed, and tiny needle samples are taken from the prostate.
If an MRI was done and identified a concerning region, you may be a candidate for a ‘fusion’ prostate biopsy. This is an advanced type of biopsy that enables your urologist to precisely target the concerning spot, while also sampling the remainder of the prostate. This has been shown to improve detecting and accuracy.
In other situations, it may be best to perform a standard biopsy. This is a personalized discussion to have with your urologist.
Other testing is often used to help determine staging and prognosis.
I was diagnosed with prostate cancer, what are my options?
Every patient and every prostate cancer is different, and warrants a personalized approach. Prostate cancers can range from the slow-growing variety that may not require treatment, or could have already spread outside the prostate requiring aggressive intervention.
Regardless of what type of prostate cancer you or your loved ones are dealing with, the team at Fore River Urology has focused expertise to guide patients wherever they are in their prostate cancer journey. Many different treatment options are available at Fore River Urology and our multi-disciplinary colleagues, and all relevant options will be discussed with you:
- Active surveillance: monitoring very low, low risk, and select favorable intermediate risk cancer with periodic exams, blood work, and repeat biopsies
- Focal therapy: newer modalities like freezing, heating, high-intensity ultrasound (HIFU), etc. to kill prostate tissue for select patients
- Radiation: external beam radiation therapy (EBRT), implanting radioactive seeds (brachytherapy), and other varieties of delivering radiotherapy
- Minimally Invasive Surgery: surgically removing the prostate, seminal vesicles and pelvic lymph nodes. This can be done open or robotically.
- Hormone therapy: medications that can starve the prostate cancer by shutting off testosterone production
- Advanced medical therapies: targeted medications such as abiraterone (Zytiga), enzalutamide (Xtandi), apalutamide (Erleada), darolutamide (Nubeqa) for metastatic prostate cancer
- Immunotherapy: customized cell-based cancer immunotherapy such as Sipuleucel-T (Provenge),
- PARP inhibitors: olaparib (Lynparza)
- Chemotherapy
The prostate cancer experts at Fore River Urology can help you decide whether prostate cancer screening is right for you. If you have been diagnosed with prostate cancer, our experienced and caring team will promptly guide you to the information, testing, and treatment you need. For an appointment, please call 207-518-6600.
For more online information about PSA screening and prostate cancer in general, excellent resources can be found at Know Your Stats, the American Cancer Society, and the National Institutes of Health.
