Prostate cancer is the No. 1 cause of cancer death among American men who don’t smoke, and the No. 2 cause of cancer death in American men overall. In other words, it steals a lot of fathers, husbands, brothers, sons, and friends. We asked Mayo Clinic prostate cancer experts Dr. Matthew Tollefson, Dr. Dan Childs, and Dr. Jacob Orme to help us understand not only what prostate cancer is, but what can be done to treat or even cure it. Their advice just might save you or someone you love.
How is prostate cancer diagnosed?
DR. TOLLEFSON: The most common way prostate cancer is diagnosed is through prostate cancer screening with one’s primary care doctor. Usually, that’s by finding an elevated PSA (prostate-specific antigen), but could also include an abnormal prostate exam. Most men with prostate cancer actually don’t have any symptoms, and that’s important to recognize because the prostate sits so deep in the pelvis. Many times there aren’t symptoms until the cancer becomes quite advanced, so it’s important to have that discussion with your doctor to make sure they’re checking for signs of cancer.
If someone has an elevated PSA, what is the next step to confirm a diagnosis?
DR. TOLLEFSON: When you have an elevated PSA, consulting with your doctor or even a subspecialist is important so they can determine whether you need additional imaging. Sometimes when people come in with an elevated PSA, we get an MRI, for example—that’s a very common test we do to evaluate one’s risk for prostate cancer. Prostate cancer is only diagnosed on biopsy, so if there are abnormalities with PSA or imaging, a prostate biopsy is a common next step.
Prostate cancers can some-times be slow-growing and other times aggressive. How do you know what treatment approach to take?
DR. TOLLEFSON: When we get a biopsy, we not only see the presence or absence of cancer, but we also get a sense of how aggressive that cancer is likely to be. Typically, that’s evaluated by assigning a Gleason score—a pathologist’s interpretation of how aggressive the prostate cancer is and how quickly it’s growing. This number dictates how aggressively the cancer would need to be treated, if it’s even treated at all. The Gleason score is used together with imaging, PSA values, and the patient’s health and desires to develop a comprehensive treatment plan.
What is advanced prostate cancer?
DR. CHILDS: Advanced prostate cancer is cancer that started within the prostate gland but has spread to more distant locations in the body. This is also referred to as metastatic prostate cancer or Stage 4 prostate cancer.
How do you determine where the cancer has spread?
DR. CHILDS: We have a variety of tools in our toolbox. We use forms of advanced imaging like CT scans, bone scans, and very sensitive PSMA PET scans, which can find even small locations of cancer in different parts of the body.
DR. ORME: When we do a molecular scan like a PSMA PET scan, we’re taking this little bit of ‘molecular Velcro’ that attaches to PSMA on the surface of prostate cancer cells wherever they are in the body, but doesn’t stick on the surface of other cells. It emits a small amount of radiation that’s picked up on PSMA PET scans, so we take an image and see where the cancer is. This is incredibly helpful for us as medical oncologists because we want to know the extent of where the cancer is and how to treat it.
What role does genetic testing play in treatment?
DR. ORME: Any man who has prostate cancer that has moved outside of the prostate should certainly have their genetics and their cancer’s genetics tested because it helps us know what kind of prostate cancer they have and gives us more options to treat that cancer. There are five major prostate cancer types, and there are many other subtypes that are much less common. Those genetic mutations tell us how the cancer came to be and may help us know how we can specifically treat it.
DR. CHILDS: We are in an era now where we use a personalized, targeted approach to treating cancer. Having the latest genetic studies done is essential for being able to choose the right treatment for each patient.
How do you determine the right treatment approach?
DR. CHILDS: When a patient finds out they have advanced prostate cancer, the first things we want to understand are their values and preferences. These heavily influence what tools we use in treating their cancer. We review the imaging scans to understand where the cancer has gone. We ask the patient about what side effects they’re experiencing and what their goals with treatment are. We look at the genetic test to make sure we’re using the right treatment for the right patient at the right time.
“Fortunately, we have more life-prolonging therapies for prostate cancer than ever before.”
–Dr. Dan Childs, Mayo Clinic Oncologist
What are some of the recent advances that are making prostate and advanced prostate cancer more treatable?
DR. CHILDS: Fortunately, we have more life-prolonging therapies for prostate cancer than ever before. We can use chemotherapies and hormone therapies to help shrink or slow the growth of the cancer. We can also use a new kind of therapy called radiopharmaceuticals, which have been an incredibly important innovation within the last decade. They precisely target the cancer cells, delivering radiation directly to the cancer cells through the IV, while sparing the surrounding tissues.
DR. ORME: Radiopharmaceuticals are like ‘molecular Velcro’ that sticks to PSMA on the surface of the cancer cell. That molecule is combined with radioactive lutetium-177 to find and kill the cancer cells. It’s an amazing process, and we’ve seen some fantastic results.
What are some of the surgical advances in prostate cancer?
DR. TOLLEFSON: Radical prostatectomy is a surgery to remove all or part of the prostate gland. It’s a common and highly effective treatment usually used for younger men with intermediate or higher-risk prostate cancer—especially when it’s diagnosed at a point where the tumor is contained to the prostate gland itself. Many patients are cured with this surgery alone, and today, most of these surgeries in the United States are done robotically. Robotic radical prostatectomy is the king of minimally invasive surgery. It has taken what used to be a big surgery with a higher risk of complications to one that can typically be performed as an outpatient with lower risks of long-term side effects. Advances like single-port prostatectomy promise to reduce the ‘invasiveness’ of surgery even more.
What are the benefits to a team approach to care?
DR. TOLLEFSON: One of the things we pride ourselves on at Mayo Clinic is the ability to work across specialties. We’re not confined to one treatment or another. We offer expertise across multiple treatment approaches so that we’re not pigeonholing men into one treatment or another based on the doctor they happen to see. Rather, this is a team approach where we try to find the best course of action for each person, while understanding their priorities in treatment, their risks, and how they want to live their lives.
To learn more about Mayo Clinic’s prostate cancer care, visit: careinfo.mayoclinic.org/prostate-cancer-MN | 507-923-2566
