There’s a good chance you know someone who has had or is battling prostate cancer. This malignancy is the most common solid organ cancer in men, and the second leading cause of cancer death among men in the United States. Approximately one in thirty-five men will die of prostate cancer and for African American men, the risk is doubled.
According to the American Cancer Society, prostate cancer accounts for about 10 percent of cancer-related deaths in men between the ages of sixty and seventy-nine and nearly 25 percent in those over the age of eighty. In 2014, there were more than 230,000 new cases and 29,000 deaths from prostate cancer in the United States.
The exact causes of prostate cancer remain unclear. However, worldwide research has moved us closer to answering many questions about this disease process. The current theory suggests there are multiple factors that increase a man’s risk for developing prostate cancer.
These include: age, world region location, ethnicity (African Americans have twice the risk of Caucasians), smoking, family history, dietary habits, and vitamins.
Recently, there has been much contro- versy over prostate cancer screening. Although cancer screening has been proven to save lives, those men with very low risk may not necessarily need to undergo routine prostate cancer screening.
The American Urologic Association has developed a clinical guideline for PSA (prostate-specific antigen) screening that recommends the greatest benefit resides with screening men age fifty-five to sixty-nine years old. For men younger than age fifty-five at higher risk (for example a positive family history or African American race), decisions regarding prostate cancer screening should be individualized and earlier initiation of screening should be considered. Naturally, shared decision-making between a man and his physician remains a critical component.
Prostate cancer diagnosis has traditionally been accomplished by performing systematic two-dimensional ultrasound-guided random biopsies of the prostate. New 3D magnetic resonance imaging (MRI) technology has revolutionized the approach to prostate cancer diagnosis and can also aid monitoring existing prostate cancer. This technology involves an initial MRI procedure to evaluate the prostate for any suspicious lesions. If the findings are positive, the next step involves a fusion-directed prostate biopsy under general anesthesia. The images from the prior MRI are fused with real-time ultrasonography to target the specific lesion in question. This leads to fewer and more accurate biopsies. What’s more, recent studies show that the detection rate of what is known as clinically significant prostate cancer is near doubled with this technology.
After a diagnosis is made, one of the next steps involves risk assignment. Factors such as PSA level, Gleason score (the name for the standard grade the prostate biopsy cells are given which indicates how aggressive the cancer is, or how likely it is to grow and spread outside the prostate); age, and volume of disease have been the standard over the years. Lately, there has been a surge in genetic testing used throughout oncology. In regards to prostate cancer, Oncotype DX is one technology that utilizes the tumor biology from your biopsy to determine the risk of the cancer spreading beyond the prostate. This tool can aid in the decision-making process to proceed with treatment or active surveillance.
Much progress has also been made in the area of management of prostate cancer resistant to hormonal manipulation. Newer drugs such as abiraterone (Zytiga) that block production of androgens, enzalutamide (Xtandi) that block the prostate cancer cells from responding to androgens, and Sipuleucel-T (Provenge) that work as a cancer vaccine by boosting the body’s immune system to specifically attack prostate cancer cells, have all shown to improve overall survival in patients.
