Prostate cancer is one of the most common types of cancer affecting men, with one in six American men receiving the diagnosis in their lifetime. In most cases, the disease grows slowly and causes no problems. But some prostate cancers are fast-moving and lethal, causing more than 29,000 deaths annually because the disease wasn't detected and treated in time.
Here Jennifer Linehan, M.D., a surgeon on City of Hope’s renowned Division of Urology and Urologic Oncology program team, clears up confusion about using prostate-specific antigen (PSA) tests to screen for the disease, and how technology plays a role in some of the newest advanced prostate cancer treatment options available.
There’s been a lot of debate about the usefulness of PSA screenings. What’s the latest thinking?
For years, routine PSA assessment was considered a standard part of preventive medicine, and surveillance was commonly encouraged. However, last year, the U.S. Preventive Services Task Force came out with a new recommendation — namely that all men do not need regular PSA screening tests performed unless they are determined to be at increased risk for prostate cancer.
My thought is there needs to be a balance between over-treatment and care for those patients who really need it. I try to educate patients, as well as primary care physicians, about screening for risk factors instead of just screening based on age. We balance risks factors such as having a first-degree relative with prostate cancer or ethnicity against patient life expectancy, co-morbidities and age to decide on PSA testing.
The American Urology Association still currently recommends that we test PSA every year, but this includes a lengthy discussion about the patient regarding other factors that can elevate PSA artificially and the endpoints of screening, such as diagnosis of prostate cancer and treatment.
What are the latest advances in prostate cancer treatment?
One of the latest advances in prostate treatment is robotic surgery. With this minimally invasive surgery, patients often recover faster, experience less blood loss, decreased positive-margin rate and sometimes better nerve preservation. Another new option we’re soon offering at City of Hope is using MRI-U/S Fusion Biopsy and advanced imaging techniques to aid in diagnosis, as well as active surveillance.
Are there ways to reduce the risk of prostate cancer?
The biggest risk factor for prostate cancer is obesity. What I recommend to my patients is to work with a nutritionist, eat a healthy diet and exercise. These are the best things you can do to reduce your risk for prostate cancer. There have been a lot of studies with green tea, and although findings haven’t been published yet, it has been shown to decrease inflammation which we think is a precursor to forming prostate cancer.
What progress has been made in reducing the risk of impotence and incontinence following prostate cancer treatment?
We have an increasing understanding of the etiology of impotence and incontinence after prostatectomy and the importance of the prostatic nerves in both functions. One method we use is “penile rehabilitation,” with the goal of re-oxygenating the nerves/tissues after surgery. This can be done with drugs like Viagra or Cialis, or a vacuum erection device. We are finding this treatment helpful for both continence and erectile dysfunction. Pelvic Floor Physical Therapy is another method to improve continence and is offered at City of Hope in Duarte.
What advice do you have for someone recently diagnosed with prostate cancer?
Advice I often share with my patients is to first find a doctor that you trust. Second, explore every option – look at surgical options, find a radiation oncologist, find a medical oncologist and find a prostate cancer support group. The more information you have, the better decision you’re able to make.
Why did you choose this specialty? What inspires you to do the work you do?
I chose urologic oncology surgery first and foremost because I love helping people. Working with cancer patients is the most rewarding job. I find their courage and resilience inspiring. I also have a deep interest in robotics and technology. Urology allows me to use world-class robots and other state of the art technologies in many cancer and noncancer procedures.
Do you think annual screenings for prostate cancer should continue for all men, or only for those at high risk of the disease? Let us know your thoughts by commenting below. To learn more about City of Hope's prostate cancer diagnosis and treatment options, visit cityofhope.org/prostate-cancer.