28 LONGISLANDPRESS.COM • SEPTEMBER 2020
SEPTEMBER IS PROSTATE CANCER AWARENESS MONTH
Diagnostics for prostate cancer include
a physical examination to ascertain if
there is unusual firmness or a nodule
on the prostate, and prostate-specific
antigen (PSA) screening. PSA is a protein
produced by both cancerous and
noncancerous tissue in the prostate.
The PSA test measures the amount of
PSA in the blood. The American Urological
Association recommends “shared
decision-making” between doctor and
patient for men ages 55 to 69 years who
are considering PSA screening. Men
in their 40s or 50s who are at risk may
consider getting screened earlier.
At-risk males include those with a family
history of prostate, breast, ovarian, and
colorectal cancer and specific genetic
factors.
“We know that men who carry the BRCA
mutation gene mutations associated
with increased breast cancer risk also
carry increased risk of not just prostate
cancer but aggressive prostate cancer,”
Dr. Vira says.
An elevated PSA does not necessarily
equate to a definitive prostate cancer
diagnosis or necessitate a biopsy, says Dr.
Michael P. Herman, chief of the division
of urology at South Nassau Communities
Hospital. There are two additional blood
tests — the 4Kscore® and the Prostate
Health Index (PHI) — that can aid in
determining whether or not a patient
needs a biopsy.
“If needed, MRI-guided biopsies could
increase accuracy of the biopsy,” Dr. Herman
says. “We’re biopsying fewer people
because we’re able to figure out which men
don’t actually need it, but the ones we’re
biopsying are the ones that are truly at
risk, not just because of the high PSA.”
Surgery has improved by using robotics,
says Dr. Herman.
“We’re able to construct everything
very precisely and give people the best
outcomes when it comes to urinary control
and sexual function,” he says.
Recovery from surgery tends to be very
fast, too, he adds. Treatment time for radiation
for prostate cancer is also much
different than it is for other cancers.
“Radiation treatment can be as short
as a week or up to two months, but once
you’re done with radiation, that’s typically
it,” Dr. Herman says.
Treatments for men diagnosed with
Stage 4 prostate cancer especially have
dramatically improved over the years,
notes Dr. Vira.
“Traditional stage 4 prostate cancer
was treated with hormonal therapy to
eliminate testosterone from the body and
that treatment would be successful for a
period of time, but eventually the cancer
would start to grow again,” he explains.
Several drugs or treatments have
been developed for patients who have
failed hormonal therapy. A drug called
olaparib has shown positive results in
clinical trials in men who have the BRCA
mutation, Dr. Vira says. A big avenue of
treatment is actually no treatment at all,
he adds.
The idea behind “active surveillance”
is that “many men who have no risk of
prostate cancer at diagnosis may not
need treatment right away, because their
cancer is going to have a very slow and
somewhat indolent course.”
Surveillance, monitoring, and routine
PSA testing would be recommended. If
the cancer becomes more aggressive,
treatment such as surgery or radiation
could follow.
“Treatment recommendations should
always be tailored to the individual
and their personal approach,” says Dr.
Herman, “and with a physician that is
willing to take that personal approach,
work with the individual, and understand
where they are coming from.”
“We’re biopsying fewer people,"
says Dr. Michael P. Herman.
PRESS HEALTH
continued from page 27
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