Five things to help you better understand prostate cancer

PSA may not be the best way to determine if you have cancer—but it’s not bad either.

Sidana: PSA, or prostate-specific antigen, is a protein produced by both cancerous and noncancerous prostate tissue, though cancerous tissue produces PSA at much higher levels. Blood PSA levels along with prostate exams through rectum are the screening tests used in men aged 55 to 69 to estimate their risk of prostate cancer. If an abnormality is found in either one, further evaluation is prompted. Over the last decade, prostate magnetic resonance imaging, or MRI, has emerged as a vital test in further evaluation and has improved accuracy of prostate cancer detection.

There are two aspects of PSA testing which have led to controversary. Firstly, it’s not a very specific test, which means it’s not elevated every time the patient has prostate cancer. Benign enlargement, infection and inflammation of the prostate can cause PSA levels to be elevated. Approximately 50% of men with elevated PSA will be found to have a noncancerous cause of elevated PSA, amounting to unnecessary prostate biopsies. Secondly, a lot of patients who find they have prostate cancer due to PSA testing have low-risk disease. This leads to patient anxiety, over treatment, side effects and excess health care costs for a cancer which will probably not lead to death. All of this could be avoided if they are not diagnosed with low-risk prostate cancer in the first place. So, critics advocate either a better way of diagnosing or no screening at all. The proponents argue that PSA testing still saves the lives of thousands of men.

I feel in the hands of somebody who has in-depth understanding of prostate cancer and PSA kinetics, PSA is a reasonably good test.

 Not every prostate cancer must be removed or even treated for the best outcomes.

Sidana: Approximately a third of prostate cancer diagnoses are low-risk, implying the risk of death from such cancers is low—less than 5%. However, until a few years ago, a very high percentage of such men were still undergoing treatment causing significant side effects without significant benefits in terms of survival. More recently, physicians have started monitoring these patients closely, known as active surveillance, and patients are treated only when the cancer gets more aggressive. A large percentage of such patients can either put off their treatment for several years or not require treatment at all during their lifetime.

For patients diagnosed with aggressive cancer upfront, surgery in terms of removal of the entire prostate and radiation therapy to the prostate are the two most common treatments.

But there is now a “lumpectomy” option for these types of cancers in men.

Sidana: Recently, focal therapy for prostate cancer has emerged as a new treatment strategy, which is considered the equivalent of a lumpectomy in prostate cancer. In such treatments, only the cancerous part of prostate is located and destroyed while the noncancerous part is preserved, minimizing the side effects from prostate cancer treatments. Incorporation of prostate MRI in the diagnosis of prostate cancer has allowed us to offer these treatments to prostate cancer patients and minimize side effects on erections and urination.