Dr. Sam Kieley

QUESTION: What is the update on prostate cancer treatment?

In 2017, prostate cancer is the most common cancer diagnosis and second leading cause of cancer death among American men with approximately 161,000 newly diagnosis and almost 28,000 deaths. This represents 19 percent of the total new cancer diagnosis among men and 8 percent of the deaths. The good news is that the risk of death has declined between 1993 and 2014 by 51 percent thanks to screening for prostate cancer.

Prostate cancer screening includes both a prostate exam and a PSA blood test. The combination of these two tests offers improved diagnostic accuracy more than either alone. In 2017, the U.S. preventative services task force upgraded their screening recommendation to promote shared decision making with a physician. This now falls more in line with the consensus among cancer specialists to screen healthy men between 45 and 75  years old and select men over age 75. African-American men and those with a family history of prostate cancer are at increased risk and should have yearly screening. Those men found to be a low risk may lengthen their screening interval to every two to four years.

Treatment of prostate cancer varies between active surveillance (monitoring the cancer), radiation and surgical treatment. In general, the treatment is dependent on the pretreatment risk classification.

Now, most of the surgeries are done with robotic assistance, which leads to smaller incisions and less blood loss. Radiation treatments are able to focus more on the prostate and less on surrounding areas.

An update to the PIVOT trial was released this year. This trial has looked at outcomes between varying treatment options for prostate cancer. The updated results suggested similar survival in men with low-risk cancer who had surgery or observation. Active surveillance is a great option to older men with low-grade and low-volume disease.

One new treatment is high-intensity focused ultrasound (HIFU), which allows for minimally invasive treatment of the cancer. This is a promising FDA approved treatment, but was only recently approved.

The decision to screen for prostate cancer should be based on a thorough discussion between a patient and his primary care physician and/or urologist.

Similarly, a newly diagnosed cancer should be risk stratified, staged and treated based on the aggressiveness of the disease and the risks and benefits of the treatment.

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In September, we are glad to celebrate prostate cancer awareness month as a chance to raise awareness and start a discussion about this common and challenging disease.

For Prostate Cancer Awareness Month, Mission Hope is hosting an interactive session Sept. 22 at 8 a.m. Held in conjunction with the Men with Cancer Support Group, the format will be a question-and-answer discussion to allow participants to get specific information about prostate, bladder, kidney and/or testicular cancers from a specialist. Reservations required as space is limited. Call 219-4673. The program will be interpreted into Spanish.

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Have a question for "Your Cancer Answers," a weekly column produced by Marian Regional Medical Center, Cancer Program? Email it to mariancancercare@dignityhealth.org.

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