One in six men will get prostate cancer. African-Americans (notably of Caribbean decent) are at the highest risk.
Like many treatable cancers, screenings are essential to positive outcomes as most prostate cancers are not symptomatic until late stages of the disease. Screening dramatically increases the ability to detect prostate cancer at early stages when it may be cured. Men between the ages 50-75 should be screened annually as should those with elevated prostate-specific antigen (PSA) levels.
Here are the latest developments in treating and detecting prostate cancer.
1. Transperineal biopsies
Transperineal ultrasound guided prostate biopsy, with near zero risk of infection, is a new diagnostic tool for prostate cancer that dramatically improves the ability to safely test men needing a biopsy. The vast majority of prostate biopsies in the United States are done by a transrectal ultrasound guided approach. Even with the use of antibiotics before and after the procedure, the risk of infection associated with sepsis is between 1-5% because needles pass through the rectum to reach the prostate. The Department of Urology at Northwell is one of a handful of institutions nationally offering the new transperineal procedure. During transperineal biopsy, needles are inserted through the perineum (skin between the anus and scrotum) to reach the prostate. The procedure takes about 10-15 minutes under local anesthesia in the office. This procedure represents a major step forward in patient safety.
2. MRI fusion biopsies
Prostate fusion biopsy imaging combines magnetic resonance (MR) imaging with ultrasound-guided biopsy to increase the ability to detect cancer and improve the accuracy of biopsy.
MRI images, obtained prior to the biopsy, are overlaid with prostate ultrasound images in real-time at the time of biopsy. A magnetic field generator — similar to a GPS tracking device — is placed over the patient’s hip to guide the biopsy toward areas of the prostate that appear suspicious for harboring prostate cancer on MRI. The fusion-guided biopsy can direct your urologist to sample to areas of the prostate not typically sampled by a standard 12-core biopsy and improve the ability to detect the disease.
3. High intensity focused ultrasound (HIFU)
High intensity focused ultrasound (HIFU) uses thermal ablation of the prostate to destroy prostate cancer cells. This less invasive approach to prostate cancer treatment has many potential advantages related to urinary function and erectile function relative to prostatectomy or radiation therapy. HIFU has produced promising results for people malignant tumors and has been used for prostate cancer, hepatocellular carcinoma, uterine leiomyomas and breast tumors. HIFU is not appropriate for all patients with prostate cancer, but patients should discuss this potential option with their physician if diagnosed with prostate cancer.
4. Robotic surgery
Less scarring. Quicker recovery times. These hallmarks of robotic surgery hold true for prostate cancer. Robotic surgery for prostate cancer (robotic prostatectomy) remains a very popular minimally invasive prostate cancer treatment. Men typically are typically discharged the day after surgery. If diagnosed with prostate cancer, men should discuss this option with their urologist.
5. Reducing incontinence post-surgery
After prostatectomy for cancer treatment, it is expected that men will develop temporary urinary incontinence. I have made it part of my practice to recommend that men undergo treatment with pelvic floor physical therapy after surgery, which is helpful in expediting recovery and regaining bladder control.
Michael J. Schwartz, MD, is director of laparoscopic and robotic surgery at Northwell Health’s Smith Institute for Urology. He is a board-certified specialist in robotic, laparoscopic and minimally invasive surgery focused on treatment of urologic cancers.