Prostate Cancer Advancements in 2023
Prostate Cancer Advancements in 2023
By Ali Hajiran, MD, chief, Urologic Oncology, WVU Cancer Institute
Understanding Prostate Cancer
Prostate cancer is a disease that originates in the prostate gland, a small, golf-ball sized organ that is responsible for producing seminal fluid in men. Prostate cancer occurs when normal cells within the prostate develop genetic changes that cause them to multiply uncontrollably. Other than skin cancer, prostate cancer is the most common cancer in American men. Several risk factors, including age, family history, and ethnicity, increase the likelihood of developing prostate cancer.
It is important to understand that every man’s prostate cancer is unique. Many men harbor slow-growing prostate cancers that do not pose a threat to their health. On the other hand, some prostate cancers are fast-growing and have a high risk of spreading. Most men will not experience any symptoms from prostate cancer; therefore, early detection through screening is key to unmasking the bad players.
Advancements in Diagnosis
In the past, prostate cancer was diagnosed using a physical exam and a prostate-specific antigen (PSA) blood test. Although effective, this method
of screening led to overdiagnosis and overtreatment of prostate cancer. With more refined tests, we are now able to better discern aggressive from non-aggressive disease, reducing the risk of unnecessary treatments.
A major advancement in prostate cancer diagnosis has been the adoption of magnetic resonance imaging (MRI). This non-invasive imaging technique allows for more precise identification of prostate tumors. If an area suspicious for cancer is detected on an MRI, we can combine real-time ultrasound imaging with MRI images to perform targeted biopsies. This method, known as MRI-fusion prostate biopsy, is a powerful tool that improves the accuracy of tissue sampling and reduces the likelihood of missed cancers and unnecessary biopsies.
If prostate cancer is detected on a prostate biopsy, we can classify cancers into low, intermediate, and high-risk groups. To further classify cancers, there are now molecular studies that analyze specific genes and genetic mutations within a tumor. Understanding the molecular profile of an individual patient’s prostate cancer allows healthcare providers to tailor treatment plans to match the aggressiveness of the cancer.
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scans are another major innovation in prostate cancer imaging. This cutting-edge advanced imaging modality enables physicians to detect tiny cancer lesions with remarkable precision. This study is especially beneficial for locating recurrent or metastatic prostate cancer.
Advancements in Treatment
Once patients are deemed to be candidates for localized prostate cancer therapy, recent advancements in surgical techniques have opened new doors for enhanced precision and quicker recovery. One such innovation is single-port robotic surgery. Using just one very small incision, this approach allows surgeons to access and remove the prostate with exceptional precision without having to manipulate other organs. This approach can be advantageous for patients who may have extensive intra-abdominal scarring from prior surgeries or patients with cardiopulmonary disease. This minimally invasive approach can result in less pain, reduced scarring, and quicker return to normal activities for patients compared to traditional open surgery.
For patients seeking alternatives to surgery in their prostate cancer treatment, there is promising news in the realms of focal therapy and radiation therapy. Treatments like high-intensity focused ultrasound (HIFU) can precisely target and destroy cancerous areas within the prostate while minimizing side effects. Radiation therapy has seen remarkable advancements in delivering higher doses of radiation with pinpoint accuracy in fewer treatment sessions.
The results of recent clinical trials have expanded the therapeutic options for patients with meta- static prostate cancer. In addition to hormone therapy, there is now a list of chemotherapy, immunotherapy, and targeted therapy options that can be used in different combinations and sequences in patients with advanced disease. The latest radiopharmaceuticals, drugs that deliver radiation to PSMA-expressing prostate cancer cells, are showing promising outcomes in
patients who previously had limited options.
In conclusion, the year 2023 marked an exciting time in the management of prostate cancer. As the Urologic Oncology team here at the WVU Cancer Institute continues to ride the wave of medical innovation in 2024, it is imperative that patients and healthcare providers stay informed about these advancements, ensuring that men receive the best possible care and support throughout their prostate cancer journey.
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