Prostate cancer: Moving toward a future with better screening, imaging
September 3, 2015 | by Denise Heady
In 2015, only a handful of cancers can be declared highly curable. Prostate cancer, which is the most common cancer in men, is one of them.
“People don’t realize prostate cancer is one of the most treatable forms of cancer,” said Ali Zhumkhawala, M.D., clinical assistant professor of the Division of Urology and Urologic Oncology at City of Hope. “Even patients that have had cancer spread widely throughout their body can be treated for years and still have a very good quality of life.”
Current treatments for the disease have proved life-changing for patients, and today there are more than 2.9 million men in the United States who are prostate cancer survivors.
“Because prostate cancer affects so many people, there’s been so much research put into studying it,” Zhumkhawala said. “Even when patients don’t respond to the first line of therapy, there’s a second, third, a fourth and fifth line of therapy. And then there are a number of clinical trials they can enroll in. So even if we can’t cure them surgically, that doesn’t mean we don’t have treatments to offer.”
Treatments and screening methods for prostate cancer have evolved tremendously over the past two decades, and Zhumkhawala expects more improvements on the horizon for prostate screening tests and surgical imaging.
The screening debate
In 2012, the U.S. Preventive Services Task Force decided to recommend against routine prostate specific antigen (PSA) screening for prostate cancer. Many medical professionals fear that this decision will cause an increase in higher-risk prostate cancer.
“The problem with their recommendations, as I and most cancer specialists see it, is that they (task force members) focused on one clinical trial that was deeply flawed,” Zhumkhawala said. “There’s going to be a lot of data in the next 10 years that shows that when we stopped PSA screening, we started picking up more cancers at a later stage, where it’s harder to treat and unfortunately there will be more morbidities associated with the cancer.”
City of Hope researchers already have data suggesting that the recommendations against PSA screening for prostate cancer may have led to an increase in higher-risk prostate cancer.
Zhumkhawala acknowledges that the current PSA screening does have its flaws, but says it's the best tool currently available for detecting prostate cancer early.
“We do need a better screening tool,” Zhumkhawala said. “PSA is good, but it’s not perfect. I think we need a combination of a lot of different tests that work together – including genetic profiling. We are working on a lot of things that are a little bit more personalized to each patient, and we’ll really start to make a lot of progress in that field in the next five to 10 years.”
Researchers at City of Hope, for example, are working on a noninvasive "liquid biopsy" that would dramatically decrease the risk of infection and bleeding associated with traditional biopsies.
New imaging techniques
Then there's the matter of tumor removal. Here, too, doctors have seen advances.
When removing cancer tumors, surgeons also often must remove part of the organ the cancer is disturbing. This is true for kidney cancer, liver cancer and even colon cancer. But for prostate cancer, the entire prostate is typically treated with radiation or removed completely with surgery.
“This is probably something that needs to change for a lot of patients,” said Zhumkhawala. “There are a subset of patients where we may be able to just treat the cancer and not the whole prostate, with the same quality of life and equivalent cancer outcomes.”
Zhumkhawala and other City of Hope researchers are studying how to improve surgical outcomes for prostate cancer with the use of fluorescent antibodies. This study, which is a first in humans, uses a unique antibody that attaches to the prostate specific membrane antigen and can fluoresce bright green when exposed to a specific wavelength of light.
“The use of fluorescent antibodies has the potential to advance surgical technique and improve outcomes by allowing surgeons to visualize the margins of the prostate and cancer more accurately,” said Zhumkhawala. This will allow for more accurate preservation of the structures that are responsible for both erections and urinary control.”
Zhumkhawala is hopeful for these prostate cancer advancements, but reminds patients that every person is different and therefore needs a unique treatment plan.
Sometimes that individualized plan may not even include treatment. Known as active surveillance, this option doesn’t warrant any immediate treatment, and instead monitors a patient’s cancer and PSA levels to ensure there are no signs of the cancer growing. This type of plan helps avoid unnecessary treatments for patients with low-risk prostate cancers that may not significantly affect a man’s life.
“What people really need to know about prostate cancer is that there are different treatments that can be used for different people. When you see a urologist to treat your prostate cancer, it should really be a team approach, and it should be an approach that finds the treatment that works best for each individual patient.”
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