Chicago Health | Homepage
New Treatments in Prostate Care

New Treatments in Prostate Care

By Tom Mullaney

It seems inconceivable that a small, walnut-sized gland lying just below the bladder could be the vicious killer of about 28,000 American men this year. Yet, that is the devastating toll inflicted by prostate cancer.

Until quite recently, urologists had a limited, unreliable arsenal to screen for the disease, namely the prostate-specific antigen blood test (PSA) and a digital rectal exam. Speaking with a number of medical urologists and urologic surgeons at leading Chicago facilities, Chicago Health learned how new, promising research and treatment options are offering better diagnostic and surgical outcomes.

The PSA is not a diagnostic test, but simply a blood test that is prone to false positive readings. PSA levels are correlated with risk of prostate cancer. There are not reliable normal or abnormal levels, and patients are often faced with a diagnostic gray zone. In these situations, urologists have struggled with whether to recommend biopsies.

“If a man is diagnosed with prostate cancer, many management options exist, which can range from active surveillance to surgery to radiation to androgen deprivation (hormonal therapy) or a combination of treatments,” says Scott Eggener, MD, co-director of the Prostate Cancer Program at University of Chicago Medicine and president of the Chicago Urological Society. “Today, new tests, such as the 4K Score (OPKO) and Prostate Health Index (PHI), Polaris and Oncotype, have been shown to outperform the traditional PSA test. Multiple published articles have shown these tests to more reliably identify high-grade prostate cancers on biopsy while minimizing the total number of men requiring a biopsy. They’re giving doctors a better assessment of risk.”

Eggener says that improved diagnostics can now help physicians reduce the number of biopsies doctors perform and offer a more tailored approach for men diagnosed with prostate cancer. For many of these men, active surveillance is an attractive option since many small cancers neither grow rapidly nor escape the prostate wall and can be closely monitored over time without resorting, as before, to radiation or surgery.

When a biopsy is warranted, physicians typically insert a needle through the rectum and probe 12 areas of the prostate. Yet, this method often misses hidden tumors, resulting in undertreatment. A 12-core biopsy only samples 1 percent of the prostate surface, according to Gopal Gupta, MD, prostate cancer surgeon at Loyola University Health System.

A new technology, UroNav, is giving urologic oncologists higher precision and detection capabilities for prostate biopsies. The software fuses images from MRIs with ultrasound to create a three-dimensional view of the prostate. Ultrasound determines the prostate’s size while the MRI guides the biopsy needle via GPS-style technology to lesions it has detected. This improves tumor detection and the degree of aggressiveness—vital biomarkers that guide better treatment options.

This technology is allowing surgeons to achieve a more targeted biopsy, says Gupta. Loyola was the first medical center in Illinois to install this new technology that now can be found in other major hospitals. Gupta says the new technology is “the hottest topic of discussion and excitement at medical conferences.” The goal is to detect even more microscopic tumors that previously went undiscovered.

Should all of the available information suggest that the cancer has not escaped the prostate wall nor entered the patient’s lymph nodes and/or bones, new treatment options can be considered. Eggener practices a procedure titled Focal Therapy (focal laser ablation), which pairs MRI with a pinpoint laser to ablate—vaporize—a prostate’s cancerous cells using high heat.

In surgery, urologists are turning to robotic surgery with its minimally invasive incisions and faster recovery times. Vishal Bhalani, MD, a urologic surgeon and chair of the Robotics Steering Committee at Weiss Memorial Hospital, has performed close to 200 operations with the da Vinci Surgery robotic platform.

Joe Murphy, a business owner from Aurora, was referred to Bhalani last summer. He showed none of the normal prostate symptoms, yet his PSA test score was quite high. The biopsy revealed a prostate, not walnut-sized, but as big as an orange. “I was shocked when they told me,” Murphy says.

Murphy says Bhalani made five small cuts in his abdomen. The robot was used to remove the prostate and reconnect the bladder to the urethra. Murphy left the hospital two-and-a-half days after surgery and is amazed at his rapid recovery.

“I couldn’t lift anything for a week. [Bhalani] took the [catheter] out a week later, and then I could do pretty much anything. I drove my car and went to the store. I just couldn’t do any heavy lifting for three weeks,” Murphy says. He has had three blood tests over the past nine months; all have shown no sign of any cancerous activity. He praised his surgeon’s “incredible patience” with all his concerns.

Bhalani is excited by current prostate cancer research focusing on lifestyle (smoking and exercise) and nutrition. Eggener heads a clinical trial based on these factors for the National Cancer Institute, further exploring whether dietary modifications (more fruits and vegetables, less red meat) can slow the growth of this silent but deadly cancer.

As long as physicians continue improving their approaches to prostate cancer faster than the cancer can grow and spread, the future of prostate health is looking good.

Read six critical questions to ask your doctor about prostate cancer.

Originally published in the Fall 2015 print edition.

Similar Articles

Developments in Male Birth Control

Developments in Male Birth Control

Men’s choices are limited, but promise is on the horizon By Erika Napoletano It’s not uncommon to

Low Testosterone Can Cause Declines Throughout the Body

Low Testosterone Can Cause Declines Throughout the Body

By Laura Drucker Our bodies are complex centers of communication. And testosterone is a hormone with

Multiple options to help men with ED, enlarged prostate

Multiple options to help men with ED, enlarged prostate

The Medicine Cabinet: Ask the Harvard Experts By Howard LeWine, M.D. Q: I recently saw my doctor

Simple steps to relieve prostate symptoms

Simple steps to relieve prostate symptoms

The Medicine Cabinet: Ask the Harvard Experts  By Howard LeWine, M.D. Q: I have a frequent urge

Diagnostic approaches to female infertility

Diagnostic approaches to female infertility

The Medicine Cabinet: Ask the Harvard Experts By Joan Bengtson, M.D. Q: What kind of tests will

Articles By Category

Family Health

In The Know

CH Lifestyle

March 2017
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
February 26, 2017 February 27, 2017 February 28, 2017 March 1, 2017 March 2, 2017 March 3, 2017 March 4, 2017
March 5, 2017 March 6, 2017 March 7, 2017 March 8, 2017 March 9, 2017 March 10, 2017 March 11, 2017
March 12, 2017 March 13, 2017 March 14, 2017 March 15, 2017 March 16, 2017 March 17, 2017 March 18, 2017
March 19, 2017 March 20, 2017 March 21, 2017 March 22, 2017 March 23, 2017 March 24, 2017 March 25, 2017
March 26, 2017 March 27, 2017 March 28, 2017 March 29, 2017 March 30, 2017 March 31, 2017 April 1, 2017

Categories

Recent Comments

Swing for the fences in the fight to Sideline Pancreatic Cancer

Swing for the fences in the fight to Sideline Pancreatic Cancer

Enjoy a great night of baseball at Peoples Natural

VIEW ARTICLE
Cost to give birth 1943 - Page 3 - Defending The Truth Political Forum

Cost to give birth 1943 - Page 3 - Defending The Truth Political Forum

A Hazy Shade of Healthcare: What does tort reform

VIEW ARTICLE

Archives