January 5, 2024
Screening, Diagnosis and Treatment Promises in Prostate Cancer
As the calendar turns to a new year, I find this an excellent time to gaze ahead with hope at the promising progress made in prostate cancer screening, diagnosis, and treatment. The scientific medical community isn’t always great at getting the word out to the public about its incredible advancements, but rest assured, those advancements are happening in amazing ways. Specifically, I want my community to feel confident in the considerable effort underway by a wide range of urologic scientists to find novel ways to screen for, diagnose, and treat prostate cancer.
The most essential way urologists can identify and provide early (and the most effective) treatment for prostate cancer is via the screening process. I am happy to report that much recent progress has been made in effectively screening for prostate cancer. Traditionally, prostate cancer screening involves a rectal examination and blood testing for PSA (prostate-specific antigen). If either of these examinations increases suspicion of prostate cancer, then a biopsy of the prostate is indicated. More recently, however, if a man’s rectal exam or PSA test is abnormal, then several other newer tests (MRI of the prostate, 4K prostate test, prostate liquid biopsy) may be performed to determine his risk for the presence of prostate cancer — before a biopsy is performed. If these diagnostic tests are abnormal, then a prostate biopsy is performed to determine the presence or absence of prostate cancer definitively. Newer testing modalities help to provide a clearer diagnostic picture for urologists without having to invasively biopsy the prostate at the first hint of abnormality — a definite win for our patients.
Over the past few years, research on the genetic components of prostate cancer has aimed at identifying various genes and pathways to the development of aggressive (which can also be deadlier and more challenging to treat than non-metastatic) prostate cancer and the ability of cancer to advance into metastasis. One of the new ways in which research has identified treatment is something called the PARP pathway. PARP stands for poly (ADP-ribose) polymerase - an enzyme responsible for DNA repair in cancer cells.
Recently, medication therapies that inhibit PARP, known as PARP inhibitors, have been shown to be effective against various cancers, including prostate cancer.
Another novel way in which prostate cancer can be treated is by activating the immune system, a treatment modality known as immunotherapy. There are multiple immunotherapy medications available currently, one example being Pembrolizumab. Pembrolizumab is a monoclonal antibody that stimulates the immune system to destroy cancer cells. This medication binds to the receptors on immune T-cells and blocks the receptors’ interactions with the receptors on tumor cells. These blocked cell interactions then lead to the T-cells’ ability to recognize the cancer cells as foreign and destroy them.
Recent advances in artificial intelligence (AI) may also aid urologic health providers in the improved interpretation of prostate MRI images by finding more abnormal lesions and improving the recognition of cancer cells under microscopy after a prostate biopsy. Robotic surgery is associated with lower blood loss, less pain, faster recovery, more accuracy in dissection of the tissues, and less scar formation. Robotic surgery is in a state of constant flux, as there are numerous improvements in this way of performing prostate surgery. These improvements are categorized by surgeon technique and technological advancement of the robot.
Though no one likes to think of their future cancer risk, it is important to me that my community knows how seriously my urologic health colleagues and I take our jobs. Cancer prevention is always at the forefront of our minds but our loftiest goal is to cure our patients’ cancer when it does develop. I am confident that the many recent advancements in the screening, diagnosis, and treatment of prostate cancer will help us do just that.