August 04, 2022
One in eight men in the United States will develop prostate cancer as they get older. It’s the most common cancer in men in this country besides skin cancer. Worldwide, it is second only to lung cancer.
Prostate cancer occurs in the prostate, a small, walnut-shaped gland that produces seminal fluid, which is important for sperm motility and thus fertility. The biology of the disease varies widely, from extremely aggressive cancers that need intervention to slow-developing cases that can be safely monitored with active surveillance over many years.
About six in 10 men diagnosed with prostate cancer are over the age of 65, but the risk of developing the condition increases rapidly among men over 50 years old. Black men are at a particularly high risk compared to their peers. There are no well-established causes of prostate cancer, though a family history of the disease increases risk.
The Abramson Cancer Center at Penn Medicine offers comprehensive care for people diagnosed with prostate cancer, as well as those at risk of developing it. From a world-class active surveillance program to combined expertise in surgery, medical oncology, genetics and radiation oncology, patients in Penn’s prostate cancer program can have confidence that their care will be personalized to best fit their needs.
“There is no one size fits all approach to treating prostate cancer.” Said Dr. Vivek K. Narayan, a medical oncologist at Penn Medicine. “It depends on every individual, their other medical conditions, and how the patient weighs the pros and cons of therapy. At Penn, we take a multidisciplinary approach to prostate cancer.”
Given the prevalence of prostate cancer and the range of disease characteristics found in men who are diagnosed, regular screening and follow-up care with a urologist are crucial to cancer detection.
Men with prostate cancer will often not experience any urinary or other physical symptoms. This makes screening that much more important to discovering cancer and developing the right treatment plan. For many men, a prostate cancer diagnosis simply means entering an active surveillance program. Long-term studies have found that the risk of developing metastatic disease is less than one percent among such patients with low-risk and localized prostate cancer.
"Patients hear the world 'cancer' and everything else kind of goes blank from there," said Dr. Thomas J. Guzzo, Chief of the Division of Urology at Penn Medicine. "A lot of patients come into my office with low-risk prostate cancer, and they'll push for treatment. In some situations, treatment is appropriate. But a big part of my job is really explaining to people what low-risk prostate cancer means. I end up talking a lot of people out of definitive treatment because it's more appropriate for them to be on active surveillance."
Active surveillance consists of regular PSA tests, a blood test that looks for elevated levels of a protein called prostate-specific antigen. PSA tests are usually done every three to six months to monitor the cancer and complete any additional tests needed to assess risk over time. Typically, an annual biopsy is done after the initial diagnosis to confirm the finding and rule out a more aggressive prostate cancer.
"We can safely monitor these patients. The critical part of active surveillance is the 'active' part. This isn't watchful waiting," Dr. Guzzo explained. "It's active monitoring with PSAs on a routine basis, physical exams and often MRIs of the prostate. Most notably, we do a prostate biopsy typically on an annual basis to monitor for more signs of aggressive disease, at which point we would intervene with appropriate treatment."
Men who have intermediate and high-risk prostate cancers typically will consult with a urologist and radiation oncologist to determine the best course of action for a curative treatment.
At the Abramson Cancer Center, treatment recommendations are based on the cancer diagnosis and the preferences of the patient. Specialists will weigh the aggressiveness of the patient’s disease, the stage of the cancer, the age of the patient and co-morbidities they may have.
"Once you're diagnosed, especially if it's an intermediate or high-risk cancer, you want information and treatment options sooner rather than later. Penn's wide scope of expertise gives us the ability to make those things happen quickly." said Dr. Narayan.
In terms of cancer outcomes, surgery and radiation are generally considered equivalent in efficacy. These treatment approaches usually have success rates between 85%-90%, and if one of them doesn’t work, the other may be used for a definitive intervention. In some cancers, both approaches may be needed.
In more complex cases, particularly among patients with other health issues, a medical oncologist will sometimes be consulted along with the urology and radiation oncology teams to offer an opinion about what will be the safest and most effective treatment approach. Medical oncologists are also often involved in the care of patients who have advanced stage prostate cancer, or who have had a recurrence of the disease after an initial treatment.
In recent years, the Abramson Cancer Center has expanded its use of more advanced treatments for prostate cancer, such as proton therapy, high dose rate brachytherapy, immunotherapy and next-generation hormone therapy. As a research institution, Penn is committed to improving the management and treatment of this disease.
"You're going to get access to physicians who are not only aware of the research, but also defining and moving the research forward," said Dr. Neha Vapiwala, professor and vice chair in the department of radiation oncology at Penn Medicine, who leads several national and institutional clinical trials for prostate cancer patients. Clinical trials are studies performed on individuals to help evaluate new treatment approaches. "In addition to the cutting-edge science and technology, we place a lot of emphasis on integrative oncology and supportive care, such as counseling and guidance on nutrition, fertility preservation, and follow-up care. We have a holistic, patient-centered approach."
Most men who undergo treatment for prostate cancer can be encouraged by excellent cure rates for most forms of intervention, particularly when action is taken before the disease reaches an advanced stage. This is why it’s so important to ask your primary care provider whether a PSA screening is appropriate based on your age and cancer risk.
Penn Medicine’s Abramson Cancer Center is committed to offering world-class treatments and innovative clinical trials for prostate cancer patients, as well as an industry-leading active surveillance program for those at risk of developing it. The best way to prevent cancer or minimize your risk is to get screened. Schedule a screening today.