September is Prostate Cancer Awareness Month. A common cancer affecting men worldwide, prostate cancer occurs in the small gland that produces seminal fluid. While it is often slow-growing, more aggressive forms can be life-threatening.
Dartmouth Health urologist Lawrence M. Dagrosa, MD, who specializes in several genitourinary cancers, answers some common questions about prostate cancer, major risk factors, early detection, and the advances in treatment options, including a major new initiative here at Dartmouth aimed at improving prostate cancer surgery and reducing side effects.
Q: What is prostate cancer, and who is most at risk?
Dagrosa: The prostate is a gland in men only that is located below the bladder. About 1 in 8 men will be diagnosed with prostate cancer during their lifetime*. Because it generally grows slowly, few men will have any related symptoms or problems. However, more aggressive forms can spread quickly.
Men over the age of 50 are at higher risk, and African-American men tend to have a higher incidence. A family history of prostate cancer as well as certain genetic mutations, such as BRCA1 and BRCA2, are also linked to an elevated risk.
Q: What are some common symptoms of prostate cancer?
Dagrosa: Symptoms of prostate cancer generally only appear in later stages. These may include:
- Problems urinating, including a slow or weak urine stream or frequent urination, especially at night
- Blood in the urine or semen
- Pain in the hips, back, or pelvis
It's important to note that these symptoms are rarely a sign of prostate cancer. They are more likely related to a non-cancerous condition, such as benign prostatic hyperplasia (BPH), so it’s crucial to consult a doctor for a proper diagnosis.
Q: What is the proper diagnosis?
Dagrosa: Most prostate cancers are detected through a Prostate-Specific Antigen (PSA) blood test. PSA is a protein produced by both cancerous and healthy tissue in the prostate. Elevated levels may indicate cancer, although high PSA can also be due to other factors like inflammation or BPH. Therefore, if PSA levels are high, we’ll then do a digital rectal exam to manually check the prostate for abnormalities like lumps or hard areas.
If these tests together suggest the possibility of cancer, we generally recommend imaging the prostate with an MRI followed by a prostate biopsy to confirm the diagnosis. If cancer is confirmed, we may do further imaging tests, such as a PET scan to determine if the cancer has spread.
Q: Are there any new treatment options for prostate cancer?
Dagrosa: The treatment for prostate cancer depends on the stage of the disease, the patient’s overall health, and personal preferences. Common treatment options may include active surveillance for early-stage or slow-growing prostate cancer, surgery (prostatectomy), radiation therapy, hormone therapy, chemotherapy or immunotherapy.
Other techniques like high-intensity focused ultrasound and cryotherapy offer less invasive options with fewer side effects in certain patients. These treatments, however, are not currently standard of care and are ideally suited for very specific situations or in a clinical trial setting.
Robotic surgery has also come a long way, significantly decreasing up-front risks for patients. Dartmouth Health has been on the forefront of robotic surgery since it was first introduced in the early 2000’s. We now have five Da Vinci Robot systems at Dartmouth Hitchcock Medical Center. Our fleet includes the newest generation robotic platform called the Da Vinci 5, as well the Da Vinci Single Port robotic system. All of the surgeons in the Genitourinary Cancer Program at Dartmouth Cancer Center are specially trained in the latest robotic surgery techniques.
Q: Can prostate cancer be prevented?
Dagrosa: While there is no guaranteed way to prevent prostate cancer, certain lifestyle choices and health measures may reduce the risk. These include a healthy diet and regular exercise, proper screening, genetic testing and regular check-ups. Routine health check-ups allow you and your doctor to discuss your individual risk and monitor potential symptoms, especially as men age.
Q: What is the latest in prostate cancer research?
Dagrosa: Here at Dartmouth Cancer Center, we’re conducting multiple clinical trials to improve surgery, radiation therapy and medical management of prostate cancer.
For example, we've been working for many years with the Thayer School of Engineering at Dartmouth to improve prostate cancer margin detection during surgery. Our goal is to decrease the likelihood of prostate cancer recurrence following surgery. We're now able to test this sensor during robotic prostate cancer surgery cases at DHMC with eligible patients who are interested in being part of the trial.
In addition, a collaborative team led by researchers from Thayer and including surgeons from Dartmouth Cancer Center was chosen as one of the first teams in the federal Advanced Research Projects Agency for Health (ARPA-H), Precision Surgical Interventions program. This award comes with up to $31M of funding with which we hope to leverage Dartmouth’s strong history in the optical navigation space for surgery to develop a fluorescence-guided imaging solution for use during robotic surgery. If successful, this technology will allow us to maintain the extremely high cure rate associated with prostate cancer surgery, while minimizing the significant risk to urinary and sexual function often associated with surgical treatment.
While we are in the early phases of this study, we will soon be able to launch clinical trials to offer this novel technique to surgical patients here at Dartmouth Cancer Center.
*American Cancer Society Key Statistics for Prostate Cancer.