Update on Prostate Cancer Screening and Treatments

Prostate-specific antigen (PSA) is measured in nanograms per milliliter, or ng/mL. Higher amounts of PSA in the blood have been linked to higher risk for prostate cancer. Levels below 3 ng/mL are basically considered normal, but there is a big grey area because PSA levels can be higher or lower due to conditions that aren’t related to prostate cancer. For example, urinary tract infections, or an enlarged or inflamed prostate gland can result in higher PSA. Other factors may lower PSA and mask a potentially cancerous condition; these include obesity, smoking, recent ejaculation, and the use of medications, including some common high blood pressure and cholesterol-lowering drugs.

The case for PSA screening is that the test may detect prostate cancer before it starts causing symptoms, and thus is easier to treat and often cure. The disadvantage is that it also finds small tumors that are very slow growing and may never cause a problem. In some cases, this has led to unnecessary treatments, which come with potential risks, such as urinary leakage and sexual dysfunction.

In general, however, if PSA is over 10 ng/mL, it’s likely due to cancer. Conversely and rarely, some men with a low PSA level may still have cancer. Therefore, many experts advocate for the use of formulas and risk calculators which incorporate PSA and other clinical factors to compile an individual’s risk assessment.

Key Clinical Data

With early-stage prostate cancer there are three factors that are critical to know, according to urologist Christopher Saigal, MD, professor of urology at UCLA Medical Center. The first is knowing your PSA at diagnosis.

“In men with prostate cancer PSA is overproduced in the blood. The more of it you make, the greater the chance of recurrence after treatment,” explains Dr. Saigal. “The second most important is the Gleason score, a measure of how aggressive the cancer looks on slides. The T-stage or tumor stage is also critical. In a physical exam you might not feel anything abnormal, but if you can feel a bump that is an indication of a higher T score.”

Most men diagnosed with prostate cancer have localized and low-risk or intermediate disease. Management options include radiation, radical prostatectomy, brachytherapy (surgically implanted radiation), and many choose active surveillance.

Advances in Treatment

Technical advances have improved upon external radiation treatment, significantly cutting down on the time commitment required for treatment. This newer type of radiation, known as stereotactic body radiotherapy, is a form of external beam radiation therapy that reduces the duration of treatment from 45 days to four to five days. The approach has been in use since 2000, but has not yet been widely adopted because of concerns over how safe and effective this approach would be in the long term. A recent UCLA-led study showed that men can safely undergo higher doses of radiation over a significantly shorter period of time and still have the same, successful outcomes as from a much longer course of treatment.

“We’ve found that using stereotactic body radiotherapy, which has a higher dose of radiation, can safely and effectively be done in a much shorter timeframe without additional toxicity or compromising any chance of a cure,” says the study’s lead author, Amar Kishan, MD, researcher at the UCLA Jonsson Comprehensive Cancer Center.

Researchers followed study participants for about seven years and discovered that recurrence rates for the disease were identical to recurrence rates found using more conventional forms of radiation.

Consider Your Options

With a prostate cancer diagnosis you have time to decide what’s best for you. Studies show there’s no difference in outcomes between immediate treatment and waiting six months. If possible, consider going to a medical center that has a prostate cancer program. Those centers provide more robust options that include caring for patients’ pelvic, urinary, sexual, and psychological needs. Men with higher-risk cancer are often eligible for prostate clinical trials, and centers with prostate cancer programs tend to have those available.

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