How Doctors at The Oregon Clinic Find and Treat Prostate Cancer
Prostate cancer is very common and is the second leading cause of cancer death in men after lung cancer. But here’s the good news: prostate cancer can easily be found early, which gives doctors many options to help people with prostate cancer live full, healthy lives.
Learn more about prostate cancer screening, testing, and cutting-edge treatment options from Dr. David Jiang, a board-certified urologist with The Oregon Clinic Urology and Dr. Matthew Solhjem, a board-certified radiation oncologist with The Oregon Clinic Radiation Oncology.
When should Prostate Cancer screening begin and end?
The main screening test is called the PSA (Prostate Specific Antigen). It’s a simple blood test given by your primary care doctor that measures a protein made by the prostate.
- Normal PSA is usually up to 4 ng/mL
- Higher numbers might mean you need to see a urologist
- Several benign things can make PSA go up, like having a large prostate, bike riding, or having sex recently
The US Preventive Services Task Force (USPSTF) suggests a PSA test every 2-4 years from age 55 through 70, while the American Urological Association’s (AUA) recommends PSA screening every 2-4 years from 50 to 69 years of age. High risk screening should start at 40 for people with a family history of prostate cancer, germline mutations, or of African American heritage.
“I’ve become more fluid with the screening age guidelines,” shared Dr. Jiang. “PSA naturally rises with age, so a 50-year-old with a PSA of 3 might concern me more than a 70-year-old with the same result. It really depends on a person’s health status.”
How Do Doctors Confirm Prostate Cancer?
The PSA blood test doesn’t completely rule out prostate cancer, so urologists like Dr. Jiang will also perform a physical exam of the prostate known as a digital rectal exam (DRE). He says, “Even though it’s fallen out of favor, at least once or twice a year I find a bad cancer during a physical exam in a patient who has a low PSA.”
To confirm prostate cancer, Dr. Jiang begins with MRI to map out suspicious lesions and then performs a biopsy to take a tissue sample. Although some patients are hesitant to do a biopsy, it’s one step that Dr. Jiang will not skip. “We can do other tests that provide markers, but unless we have tissue to confirm a diagnosis, categorize the risk group, and guide our treatment, we can’t really move forward.”
Dr. Jiang performs the biopsy through the perineum (the space between the scrotum and anus). “I like this approach because a transperineal biopsy reduces the risk of infection to nearly zero and doesn’t require antibiotics.”
What Treatment Options are Available?
If cancer is present, patients are placed in low, intermediate or high-risk groups based on data from their biopsy, PSA, and MRI. Genetic testing of the cancer helps to determine how it might mutate. There are several treatment options for each patient’s risk group.
Active Surveillance
The most common plan for low-risk prostate cancer is Active Surveillance, or “watchful waiting.” This approach includes regular PSAs and a biopsy one year out from diagnosis to monitor any spread of cancer. 50% of men on active surveillance are still stable without disease progression after 10 years. While on active surveillance the risk of cancer spreading is very low – less than 2% and less than 1% died of their disease. Active Surveillance is also used for intermediate risk patients who have a favorable outlook.
Prostate Surgery
There are several ways that surgeons can perform a prostatectomy based on a patient’s cancer, prostate size, BMI, and other factors. Most prostate surgeons today use minimally invasive robotic procedures. Dr. Jiang performs single port surgery whenever possible and uses special techniques to help patients regain control of their bladder faster after surgery.
Radiation Oncology
Urologists work closely with radiation oncology and encourage patients to gather information on radiation treatments so they can make an informed choice.
Dr. Solhjem explains, “Image guidance has revolutionized radiation treatment for prostate cancer. We can target and treat just the prostate instead of a bigger area. This better protects the bladder wall, rectal wall and the urethra.”
Dr. Solhjem and Dr. Jiang use an advanced gel technology called Barrigel to further protect the rectal wall from high-dose radiation. In recognition of his expertise with the technology, he is the first physician in the Pacific Northwest to be named a Barrigel Center of Excellence. “I place the gel between the prostate and the rectum to push the rectum away from the prostate by about a centimeter to minimize rectal toxicity. In radiation oncology that is a huge margin!”
Advanced radiation treatments include:
- MRI-guided SBRT: the most accurate treatment available. Uses MRI images to guide treatment in real time.
- CT-guided SBRT: very accurate and a good option for patients who can’t have MRI-guided treatment.
- HDR (high dose rate) Brachytherapy: a procedure under general anesthesia that delivers radiation directly to the cancer through many hollow needles which protects the urethra.
Focal Therapy
Focal therapy targets precise areas of cancer with heat, cold, or electricity. When used in combination with MRI, focal therapy can preserve more prostate tissue. Treatments include:
- High-Intensity Focused Ultrasound (HIFU): Focused sound waves that destroy tissue through high heat.
- Cryotherapy: Thin needles deliver very cold gases to freeze and destroy cancer tissue.
- NanoKnife: Uses electrical pulses to target and destroy cancer cells with less damage to healthy tissue.
Can you Prevent Prostate Cancer?
Unlike lung or bladder cancer, prostate cancer is more about genetics than exposure. Dr. Jiang is often asked about preventative measures and says, “Everything we say in general to be healthy is what you should also do for any cancer prevention. Eat a whole food diet, stay at a healthy weight, and exercise regularly.”
What Should You Do Next?
Primary care doctors may not have time to discuss prostate cancer screening or risks in detail. To be proactive about prostate health:
- Ask questions about PSA testing at your next visit
- Request a referral to a urologist if you have concerns
- Don’t wait if you have family history or other risk factors
Dr. Jiang adds, “If you’re ever concerned about prostate cancer and you want to have an in-depth discussion, ask your primary care doctor for a referral to a urologist.”
Learn more about Urology and Radiation Oncology at The Oregon Clinic