“We found that the information we could get from PSMA scanning in patients with newly-diagnosed prostate cancer before surgery was at least as reliable and useful as other information from biopsy, PSA levels, or clinical exam for predicting how patients would do after surgery or other treatment,” says Farshad Moradi, a radiologist at Stanford who co-authored the study.
In December, scientists at Stanford University reported promising findings with a new technology that lights up prostate tumors on specialized imaging scans. The approach relies on a minimally-radioactive tracer that travels the body hunting for cancer cells.
Called 68Ga-PSMA-11, and delivered intravenously, the tracer binds exclusively with a protein called prostate- specific membrane antigen (PSMA). Prostate cancer cells contain far more of this protein on their surfaces than normal prostate cells do. Tumors flagged by 68Ga-PSMA-11 show up on an imaging scan like lit matches in a dark room. Doctors are already using PSMA scans to diagnose early metastatic cancer, and the tracer can also be used to ferry drugs directly into malignant tumors.
Mitchell Humphreys, M.D., a urologist at Mayo Clinic, answers the important questions you may have about prostate cancer.
Video timeline: 0:00 Introduction 0:16 How do you know how fast my cancer is growing? 0:49 Is prostate cancer sexually transmitted? 1:04 Is prostate cancer hereditary? 1:36 What can I do to prevent or slow prostate cancer? 2:03 Is there a risk of cancer spreading if I have a biopsy of my prostate? 2:20: When should I stop screening for prostate cancer? 2:46 How can I be the best partner to my medical team? 3:12 Ending
Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm.
However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.
Prostate cancer that’s detected early — when it’s still confined to the prostate gland — has the best chance for successful treatment.
Prostate cancer may cause no signs or symptoms in its early stages. When it’s more advanced may cause signs and symptoms such as:
PSA screening will pick up prostate cancer very efficiently. However, it will also pick up slow growing cancer that might never be require treatment, and responding to the positive test could cause problems ranging from pain and convenience to erectile dysfunction and incontinence.
It takes 1000 men screened to produce one life-saving treatment for prostate cancer.
Risk reward analysis means that the younger you are, the more reasonable is a test, since you have many more years of potential life. The older you are, conversely, the less you have to gain. The problem is that most cancers are slow growing, and might never cause a problem, especially if you have only a few years left to live.
Most experts recommend a test when a man reaches the age of 45, but reserve annual testing for those who are at high risk, such as having a brother or father with aggressive prostate cancer.
When a man reaches the age of 70, most experts would decline to test.
Sometimes, emotional considerations present themselves; worry is very much a disease. For instance, the best man at my wedding stopped getting his PSA test about three years before he was diagnosed with fatal metastatic prostate cancer. I am inclined to continue getting my annual prostate test, and would worry if I didn’t.
A recent study in the journal Cancer reported that more than half of a group of men 75 years and older had PSA tests and biopsies.
As an interesting aside, the PSA test is the only test I have ever had rejected by Medicare, presumably because of this expert opinion factoring in the cost benefit analysis of using the test.
Prostate cancer that has become high-risk or begun to spread is treated with either surgery or radiation. While both are equally good, research has found that radiation often produces better quality of life over the long term: https://t.co/OlEMPFU0Qu#HarvardHealthpic.twitter.com/L4oEteQq5N
Focal One® high-intensity focused ultrasound uses high-intensity sound waves to destroy a cancer tumor. It’s delivered through a rectal ultrasound probe. There are no incisions. Most patients need no pain medication after treatment. And there are fewer side effects than with radiation therapy or prostate removal.
Known as the Ironman, Hall of Famer Cal Ripken Jr. was diagnosed with prostate cancer during the COVID-19 pandemic. Partnering with the Brady Urological Institute, Mr. Ripken had a successful robotic radical prostatectomy to remove his tumor and is now deemed cancer free. Watch urologic surgeon Mohamad Allaf and Cal Ripken Jr. discuss his prostate cancer journey at Johns Hopkins and share his powerful message to men across the world.
Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.
Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.
The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.
The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.
This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.
They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.
Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.
The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,
Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.
This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.
Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.
–DR. C
Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.
Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.
Doctors Without Waiting Rooms 