Prostate Cancer: Baptist Health Experts on Advances in Screenings, Treatments

Prostate cancer is the most common cancer diagnosed in men in the U.S., and it’s the second leading cause of cancer death behind lung cancer. About 1 in 8 men will be diagnosed with prostate cancer during their lifetime. But each man’s risk can vary, based on his age, family history, race/ethnicity, and other factors.

Black men are more likely to develop prostate cancer than other races and ethnicities -- and when they do, they are often younger, says the American Cancer Society.

Rohan Garje, M.D., the chief of Genitourinary Medical Oncology at Baptist Health Miami Cancer Institute.

“Prostate cancer’s varying degrees of aggressiveness, along with high incidence-to-mortality ratio, provides significant challenges for both patients and the medical community,” said Rohan Garje, M.D., chief of Genitourinary Medical Oncology at Baptist Heath Miami Cancer Institute. “However, the treatment landscape of prostate cancer and its metastatic form is rapidly evolving … with great promise of improving their outcomes.”

In a new Baptist Health Doc-to-Doc podcast -- Prostate Cancer Perspectives: Clinical Insights and Emerging Advances -- Dr. Garje was joined by Adeel Kaiser, M.D., radiation oncologist at Baptist Heath Miami Cancer Institute.

The prostate is a small gland located deep in the groin, behind the base of the penis. It helps regulate urine flow and produce seminal fluid. While it tends to enlarge as men age, enlargement isn’t necessarily a sign of cancer. The top risk factor for prostate cancer is a family history or inherited gene changes, such as mutations in the BRCA1 or BRCA2 genes, or Lynch syndrome. Other risk factors include diet, obesity, and physical inactivity.

Knowing Your Family History of Prostate Cancer

“It’s very important to do a good, solid family history at the time of the initial consultation,” explains Dr. Kaiser. “If you have a family history … and then you discover that the cancer was associated with the BRCA1 or BRCA2 mutation, then obviously those are patients that you want to flag and start screening at an earlier time point. So, it’s very important for urologists and primary care physicians to keep that data in mind.”

Prostate cancer is still more likely to develop in older men. About 6 in 10 prostate cancers are diagnosed in men who are 65 or older. But the incidence of prostate cancer in young men is increasing globally. In the U.S., about 10 percent of men diagnosed with prostate cancer are under 55. The average age of men when they are first diagnosed is about 67.

Adeel Kaiser, M.D., radiation oncologist at Baptist Health Miami Cancer Institute.

Additionally, in recent years, rates of advanced prostate cancers have been on the rise, likely driven by confusion and conflict over evolving screening guidelines from the U.S. Preventive Services Task Force.

“Screening for prostate cancer has always been a challenge,” said Dr. Garje, citing the evolving guidelines from different organizations. “But the goal is an informed, shared discussion and decision-making. A physician and a patient sit together and talk about what are their risks, what are the family risks, what are the symptoms. And then make a decision collectively whether screening for prostate cancer is an option. But the key for practicing clinicians is to make sure and identify their high-risk patients.”

Guidelines from both the American Cancer Society and American Urological Association recommend that doctors discuss screening with men at an earlier age — 40 for those with a close relative who has had prostate cancer, 45 for men at high risk, and 50 for nearly all others. Men at average risk should start getting screened for prostate cancer by the age of 50. 

The U.S. Preventive Services Task Force now recommends that men speak with their doctors about periodic screening using the prostate-specific antigen (PSA) blood test. In addition to being Black, those at increased risk include men who:  Are age 55 and above (50 and above for Black men); have a family history of prostate cancer; and have a BRCA1 or BRCA2genetic mutation. Additionally, smoking and obesity are believed to be contributing factors.

In 2018, the task force reversed an earlier stance against the PSA (prostate-specific antigen) blood test, citing mostly PSA tendencies to generate positive screening results (or “false-positive” results) in men without prostate cancer. The task force urges men to consult with their doctors about the PSA’s effectiveness. Nonetheless, there is still much confusion among men about the blood test’s accuracy.

A routine blood test for prostate cancer, the PSA measures the level of PSA in the blood, referring to a protein produced by both cancerous and noncancerous tissue in the prostate. A high PSA reading likely will lead to a biopsy, followed by an MRI which uses magnets and radio waves to produce images.

A typical A 12-core prostate biopsy is a procedure that involves collecting 12 tissue samples from different areas of the prostate to help diagnose prostate cancer. An MRI scans can show if the cancer has spread outside the prostate.

Emerging Advances in Imaging Tests

“The MRI became a real game changer in the last several years in terms of how we diagnose prostate cancers to the point that now a lot of guidelines suggest that you should actually do the MRI -- even before you do the biopsy,” explains Dr. Kaiser. “So, the initial biopsy itself is MRI-guided … and if you see any high-grade lesions within the prostate then those should be sampled in addition to the 12 cores.”

A prostate-specific membrane antigen (PSMA) PET scan is an imaging test that uses a radioactive substance to detect prostate cancer throughout the body. The scan is more accurate than other imaging tests because it targets a protein called PSMA, which is found in large amounts on prostate cancer cells.

“The PSMA has been a real game-changer at Baptist Health Miami Cancer Institute,” adds Dr. Kaiser. “We've instituted PSMA testing for patients who qualify with recurrent disease or high-grade disease And with that, we've noticed that we can much better identify recurrent lesions that we previously would not.”

Dr. Garje explains that Baptist Heath Miami Cancer Institute offers a wide range of prostate cancer treatment options, including the latest advances in surgery, chemotherapy, radiation therapy – which may include internal or external forms of radiation used to kill cancer cells – and interventional oncology which may use minimally invasive therapies to treat prostate cancer.

“It's exciting time right now because we have so many options,” said Dr. Garje. “And the most key aspect for a patient is that we have a multidisciplinary care. It's patient-centric where we are focused on the patient, but different modalities. It's medical oncology, radiation oncology, and our urology oncology colleagues. We all work together so that we give our patients at Miami Cancer Institute the best care.”