Prostate cancer (PCa) is the most common non-skin cancer in men, and it’s one of the most curable if it’s detected early. In addition, the American Cancer Society points out, “Catching cancer early often allows for more treatment options.” This is definitely true for PCa, since the number of available treatment methods has grown in the past 20+ years.
Today, the list includes an array of treatments that have fewer side effects:
- Nerve-sparing robot-assisted prostatectomy
- Better radiation targeting (stereotactic body radiotherapy, intensity modulated radiation therapy)
- Brachytherapy (seed implants)
- Proton beam radiation
- Focal treatment using a form of ablation (cryotherapy or freezing, focused ultrasound, photodynamic therapy)
- Active surveillance and lifestyle changes.
A problem with detecting PCa in its early stages is the lack of symptoms. Roughly 85% of cases are slow growing and don’t give any warning signs until they have grown large enough to produce urinary symptoms. By that time, there is a greater risk that they have started to spread—though cure may still be possible. On the other hand, if PCa metastasizes before localized symptoms appear, bone pain is a likely sign that it has spread to skeletal locations, and the disease is now incurable.
Missing prostate cancer when it’s still early
It’s easy to understand that a cancer with no early symptoms is often missed at that stage—but if it’s missed, patients’ lives are on the line. According to the Centers for Disease Control, “Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2-3 men will die from prostate cancer.”
This is why testing before symptoms appear is so important. It’s called screening. The most common screening test for PCa is called the PSA (prostate specific antigen) blood test. As cancer screenings go, it’s easy and cheap compared to screening mammograms for breast cancer or colonoscopy for colon cancer. And yet, the numbers of cases diagnosed at later stages has been increasing.
Why is there a failure to detect PCa when it’s easiest to cure? Here are three common reasons:
1. Skipping or avoiding annual doctor visits.
Men are notorious for avoiding yearly wellness exams, especially if they don’t feel sick or have no apparent symptoms. A recent survey found that men would rather clean toilets than see a doctor. Roughly 2/3 of respondents admitted they hold off seeing a physician as long as possible, while 37% said they don’t tell everything to the MD. For example, an early PCa warning sign like a change in peeing may be too embarrassing to reveal to their physician.
2. Not knowing personal risk factors for PCa.
Many men don’t know that their father, uncle or brother had PCa. Others unknowingly have job-related exposure to carcinogenic (cancer causing) substances like pesticides or manufacturing chemical.
3. Doctor confusion over the seesaw of screening recommendations.
PSA guidelines have shifted twice in the last 10 years. Given current national recommendations that individual doctors and patients decide together on whether a PSA test should be done, a doctor may not be comfortable encouraging a patient to move beyond initial doubt or reluctance.
Who’s afraid of a PSA?
Once upon a time, the PSA test was controversial. Why? Because it led to unnecessary biopsies and overdetection of insignificant disease; in turn, these practices led to aggressive treatment, leaving untold numbers of men with urinary leakage and sexual dysfunction. Therefore, the US Preventive Services Task Force downgraded screening—which tragically led to an upsurge in late detection and more cases of incurable PCa.
Today, thanks to multiparametric MRI (mpMRI) there’s no excuse to fear or avoid PSA screening. Now, noninvasive MRI imaging is the best way to evaluate need for a biopsy. The latest research shows that anywhere from a fourth to a third of biopsies can be avoided. In addition, if a biopsy is warranted, a real time mpMRI guided biopsy can target the area visible on imaging so fewer needles are required to get accurate diagnostic results. Plus, the potential for biopsy side effects is significantly reduced.
The Sperling Prostate Center supports annual PSA screening, especially when coupled with mpMRI if the blood test result is high or rising. We offer real-time MRI guided targeted biopsy if indicated. If the biopsy is positive, we go over all imaging and biopsy results with each patient, and discuss all treatment options that are appropriate to the patient’s PCa and lifestyle.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
