Oakland, CA February 5, 2014.
Herbert Lepor M.D. Chairman of the Department of Urology at New York Langone Medical Center was interviewed January 16, 2014 on CBS about the highly-debated prostate cancer screening with prostate-specific antigen (PSA) test. “Before the PSA test, being diagnosed with prostate cancer was almost a death sentence,” he said because the disease was advanced by the time it could be detected on digital rectal examination (when a doctor checks the prostate through the rectum using a gloved finger). After PSA testing became widely available, the disease was diagnosed earlier, and cure rates were much better.
“It seemed as though it would be the answer to help us identify earlier cancers,” Lepor explained. It would seem like a screening test that can catch the disease early would be a major advance in medical care. In fact, “it’s one of the most controversial areas in medicine,” said CBS News Chief Medical Correspondent Dr. Jon Lapook. The problem is that the many of the tumors are low risk and not significant enough to warrant treatment. The biopsies, radiation and surgery can cause serious side effects, including infection, impotence, incontinence and other complications which would adversely affect the man’s quality of life.
That’s why a panel that advises the U.S. government on medical treatment guidelines, the U.S. Preventative Services Task Force, recommended against healthy, symptom-free men of any age getting the PSA test in the May 2012 guidelines. However, many cancer experts believe that the PSA test should still play a role. Without using the blood test, the only method left to check for prostate cancers is a digital rectal exam and they are often discovered too late.
Lepor said that what doctors need is to “screen smarter.” He suggested still using the PSA test and if it is elevated repeating it to reconfirm. Then, Lepor said, doctors could use an advanced MRI scan to see if there is a suspicious area. The biopsy could be directed or “targeted” to the abnormal area rather that the common practice of random biopsies throughout the gland as done currently if the PSA is elevated. If the MRI scan is negative, Lepor said, a man might not need a biopsy unless their PSA scores keep increasing or they have significant family history.
“Dr. Lepor’s proposal for smarter screening makes some sense. If the MRI scan is negative, the patient could avoid a biopsy and possible infection,” says Dr. Hill.
If prostate cancer is proven on biopsy, treatment options are active surveillance or interventional treatment such as radical surgery, external beam radiation, permanent seed implant or high dose rate brachytherapy. In low risk disease the cure rate excellent with any of the treatment methods. However, High Dose Rate Brachytherapy has a very low complication rate compared to the other modalities. There are essentially no rectal complications, no incontinence and a low percentage of erectile dysfunction.
About Dennis R. Hill MD
Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is firstname.lastname@example.org and his website is hdrprostatebrachytherapy.com