By Alexandra Becker
Did you know that approximately one out of nine men will be diagnosed with prostate cancer in their lifetimes, and that prostate cancer is second only to skin cancer as the most common cancer affecting men in the U.S. today? Even more, prostate cancer does not typically present with symptoms, a fact that makes awareness about risk factors and screening even more critical for the general public.
Each September, physicians in the U.S. highlight Prostate Cancer Awareness Month to share important information about this dangerous disease. Below, Dr. Nathaniel Barnes, MD, a urological surgeon with Memorial Hermann Medical Group, and Dr. Steven Canfield, MD, Professor and Chair of the Division of Urology at McGovern Medical School at UTHealth Houston and Chief of Urology at Memorial Hermann-Texas Medical Center, discuss the importance of screening, risk factors, and the latest research underway at UTHealth Houston.
Q: Why is screening such an important tool when it comes to prostate cancer?
Dr. Canfield: Screening is important because it has been proven to make an impact on men’s quality of life as well as overall survival. If caught early, many forms of prostate cancer can be treated before it is too late. We have numerous screening tools available to us, including the prostate-specific antigen (PSA) blood test, and imaging tools like MRI, which allow us to determine who really needs to be diagnosed and treated while also ensuring we are not over-diagnosing or over-treating patients. In addition, prostate cancer does not present with any symptoms, which is a common misconception I see all the time. If a man experiences bothersome urinary symptoms, he may go to see his doctor, but that really has nothing to do with prostate cancer, so we cannot just rely on symptoms. Finally, there are men at higher risk, including African American males and anyone who has a first-degree, male relative with history of prostate cancer. Anyone who falls into those categories should certainly follow the latest screening guidelines, which recommend discussions about screening with your doctor beginning at age 50-55 for men who are at average risk and age 45 for men at high risk. Men who have more than one first-degree relative who had prostate cancer at an early age should begin at age 40.
Dr. Barnes: Prostate cancer is such a prevalent cancer and our ability to screen is simple and straightforward and allows us to capture those who need treatment, so the importance of screening cannot be understated. I also think as we move into the future, we’re going to be increasingly focused on other risk factors, including men in high risk groups who have one or two relatives who have had cancer related to the BRCA2 gene. We have historically looked at men whose fathers had prostate cancer, but now there is significant data showing that if their mothers or sisters have had ovarian or breast cancer, they may be at an increased risk for prostate cancer. We are constantly enhancing our ability to screen patients and capture the disease earlier.
Q: Do lifestyle factors, such as a specific diet or exercise regimen, affect a person’s risk of getting prostate cancer in their lifetime?
Dr. Canfield: When asked this question, I always take the opportunity to remind men that a healthy lifestyle is good in general. Cardiovascular disease is still the No. 1 killer in men in the U.S., and it turns out that what is good for your heart may be good for your prostate, too, although nothing has been proven. Despite many attempts over the decades—including long-term longitudinal studies and controlled trials—no diet, supplement, food substance or lifestyle factor has been proven to decrease risk or prevent prostate cancer.
Q: As Co-Chairs of the Memorial Hermann Prostate Cancer Center of Excellence, can you speak to the importance of this program and what sets it apart from others?
Dr. Barnes: The Center of Excellence is a multidisciplinary collaborative effort between a number of specialists within Memorial Hermann Health System and our partners at UTHealth. This includes urologists, radiation oncology partners throughout MHMD, medical oncologists, uropathologists, and a small group of very specialized radiologists who specialize in MRI. Our multidisciplinary group works together to standardize how we diagnose, manage and treat prostate cancer across the board. Some places will label themselves a center of excellence without any qualifying criteria to define them as such, but we followed a list of criteria focused on quality metrics that we have established for our hospitals throughout the System. Our aim is for the quality of care to be cutting edge and state-of-the-art while ensuring consistency of care with every encounter and with every patient. Oftentimes when we say medicine is a science and an art, the art part is how we subjectively interpret diagnoses and treatment, but that is all based on a strong foundation of the science. Our goal at the Center for Excellence is to use late-breaking, cutting-edge science to be the foundation of how we evaluate and manage these patients, and to do it on a multidisciplinary level versus from office to office or campus to campus. In short, we are a collaborative group made up of multiple specialties all with the same goal in mind and all with the same quality metrics as our standard.
Q: Tell us about the latest research taking place at McGovern Medical School at UTHealth Houston, which uses gold nanoparticles to help localize treatment for prostate cancer.
Dr. Canfield: We are working to make focal therapy even more precise. A few modalities to ablate the area of a prostate affected by cancer currently exist, but we are trying to make this technique smarter by targeting the actual cancer cells in the prostate with nanoparticle technology. We infuse the prostate with special-property gold nanoparticles that were invented in a physics lab at Rice University by a brilliant scientist with whom we collaborate. Once they are in the prostate, we place a unique laser using MR fusion localization technology, and we then activate those nanoparticles, just where the cancer is. So it is a much more precise, smart, and ultra-focal way of getting rid of the cancer. Through this increased precision, our goal is to not only ensure we are getting all of the cancer, but also to minimize the other side effects that are common with radical treatments. So far, it seems to be working and our trial is going really well. Our next steps are to gather more data and then submit to the FDA with the hope that eventually, this can become a new standard treatment option for men with prostate cancer.