{"id":129183,"date":"2017-09-07T10:39:49","date_gmt":"2017-09-07T14:39:49","guid":{"rendered":"https:\/\/today.uconn.edu\/?post_type=school-college-post&p=129183"},"modified":"2017-09-07T10:39:49","modified_gmt":"2017-09-07T14:39:49","slug":"important-points-prostate-cancer","status":"publish","type":"post","link":"https:\/\/today.uconn.edu\/2017\/09\/important-points-prostate-cancer\/","title":{"rendered":"Important Points about Prostate Cancer"},"content":{"rendered":"

September is Prostate Cancer Awareness Month so it\u2019s an opportune time to discuss one of the most common cancers in men. UConn Health urologists, Drs. Peter Albertsen, Brooke Harnisch and Benjamin Ristau, answer questions about the latest information concerning diagnosis and treatment.<\/em><\/p>\n

How much of a factor in prostate health is the PSA test today, and how has that changed over the years?
\n<\/strong>PSA was originally developed as a blood test to\u00a0detect prostate cancer recurrence after treatment and received its initial FDA approval for this purpose in 1986. In this setting, it is one of the best biomarkers across the entire cancer landscape. In 1994, PSA was approved as a test for prostate cancer screening. \u00a0It is in this arena where the majority of\u00a0controversy exists.<\/p>\n

PSA screening has undoubtedly reduced the incidence of\u00a0prostate cancer cells spreading outside the prostate.\u00a0By\u00a0doing so,\u00a0death from prostate cancer has declined since PSA-based population\u00a0screening began\u00a0the mid-1990s. \u00a0However, PSA screening has also led to an increase in the detection of low grade\u00a0prostate cancers. \u00a0Most of\u00a0these low grade cancers\u00a0do not require immediate treatment and many will\u00a0never negatively\u00a0impact a man’s life. Fortunately, we now have high level data from clinical\u00a0trials to support watching most low grade cancers over time – a concept called active surveillance. \u00a0The goal of active surveillance is to carefully monitor a man’s prostate cancer so that we maintain the ability to\u00a0cure if cure becomes necessary. \u00a0At the same time, active surveillance allows us to avoid treatment and its inherent risks when a prostate cancer is unlikely to have a negative impact on a man’s life.<\/p>\n

The most recent guidelines state that men should have discussions with their doctors about PSA screening and decide together on the best course of action for an individual patient. \u00a0This concept is called\u00a0shared decision-making.<\/p>\n

How do you determine what course of action to take when you diagnose a man with prostate cancer?
\n<\/strong>There are two major considerations at play when a man is diagnosed with prostate cancer. \u00a0First, how aggressive is the cancer?\u00a0 The vast majority of low grade grade cancers can very safely be watched over time. High grade cancers and some intermediate grade cancers,\u00a0on the other hand, may require treatment. This brings us to the second consideration; how long do we expect a man will be living with prostate cancer. \u00a0The interplay between these two considerations is individualized and requires a\u00a0nuanced discussion between a patient and his urologist.<\/p>\n

Explain the concept of \u201cwatchful waiting\u201d or \u201cactive surveillance\u201d?
\n<\/strong>Watchful waiting and active surveillance sound similar, but describe management options with different priorities in mind. With\u00a0watchful waiting, the\u00a0goal of cure is not front and center. Rather, treatment begins\u00a0when prostate cancer starts to cause symptoms. Typically, this happens\u00a0several years after the initial diagnosis,\u00a0and often,\u00a0the cancer has spread outside of the prostate gland by the time it starts to cause these symptoms.\u00a0As such, it is a strategy used mostly in men with a\u00a0limited life expectancy. Hormone therapy is commonly\u00a0used to reduce the symptoms, and men can live for many years without symptoms from advanced\u00a0prostate cancer\u00a0when they are on\u00a0hormone therapy.<\/p>\n

\"Albertsen\"
Dr. Peter Albertsen, chief of the Division of Urology at UConn Health. (Lanny Nagler\/ UConn Health)<\/figcaption><\/figure>\n

In contrast,\u00a0the\u00a0goal of cure\u00a0remains\u00a0front and center\u00a0with active surveillance. However, this is contextualized by a desire to avoid the\u00a0risks of prostate cancer treatment until it becomes clear that a prostate cancer may negatively impact a man’s lifespan. Active surveillance is an option for the vast majority of men with low risk prostate cancer. \u00a0It is characterized by active monitoring through periodic PSA blood\u00a0tests, use of MRI, and occasional repeat prostate biopsy to ensure that a low risk cancer doesn’t become more aggressive. \u00a0By so doing, the window of opportunity for cure is maintained while avoiding some of the undesirable side effects of treatment.<\/p>\n

In Connecticut, we are extremely fortunate to have one of the pioneers of active surveillance – Dr. Peter Albertsen – who wrote the initial research studies demonstrating that most men with low risk\u00a0prostate\u00a0cancers are not at risk of dying from their cancer. \u00a0Nearly 15 years later, active surveillance is\u00a0a\u00a0widely\u00a0accepted\u00a0management strategy for low risk prostate cancer. \u00a0With his seminal\u00a0work,\u00a0Dr. Albertsen laid the\u00a0foundation that\u00a0has prevented\u00a0unnecessary overtreatment for countless men.<\/p>\n

At what point do you decide to intervene, what are today\u2019s most effective treatments?
\n<\/strong>Unfortunately, not all prostate cancers\u00a0are\u00a0low grade;\u00a0there are some bad actors. After discussion with the individual, a surgeon usually recommends intervention if there is a significant risk of shortened life span or significantly\u00a0decreased quality of life due to advanced prostate cancer.<\/p>\n

Intervention can be divided into two basic categories: surgery and radiation therapy. Both options are available at UConn Health.\u00a0Surgery can be done as\u00a0either an\u00a0open procedure or a minimally-invasive approach using small key-hole incisions (robotic surgery). Radiation therapy involves several prostate-focused\u00a0radiation treatments typically accompanied by\u00a0hormonal therapy. \u00a0Generally speaking, surgery tends to be offered to younger patients and radiation to older patients as a primary treatment; though, there are no hard and fast age limits for either. Cancer outcomes and treatment side effects are comparable between the two approaches. Advances in surgical technique and radiation therapy technologies have led to a reduction in the frequency and severity of adverse side effects.<\/p>\n

What can men do to reduce their risk of prostate cancer?
\n<\/strong>Currently, there are no\u00a0known modifiable risk factors specific to prostate cancer. General recommendations are to engage in moderate regular\u00a0exercise,\u00a0increase\u00a0fruit and vegetable intake, and minimize\u00a0consumption of\u00a0red meat. As Dr. Albertsen often says to men who inquire, \u201cwhat is good for your heart, is good for your prostate.\u201d<\/p>\n

\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

During Prostate Cancer Awareness Month, UConn Health urologists answer questions about the latest information concerning diagnosis and treatment.<\/p>\n","protected":false},"author":27,"featured_media":129201,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_crdt_document":"","wds_primary_category":0,"wds_primary_series":0,"wds_primary_attribution":0,"footnotes":""},"categories":[1868],"tags":[],"magazine-issues":[],"coauthors":[1867],"class_list":["post-129183","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-meds"],"pp_statuses_selecting_workflow":false,"pp_workflow_action":"current","pp_status_selection":"publish","acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-13 23:27:43","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts\/129183","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/users\/27"}],"replies":[{"embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/comments?post=129183"}],"version-history":[{"count":0,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts\/129183\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/media\/129201"}],"wp:attachment":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/media?parent=129183"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/categories?post=129183"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/tags?post=129183"},{"taxonomy":"magazine-issue","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/magazine-issues?post=129183"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/coauthors?post=129183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}