The Doctor Is In: Prostate Cancer Screening

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Content is sponsored and provided by Henry Ford Health System

Craig Rogers, M.D. 
Chair, Vattikuti Urology Institute, Henry Ford Health System 

Among men in the U.S., prostate cancer is the most common cancer and the second-leading cause of cancer-related death. This year, the American Cancer Society estimates that nearly 175,000 men will be diagnosed with prostate cancer (about 1 in 7 men) and more than 31,000 men will die from it.  

While these statistics are alarming, prostate cancer is very survivable with proper screening and treatment. More than 2.9 million men in the U.S. who have been diagnosed with prostate cancer at some point in their lifetime are still alive today, and the five-year survival rate for prostate cancer is 98%.  

Dr. Craig Rogers, chair of the Henry Ford Vattikuti Urology Institute, explains some of the newer diagnostic tools and treatments that are adding years to the lives of prostate cancer patients. 

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Screening and Common Symptoms 

The Henry Ford Cancer Institute follows current recommendations for prostate screening, including the American Cancer Society and the American Urological Association.  

For those with an average risk:
Screening is most likely to be beneficial in their 50s and 60s.
Healthy men may want to consider continuing screening through their 70s. 

Men at high risk:
Including those with a family history of prostate cancer, BRCA gene mutations, and African American men - should begin between the ages of 40 and 45, as determined through a shared decision with their doctor.  

Screening is usually done with a prostate-specific antigen (PSA) blood test, and/or digital rectal exam. PSA is an imperfect test and can be artificially elevated due to factors such as inflammation, infection, enlargement, medications, and recent sexual activity. 

Symptoms could include problems urinating; however most early prostate cancer does not have noticeable symptoms.  

There are newer diagnostic tests for prostate cancer that can be used with PSA testing to improve accuracy. These include urine and blood tests that are available to more accurately identify patients who really need a biopsy, and those who can avoid a biopsy. Risk calculators can calculate the likelihood a patient would have cancer if they were to have a biopsy. 

When is a Biopsy is Needed? 
If prostate cancer is suspected following initial screening, a patient may need a prostate biopsy.  
Prostate biopsy is when a urologist takes a sample of tissue from the prostate, which is analyzed to determine if cancer is present.  
The most common type is a transrectal biopsy, in which a needle is placed into the prostate through the rectum in order to collect a sample of prostate tissue. This procedure is usually performed in the office. 

A new, safer approach now exists, known as a transperineal biopsy.  
With this approach, the biopsy is collected via needle entered through the skin just above the rectum, which greatly reduces the risk of infection and the need for antibiotics. This approach has the potential to improve prostate cancer detection. 

Current advances have allowed the use of MRI to the diagnostic accuracy of the biopsy. Prostate MRI has shown to improve the diagnosis of higher-risk cancers that need to be found and reduce the unnecessary diagnosis of low-risk cancers that are better not to find. 

If Treatment is Needed, What are the Latest Treatments Available? 

Focal treatments to minimize side the effects of prostatectomy. 
Rather than treating the entire prostate with surgery or radiation, focal therapy involves specifically targeting the area of the prostate with cancer using energy such as freezing, heat, or radiation to destroy the cancer cells. Focal ablation can be used for select patients with localized prostate cancer to help minimize side effects of prostate cancer treatment, including urinary incontinence and erectile dysfunction. 

Cryoablation is a minor surgery that involves placing small needles into the part of the prostate involved with cancer and freezing that portion of the prostate to destroy the cancer cells. This procedure can be done with a targeted and transperineal approach, similar to the prostate biopsy. 

Minimally-invasive Surgery 

Doctors use a robot-assisted surgical system, which provides a 3D view of the surgical area and increases precision and control. Patients experience less blood loss, less discomfort, less scaring, and faster recovery times.  

The Precision Prostatectomy, developed at Henry Ford, is an alternative to focal ablation, in which over 90% of the prostate is removed, with complete removal on the side of the highest risk cancer and sparing the outer rim of prostate (and nerves of erection) on the side without significant cancer.