Prostate Cancer Awareness

Speaker 1: Welcome to Bench-to-Bedside, a weekly series of live conversations about recent advances in cancer, from the research bench to treatment at the patient's bedside. And now, your host and the Director of The University of Kansas Cancer Center, Dr Roy Jensen.

Dr Roy Jensen: Hi, I'm Dr Roy Jensen and with me is Dr William Parker, urologic surgical oncologist at The University of Kansas Cancer Center. Today we're gonna discuss prostate cancer and why all men should discuss with their doctors whether screening is right for them, and if so, what screening procedure or combination of procedures they should choose. This is an important question, because it is estimated that one in seven men will be diagnosed with prostate cancer in their lifetimes, and it's the number three cause of cancer death in men. So, Dr Parker, could you please tell us, who is at high risk for prostate cancer?

Dr William P.: Certainly. So the highest risk men are those who are African American, those with a family history of either urethral or any prostate cancer, be that in a father, or a brother, or an uncle. And then those men who have a family history of related cancers like breast cancer, ovarian cancers, and in particular the BRCA or BROCA positive cancers.

Dr Roy Jensen: Okay. So, if you're just joining us, we're talking about prostate cancer and the importance of PSA screening in detecting the disease. And as always Alesha Miller is here in the studio to take your questions. Remember to share this link with people you think might benefit from our discussion, and use the hashtag BenchtoBedside. So, over the last decade or so prostate cancer screening has become pretty controversial, could you tell us what is driving this, and give us your viewpoint in terms of this issue.

Dr William P.: Absolutely. So the way we screen for prostate cancer is with a blood test called PSA or prostate-specific antigen, and widespread use of this test led to historically fairly broad diagnosis, and particularly over-diagnosis of prostate cancer. Not all prostate cancers are created equal, and there are lot of men who have low grade cancers who often don't require treatment. However, because we've diagnosed a lot of prostate cancers using widespread PSA screening, we also over-treated a lot of men and that really led to a lot of this controversy. Now, I think the important thing to keep in mind is that PSA screening is very important, and while it's a test that's not very accurate at diagnosing cancer, it's a great test at identifying men at risk for prostate cancer. In my personal opinion PSA screening and prostate cancer screening should obviously still be done, it just has to be done in a thoughtful way. There are newer more accurate tests that we have now to help refine that search, and refine that screening, so that that over-diagnosis and over-treatment is much less common.

Dr Roy Jensen: How does prostate cancer typically present?

Dr William P.: Most of the time it's asymptomatic, so the vast majority of men are diagnosed based on an elevated PSA or digital rectal exam. When symptoms are present, which again is very rare, it can be urinary in nature, so difficulty urinating, pain with urination, blood in the urine. But again, that's very rare.

Dr Roy Jensen: So, if you're just joining us, we're talking with Will Parker, urologic surgical oncologist about the importance of prostate cancer and whether or not you should be screened for this disease. If an individual is diagnosed with prostate cancer, what are the treatment options that are available?

Dr William P.: There are a multitude of treatment options that we have at our disposal now, certainly as I alluded to you earlier, lower grade less aggressive cancers we'll tend to watch, so active surveillance, which is the strategy fantastic keeping a close eye on the prostate cancer and making sure it's not progressing, is the mainstay of therapy. With higher grade and more aggressive cancers, aggressive intervention such as surgery or radiation are really the mainstays of therapy that have long-term data to support their use.

Dr Roy Jensen: Okay. How do we tell which prostate cancers should be aggressively treated, and which ones we can kind of engage in watchful waiting on?

Dr William P.: Prostate cancer is graded with a grading system called the Gleason score, it's a score that's made up of two different components. One is the most common type of prostate cancer identified in the prostate, and the second is the second most highest grade that they identify. That score ranges from a lower score of a 6, to a high score of a 10. The lower on the spectrum, the less likely it's going to be aggressive, and the more we'll recommend surveillance. Whereas when you start getting into scores of 7, 8, 9, or 10, those are the men who really benefit from intervention.

Dr Roy Jensen: If being over-treated for prostate cancer, what are the significant consequences of that?

Dr William P.: Unfortunately the treatment for prostate cancer does carry with it some quality of life impacts, namely with urinary function and sexual function. When we expose low risk men, where the chance that the prostate cancer is going to cause them some lethal event, when we expose them to intervention, we really are exposing them to the potential harm of urinary side effects, and sexual side effects.

Dr Roy Jensen: Okay. Again, Alesha Miller is here in the studio to take your questions, and Alesha, do you have any final words for us?

Alesha Miller: We don't have any questions currently, but as the live broadcast ends we encourage you to continue the conversation, and we will be monitoring the questions throughout the day.

Dr Roy Jensen: Well, thank you Dr Parker, it's been a pleasure having you with us today. Please join us next Wednesday at 10:00 a.m. for Bench-to-Bedside as we discuss cancer survivorship. Thanks for watching.