OU Medicine Highlights Screening Guidelines for Prostate Cancer

Prostate cancer is the most common cancer in men, but screening for early detection gives patients a better chance for successful treatment. Urology specialists at Stephenson Cancer Center at OU Medicine cite guidelines developed by the American Urological Association (AUA) and urge men to discuss screening with their doctors.

Urologic oncologist Michael Cookson, M.D., explained that early detection means discovering prostate cancer before symptoms appear - when a man would otherwise have no reason to seek medical care, and early discovery has been shown to save lives.

Diagnostic tools for screening include prostate specific antigen, or PSA, a simple process that requires a blood draw. Elevated levels of PSA in the blood may indicate a prostate disorder, such as prostate cancer or enlarged prostate.

"When tumors of the prostate are detected early, men often have many options, ranging from surveillance to localized treatments," Cookson said. "Tumors detected only after symptoms develop tend to be more advanced in stage, with fewer curative options."

AUA recommends routine screening primarily for men from 55 to 69 years of age, assuming the absence of other risk factors.

"The association does not recommend routine screening for men younger than 40, as prostate cancer is rare in this age group," Cookson said. "Similarly, there is no compelling reason to routinely screen men of normal risk between the ages of 40 and 54."

Men at greater risk include those of African American race and those with a family history of prostate cancer, male and female breast cancer, ovarian and pancreatic cancers. In all cases, however, Cookson said decisions should be individualized.

"While the intent of these guidelines is to reduce unnecessary biopsies, men should discuss the benefits of screening with their doctors and make decisions weighing all relevant information."
Cookson said MRI-guided fusion biopsy is an advanced imaging tool that may result in earlier diagnosis.

"Small, potentially aggressive tumors were often undetectable using traditional diagnostic methods, which were little improved in 20 to 30 years. MRI with targeting now allows us to find these tumors before they spread beyond the prostate. Men with high PSA levels may not have prostate cancer, and men with low levels aren't necessarily cancer-free. A biopsy of prostate tissue is needed to confirm a diagnosis."

MRI-guided fusion biopsy combines the technology of detailed MRI scans with live, real-time ultrasound images of the prostate gland. The patient first undergoes the MRI. A radiologist reviews those images, marking any areas of concern. An outpatient procedure follows, which "fuses" the real-time ultrasound images with detailed 3-D ultrasound of the prostate.

"This technology makes it possible to be more selective about taking prostate tissue for biopsy. It's far more precise - not a random sampling of tissues that may or may not be suspicious," Cookson said.

Urologists and primary care providers are on the front lines of men's health concerns and understand the limitations of annual screening. While no method is perfect, Cookson said it is still important to use available tools to the best advantage.

"In the same way that research resulted in detecting genetic mutations that enhance breast cancer risk, we are now appreciating the added predictive and prognostic role of genomics and genetics in diagnoses and treatment of prostate cancer," Cookson said. "Early versions of this form of testing are already making a difference in how we determine appropriate modes of treatment."

According to the American Cancer Society, prostate cancer will claim more than 30,000 lives this year. More than 170,000 new cases of prostate cancer will be diagnosed.

Like other cancers, prostate cancer has many forms, ranging from less aggressive to more aggressive. One emphasis of ongoing research is the ability to identify gene mutations that take on such variability in each person, including differences in immune function, environment and lifestyle.