Prostate Cancer Awareness Month: Focus on Detection and Treatment

Prostate cancer can be detected early through PSA (prostate-specific antigen) testing and digital rectal exams, which can lead to further evaluation when abnormalities are found, according to Dr. David A. Taub.

Treatment options for prostate cancer now range from active surveillance for slower-growing disease to surgery, radiation, and newer focal therapies such as HIFU, cryoablation, and NanoKnife. As September marks Prostate Cancer Awareness Month, it is an important time to highlight early detection and evolving treatment approaches that help improve patient outcomes. To delve further into this topic, Taub sat down for an interview with CURE.

He is a urologist and the director of urologic oncology at Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health.

CURE: What are the most common warning signs and symptoms of prostate cancer that patients should watch out for?

Taub: The PSA, which stands for prostate-specific antigen, blood test was made public in the late 1980s. Before that, screening was done with a digital rectal exam or a prostate examination. Consequently, we would see patients with advanced prostate cancer, who often had bone pain, bone fractures, blood in their urine, or difficulty urinating. While most people with these symptoms have a condition other than prostate cancer, that's how the disease presented itself a long time ago.

Since the advent of the PSA test in the late 1980s or early 1990s, prostate cancer is now caught much earlier in a screening format, similar to a colonoscopy. We can now detect it with just an elevated or changing blood test result.

What are the standard methods for diagnosing prostate cancer, and how do PSA testing and prostate biopsies play a role in confirming the diagnosis?

The PSA is a test that most men between the ages of 50 and 70 get on a yearly basis as part of their routine physical examinations. Any change or elevation in that number can prompt a urology evaluation. Similarly, men should be getting a prostate examination, also known as a digital rectal examination or DRE, once a year.

Again, any abnormality found in those two tests would prompt a urology referral. This would lead to either a biopsy or, more commonly now, an MRI scan before the biopsy to make the prostate biopsies much more precise.

What are the main treatment options currently available for patients with prostate cancer?

There are four main ways to treat prostate cancer. The first is active surveillance. A lot of the prostate cancer we diagnose is slower-growing and lower-volume. Good studies from England or Europe have shown that some of these earlier-stage and non-aggressive cancers can be present for 10 or 15 years and not really cause any increase in death or problems. Therefore, watching the cancer, or surveilling it, is an option. We do that by checking the PSA on a more regular basis (about twice a year), checking the MRI a bit more frequently, and repeating biopsies to ensure nothing is progressing. Active surveillance is the mainstay for low-risk prostate cancer.

More intermediate or aggressive cancers require either surgery (we do robotic surgery, which is the mainstay of prostate cancer treatment) or radiation. There are a multitude of radiation treatments, including IMRT (Intensity-Modulated Radiation Therapy), proton radiation therapy, and MRI Linac (or linear accelerator). There is a plethora of radiation options.

Beyond active surveillance, surgery, and radiation, what other treatment approaches are being used for prostate cancer, and how do doctors decide which is best?

The last option is focal therapy. We have been using focal therapy for different types of cancers. For instance, when I treat kidney cancer, I remove the part of the kidney with the tumor but not the whole kidney. Similarly, for breast cancer, women often get a lumpectomy rather than a radical mastectomy. Prostate cancer treatment has been lagging a little bit, but some research has shown that we can achieve good disease control with less side effects if we focus on treating just the area where the cancer is and leaving the rest of the prostate alone.

We can do that with something called HIFU (High-Intensity Focused Ultrasound), with cryoablation (which involves freezing that area), or with something called NanoKnife (which is irreversible electroporation). There are a number of them, and so we try to fit the right modality with the right patient.

Transcript has been edited for clarity and conciseness.

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