HLN recently had the pleasure of sitting down with UTMC urologic oncologist Firas Petros, MD, and Puneet Sindhwani, MD, chairman of the UTMC department of urology, to discuss various aspects of prostate health and the latest advances in the diagnosis and treatment of prostate issues. In the first installment of this two-part series, we’ll share our questions and Dr. Petros’ expert answers on prostate cancer diagnosis and genetic testing:
HLN: How do you determine whether a patient has prostate cancer? Is this assessment based primarily on PSA levels?
Dr. Petros: If a patient is referred to us, whether because of an elevated PSA level, an abnormal finding during a digital rectal exam, or a family history of prostate cancer, we look at a lot of different factors before concluding that it’s appropriate to perform a biopsy looking for prostate cancer.
By itself, a high PSA, which stands for prostate-specific antigen, is just one indicator that we need to explore further. If only one PSA test has been done, we’ll often repeat it to get a sense of the trend over time. In some patients, depending on rectal exam findings and PSA level, we also want to know the ratio between free and total PSA, which helps us determine whether the elevation is due to cancer or benign prostatic hyperplasia, commonly known as BPH. The lower the percentage of free PSA, the higher the chances of prostate cancer. In addition, we conduct further blood and urine testing looking for other biomarkers to predict whether cancer is present.
HLN: We understand UTMC offers a state-of-the-art approach to prostate biopsy. What can you tell us about this advanced technique?
Dr. Petros: UTMC offers MRI/Ultrasound Fusion Biopsy, which is a significant improvement on the traditional approach to prostate biopsy. With the standard approach, multiple tissue samples are taken at random from the prostate gland under ultrasound guidance. Because ultrasound is ineffective at differentiating between cancerous and non-cancerous tissue, this random approach has the potential to either overlook harmful tumors, which could then go untreated, or detect inconsequential ones, possibly leading to overly aggressive treatment.
However, with MRI/Ultrasound Fusion Biopsy, we can get a much better visual assessment of the prostate and see if there are any suspicious lesions. Then, if a suspicious area is noted, we will still do a systematic biopsy, but we can also make sure we’re getting a sample from that questionable area. This targeted sampling greatly increases the accuracy of the biopsy. Using MRI also allows us to assess the tissues around the prostate to determine whether cancer has spread to surrounding organs or structures, and our radiation oncologists and surgeons can use the same imaging to help guide their treatment planning.
HLN: What role does genetic testing play in the care you provide?
Dr. Petros: National Comprehensive Cancer Network guidelines now recommend genetic screening for individuals who are at high risk or very high risk of developing cancer. However, we’re also doing genetic testing for individuals at intermediate risk based on their biopsy result as well as those with a family history of prostate cancer or certain other forms of cancer.
The testing we do is called germline testing, which screens for a variety of hereditary gene mutations that can be associated with increased cancer risk. For example, mutations in the BRCA1 and BRCA2 genes can increase the risk of breast and ovarian cancers in women, but also prostate cancer in men. This screening involves a simple blood test that we send off to a company in California, which then sends us results in about two weeks.
Germline testing offers numerous benefits. One is that it can help us determine whether the patient’s children are at increased risk of developing cancer and may need earlier medical surveillance. In fact, if an individual tests positive for a specific gene, there’s at least a 50 percent chance of that gene getting passed on to the kids. For that reason, the testing company allows the patient’s children to be tested for free for 90 days after the initial test. So, we’re not just treating you. We’re also thinking about your family, how they should be screened, and how we should follow up with them afterward.
Another major benefit of germline testing is that it allows us to provide highly individualized treatment, which was not the case just five years ago. Cancer is different from patient to patient, and genetic testing makes it possible to tailor treatment and anticipate outcomes based on the individual’s unique genetic profile. UTMC is on the cutting edge with germline testing, and it’s really helping us take cancer care to the next level.
Next month, be sure to read part 2 of this series, in which Dr. Puneet Sindhwani will share his expert insights on the diagnosis, symptoms, and advanced treatment options for BPH, or benign prostatic hyperplasia.