Prostate cancer is the most frequently diagnosed cancer in men and the second most deadly cancer in men in the United States. However, urologists at Indiana University School of Medicine Department of Urology are developing new ways to find prostate cancer and provide the appropriate treatment.
“It’s like a puzzle. We try to find out what type of tumor it is and what type of treatment is best,” said Clinton Bahler, MD, MS.
Bahler said one of the biggest challenges is knowing when to treat and when to observe. People with prostate cancer don’t experience symptoms until it has progressed far enough to spread to the lymph nodes or bone. The only way to find prostate cancer in time to cure it is through prostate-specific antigen (PSA) screenings or a digital rectal exam. Annual PSA screenings are suggested for men ages 50-70, or starting at age 45 if there is a family history of prostate cancer. However, screening too much could do more harm than good.
“PSA is a protein measured by a simple blood draw,” Bahler said. “There’s a lot to take in with PSA screening, because PSA can be elevated from at least three different causes: benign prostate enlargement, prostate infection/inflammation and prostate cancer. About 50 percent of the biopsies we do are benign and the elevated PSA is due to non-cancerous causes.”
PSA screenings find both tumors that don’t need treatment and more aggressive tumors that do. Prostate cancer is different from many other cancers, because if you have a slow-growing, nonaggressive tumor, you may not need to take action right away. Many of those Grade 1 tumors take years to grow and spread. Bahler said more than 50 percent of all men will have Grade 1 prostate cancer at some point, but never know it.
“PSA screening finds cancer 10 years prior to symptoms beginning,” Bahler said. “So PSA screening is not recommended if someone’s life expectancy is less than 10 years.”
Bahler said these slow-growing tumors are not worth treating because the side effects that may come from some procedures outweigh the benefit of treatment. He said the focus is on finding aggressive cancer without over-treating the slow-growing tumors. In the past five years, new technologies have become available to identify those aggressive tumors. One technology is prostate-specific membrane antigen (PSMA), which uses a tracer that causes a tumor to “glow” during positron emission tomography (PET) imaging. A clinical trial is underway to find ways to use PSMA-PET imaging to better diagnose and treat prostate cancer.
“The process allows us to see the cancer better and be more confident we are not missing any significant cancers,” Bahler said.
Urologists at IU School of Medicine are also responsible for the development of a treatment for prostate cancer called high intensity focused ultrasound, or HIFU. The process uses a rectal probe guided by MRI to treat part of the prostate. It requires no radiation or incision, has few side effects and is an outpatient procedure with anesthesia. The procedure was approved by the Food and Drug Administration in 2015.
Bahler said the work they’re doing at IU School of Medicine Department of Urology is all in hopes of saving lives and helping those impacted by prostate cancer.
“It’s a special part of our job that we get to walk with you through an important and stressful time,” Bahler said.
Clint Bahler, MD, MS, is an assistant professor of urology at IU School of Medicine and a member of the IU Simon Cancer Center. Learn more about prostate cancer research and care at IU School of Medicine.