Prostate Cancer Archive

There's a lot you can do to improve your outcome if you're taking an active surveillance approach to your diagnosis.

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About 90% of men diagnosed with prostate cancer have the localized kind, which means the cancer is confined to the prostate gland. And for many, a reasonable approach is active surveillance, in which men choose to monitor their cancer instead of going straight into invasive treatments, such as surgery or radiation therapy.

Active surveillance includes a doctor visit about every six months, most often with a prostate-specific antigen (PSA) blood test and digital rectal exam.

On call

Q. I was recently diagnosed with prostate cancer. Does the occurrence of one type of cancer indicate a greater risk of developing other kinds?

A. Prostate cancer is the most common cancer among men, and almost every man will get prostate cancer if he lives long enough. In general, prostate cancer that develops after age 60 probably does not increase the risk of getting a different kind of cancer. However, there are some exceptions.

In the journals

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The U.S. Preventive Services Task Force recently updated its guideline for prostate-specific antigen (PSA) screening for prostate cancer.

The group now recommends that for men ages 55 to 69, screening should be an individual choice, and a man should discuss the pros and cons with his doctor before making a decision. The report, published online May 8, 2018, by The Journal of the American Medical Association, differs from the 2012 guidelines that recommended against screening for all men.

In the journals

Only a biopsy can determine for certain whether prostate cancer is present, but a new study suggests that using magnetic resonance imaging (MRI) can help to better identify patients who are more likely to need a biopsy versus those who aren't.

The study, published online Feb. 22, 2018, by JAMA Oncology included 651 men screened for prostate cancer with blood tests and digital rectal exams. Everyone underwent three procedures: an MRI scan, a biopsy guided by transrectal ultrasound (TRUS), and a biopsy guided by both MRI and TRUS.

In the journals

Men with intermediate-risk prostate cancer may benefit more from a shorter duration of hypofractionated radiation therapy (HRT) than from standard radiation therapy. With both types of radiation therapy, the total amount of radiation is given in multiple sessions over a set period. Compared with standard radiation therapy, HRT uses larger doses over a shorter period of time.

A study in the Nov. 4, 2017, European Urology Focus analyzed data of 3,553 men with prostate cancer, 65% of whom had intermediate-risk prostate cancer. The men were randomized to get either a one-month program of HRT or the standard radiation treatment regimen given over two months. After an average of five to six years, the intermediate-risk men who had HRT were less likely than men who got standard radiation therapy to have their prostate cancer return.

In the journals

Observation only may be the best medicine for men with early-stage prostate cancer, suggests a 20-year study published online July 13, 2017, by The New England Journal of Medicine. Early-stage prostate cancer means the cancer is small, confined to the prostate gland, and can only be detected with a biopsy.

Researchers randomly assigned 731 men, average age 67, with localized prostate cancer to receive either surgery or observation only. At the 20-year follow-up, 62% of the men who had prostate cancer surgery had died of other causes, while only 7% died from prostate cancer. In comparison, 67% of the men assigned to observation died from other causes and 11% from prostate cancer. The absolute differences in mortality were not significant.

In the journals

A study of almost 31,000 men whose prostate cancer had not spread found that the use of androgen deprivation therapy (ADT) was not associated with a higher risk of Alzheimer's disease. This counters previous studies that suggested a possible link. The results were published in the January 2017 Journal of Clinical Oncology.

ADT is used in prostate cancer treatment to eliminate testosterone, since the hormone can fuel the disease. Testosterone levels also are traditionally lower in men with Alzheimer's compared with control groups, which suggests there may be a connection between lowering testosterone and an increased risk of Alzheimer's. Previous studies that have explored this connection found that a low testosterone level caused by ADT was associated with a higher probability of developing Alzheimer's. But these studies often covered a shorter time period — for instance, one year or less — and it is doubtful that men were on ADT long enough to cause Alzheimer's.

In the journals

Prostate-specific antigen (PSA) tests are used to help identify men who may have a higher risk of prostate cancer. But a study published online Jan. 12, 2017, by JAMA Oncology, describes a new way to use PSA that may pinpoint men who are likely to die early from prostate cancer that returns after initial treatment.

The researchers used data from a randomized trial of 157 men whose localized cancer was treated with either radiation alone or radiation along with six months of androgen deprivation therapy. The men were then followed for 16 years.

Biomarkers are molecular signatures of both normal and abnormal processes in the body. Here is a more formal definition proposed by a "definitions" working group associated with the National Institutes of Health: "A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacological responses to a therapeutic intervention."

Proteins, fragments of proteins, enzymes, DNA, the RNA molecules that "read" DNA—they all can serve as biomarkers. Blood is an ideal source material because it's easy to collect and examine, but biomarkers can also be found in other body fluids, like urine, and in tissue itself. Biomarkers can inform decisions before, during, and after treatment.

Researchers have mapped patterns of prostate cancer recurrence following surgery, which may help doctors find the best way to treat men whose cancer has returned. About 30% of men who have prostate cancer surgery will have a recurrence, according to the study in the Journal of Urology.