Prostate Screening Recommendations
Current recommendations from the American Cancer Society, the American College of Radiology and the American Urological Association advise:
- Men over 50 should have annual prostate-specific antigen (PSA) and digital rectal exams.
- African-American men and those with a family history of prostate cancer should have both tests each year beginning at 40.
Types of Screenings
Prostate Health Index (phi) Blood Test
Affiliated physicians at Memorial Hermann -Texas Medical Center are finding revolutionary ways to diagnose and treat prostate cancer. In this video, Kevin Slawin, M.D., gives a presentation on the latest research and screenings for prostate cancer, with an introduction to the groundbreaking Prostate Health Index (phi) blood test. Dr. Slawin discusses how the new test will allow for more accurate readings, resulting in less false positives that have long been associated with the use of the standard Prostate Specific Antigen (PSA) blood test.
This simple blood test measures the level of prostate-specific antigen released by the prostate gland into the blood.
If your PSA results or other factors point to the possibility of cancer, your doctor may request a biopsy of the prostate. The doctors at Memorial Hermann Cancer Centers are able to analyze prostate tissue samples with exacting accuracy.
Prostate Cancer Detection And Diagnosis
Jim Spaur learned his PSA was slightly elevated more than 15 years ago when he applied for a life insurance policy and was rejected based on his score. In the years that followed, his PSA continued to rise, and he underwent four standard systematic biopsies, including a 36-core saturation biopsy known to increase cancer detection. All came back negative. An MRI with contrast in October 2013 was negative as well.
Mr. Spaur’s PSA was high and rising when his urologist referred him to Kevin Slawin, M.D, director of the Vanguard Urologic Institute and director of urology at Memorial Hermann-Texas Medical Center. In 2010, his PSA was 20.2 ng/mL. By the time he saw Dr. Slawin, it had risen to 40.3 ng/mL. Physical examination of the prostate revealed nothing out of the ordinary.
Advanced Multiparametric MRI (mpMRI): A Powerful New Technology in Prostate Cancer Detection
Dr. Slawin ordered an advanced multiparametric MRI (mpMRI), which combines several imaging techniques to provide a more complete picture of the prostate. In addition to the standard MRI view, the mpMRI measures chemical concentrations, evaluates blood flow to tissue and evaluates the nature of the cells themselves.
“With the multiparametric MRI, we located a 2.5-centimeter lesion at the top of the prostate in an area not usual- ly sampled during a routine prostate biopsy,” says Dr. Slawin, who is a clinical professor of urology at Baylor College of Medicine and a professor at the Center for Clinical and Translational Science at The University of Texas Health Science Center at Houston. “Based on the result, the lesion was highly suspicious for cancer.”
Precise Prostate Cancer Diagnosis with UroNav MRI-TRUS Fusion Biopsy
Instead of the usual biopsy procedure, Mr. Spaur was the beneficiary of a powerful new technology called UroNav MRI-TRUS fusion biopsy. By fusing MRI images of the prostate taken before biopsy with ultrasound-guided images captured during the biopsy, UroNav allows the physician to target more precisely abnormal areas identified by mpMRI during biopsy. A sophisticated algorithm maintains the fusion of MRI and ultrasound images, even during movement.
Using UroNav, Dr. Slawin targeted the lesion accurately during biopsy. All five core samples taken from the suspi- cious area identified on mpMRI showed high-volume, high-grade cancer.
“It all went very smoothly,” Mr. Spaur says. “I was impressed with Dr. Slawin’s confidence. He was positive he could locate the problem and he did.”
Offered the treatment options of surgery or radiation therapy, Mr. Spaur opted for nine weeks of radiation therapy in his hometown of Victoria, Texas. “Jim’s case is a perfect demonstration of the power of this new technology to more precisely target biopsies and arrive at an accurate diagnosis,” Dr. Slawin says. “A biopsy can sometimes miss cancer, as was the case with the four previous standard biopsies he had. Using UroNav, we finally iden- tified a very aggressive cancer that was likely present and growing for years, but hopefully before it may have advanced to metastatic disease.”
Prostate Cancer Treatment
Knowing what to do following a diagnosis of prostate cancer can be confusing, oftentimes leaving men with more questions than answers. What are my treatment options? Which therapy is right for me? What's the prostate cancer prognosis?
Unlike many other types of cancers, prostate cancer has numerous treatment options. There is no one definitive course of treatment.
Memorial Hermann Cancer Centers bring together cancer-focused specialists in one location to talk with patients directly and answer any questions. The team includes:
- medical oncologists
- nurse navigators (cancer nurse specialists)
It also allows cancer specialists to work together not only in treatment planning but also in delivery. Oftentimes, a combination of therapies is the best option for patients.
Prostate Cancer Treatment Options
Traditional & Robotic Surgery for Prostate Cancer
Prostate cancer surgery is an effective way to treat cancer that is confined to the prostate and Memorial Hermann offers a broad range of treatment options. Prostate removal surgery is available with both traditional and robotic-assisted surgery methods. Robotic surgery is a minimally invasive approach in which surgeons use advanced technology to perform precise, nerve-sparing surgery.
Sometimes a surgeon will do a pelvic lymphadenectomy, or removal of the lymph nodes, to confirm cancer is present before removing the prostate.
Once cancer is confirmed, a radical prostatectomy may be done. The surgery removes the prostate, surrounding tissue and area lymph nodes. The lymph nodes are examined for cancer.
This single method treatment currently provides three surgical approaches for patients. The stage of the cancer, along with a patient's individual medical history, determines the most effective approach for each individual.
The approaches are:
An incision (cut) is made in the abdominal wall and the prostate is removed. Area lymph nodes may also be removed at this time.
An incision (cut) is made in the perineum (area between the scrotum and anus) and the prostate is removed. Area lymph nodes may also be removed at the same time.
If your urologist recommends surgery to treat your prostate cancer, you may be a candidate for a new,
less invasive approach to surgery called da Vinci® Prostatectomy. This approach to prostatectomy provides access to the internal anatomy through five small incisions. The surgeon is empowered to perform a very precise, nerve-sparing operation with the da Vinci® Surgical System. For the patient, da Vinci® Prostatectomy may result in more complete eradication of cancer, retention of bladder control and potency.
Advanced Radiation Therapies
Radiation therapy may be used as the sole form of treatment for early stages of prostate cancer or for those patients who are not candidates for surgery. Radiation therapy may also be used in addition to surgery in more advanced stages. Memorial Hermann offers advanced radiation therapies, including IMRT and seed implant brachytherapy, which dramatically reduce damage to surrounding healthy tissue.
Types of therapy include external-beam radiation and interstitial implantation of radioisotopes. Forms of therapy are dependent upon the prostate cancer stages and the intended purpose of treatment.
Intensity-modulated radiation therapy (IMRT)
IMRT is a state-of-the-art external beam radiation system that precisely shapes radiation beams to the shape of the tumor.
Prostate Seed Implants (Brachytherapy)
The treatment involves implanting tiny radioactive seeds that emit low levels of radiation over a few months directly to the prostate.
Clinical Trials and Prostate Cancer Tumor Board
Clinical trials of new prostate cancer treatments are available through Memorial Hermann's collaboration with Texas Oncology. Some trials involve chemotherapy, which is not a typical treatment for prostate cancer and provide patients the option of participating in promising cancer therapies not yet available to the public. Memorial Hermann Cancer Centers also have a prostate cancer tumor board, which is made up of urologists, radiation oncologists, radiologists, medical oncologists, pathologists and other specialists. Patients can refer themselves for this multidisciplinary review and can be especially useful to those seeking a second opinion.