Breakthroughs in Finding, Treating Prostate Cancer

In recent years, a number of new approaches have been developed that give doctors and patients new options to spot prostate cancer more quickly and treat it.

Breakthroughs in Detection

You may have heard of the PSA test, a blood test that doctors have long used to screen men for prostate cancer. The test is not perfect.

Research suggests a PSA test can sometimes come back abnormal even when you’re healthy. It can also come back normal when you do have the disease.

The test also doesn’t distinguish between fast-growing, dangerous cancers, and slow-growing ones that might not cause health problems.

Because the number of cases of aggressive prostate cancer are on the rise, the U.S. Preventive Task Force now recommends that this baseline test may be appropriate for some men between the ages of 55 – 69. This includes those with a family history of prostate or related cancers, or those who are African-American. The group suggests talking to your doctor first to understand the risks and benefits of a PSA test.

Many doctors also now use new tests along with the PSA check to improve detection.

4KScore: This test looks at the levels of four proteins in your blood. It also considers other relevant health information. Studies have shown this test helps determine the odds of finding an aggressive prostate cancer with a biopsy. It’s not FDA-approved, but your doctor can still use it.

Prostate Health Index (Phi) test: This looks at levels of three proteins in the blood to determine the risk of finding an aggressive prostate cancer if a biopsy is done. In 2012, the FDA approved this test for some men over 50. Check with your doctor to see if it's right for you.

Progensa PCA3 Assay. This urine test looks for a specific genetic material, as well as a protein that’s made by cancerous prostate tissue. The test is usually given right after a rectal exam, because the exam causes your prostate cells to head into the urinary tract. The FDA has approved this test for men 50 and over who've had one or more normal prostate biopsies but whose lab tests have raised concerns that another biopsy might be needed.

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Mi-Prostate Score. This urine test determines if you have a higher risk for prostate cancer by looking at levels of PSA, something called PCA3 (or prostate cancer gene 3) and something called TMPRSS2:ERG. That last thing is made when two genes abnormally fuse together, something that usually only happens in people with prostate cancer. This test is not FDA-approved, but your doctor can still use it.

Axumin. This is a new radioactive diagnostic agent that can be used to help pinpoint the location of recurrent cancer in your prostate. When PSA is elevated, it still doesn’t indicate the exact location. When Axumin is used in conjunction with positron emission tomography (PET) it can help detect and localize the cancer. This helps guide decision making concerning a biopsy and any additional treatment.

New Ways to Treat It

A number of treatments are available for prostate cancer. Your doctor will help you decide which one is best for you depending on your health and the details of your cancer.

Laparoscopic prostatectomy. When prostate cancer hasn’t spread, your doctor may recommend this. It’s a surgery that removes your prostate, seminal vesicles (the tubes that make most of what’s in semen), and other tissue to remove the cancer from your body.

Many hospitals are now offering this surgery "laparoscopically," meaning it’s done with just five tiny incisions. Some surgeons do the operation with the help of robotic arms. This can make cuts more precise and minimize risks.

Improved hormone therapies. For decades, doctors have been treating prostate cancer with hormone drugs that block cancer cells from getting the testosterone they need to grow. But these drugs don’t always work well. Several new hormone treatments have been approved by the FDA. Apalutamide and enzalutamide prevent cancer cells from receiving testosterone. Abiraterone acetate blocks tissues from making testosterone.

Chemotherapy combined with hormone therapy. A recent study found that this combo helps men whose cancer has spread outside the prostate live longer.

Apalutamide (Erleada). This oral medication is used to treat men with nonmetastatic, castration-resistant prostate cancer who are at high risk for disease spread because treatment with hormone therapy is not effective.

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Radium-223. This is a drug that treats prostate cancers that have spread to the bone. It’s injected into your body, then it travels to nearby cancer cells and releases radiation that kills them.

Immunotherapy. If hormone treatment doesn’t work and your prostate cancer has spread outside of your prostate gland, your doctor might recommend a new drug called sipuleucel-T. It gets the body’s immune system to help fight off your cancer.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on August 05, 2018

Sources

SOURCES:

National Cancer Institute: “Prostate-Specific Antigen (PSA) Test.”

National Cancer Institute: “FDA Approval for Radium 223 Dichloride.”

Punnen, S; Pavan, N; and Parekh, D. Reviews in Urology, 2015.

4KScore.com: “Frequently Asked Questions.”

Loeb, S. Therapeutic Advances in Urology, April 2014.

Hologic.com: “Physician Brochure for the Progensa PCA3 Assay.”

University of Michigan MLabs: “MiProstate Score Frequently Asked Questions.”

National Comprehensive Cancer Network NCCN Guidelines for Patients: “Prostate Cancer. “

Prostate Cancer Foundation: “New Urine Test for Prostate Cancer Available; Unlike PSA Test, Is Ultra-Specific For Prostate Cancer.”

Sweeney, CJ. The New England Journal of Medicine, August 2015.

Yoo, S. Prostate International, May 2016

FDA.gov: “FDA Approves a Cellular Immunotherapy for Men with Advanced Prostate Cancer.”

FDA.gov: “PROGENSA® PCA3 Assay - P100033.”

U.S. Preventive Services Task Force. ""Prostate Cancer Screening Final Recommendation."

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