HJAR Sep/Oct 2020

50 SEP / OCT 2020 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN UROLOGY Even today, no single word stirs a health scare in the hearts of Americans like the word cancer. For American men, that word is very likely to be paired with prostate. As many as one in nine men will receive a prostate cancer diagnosis in his lifetime. Fortunately, this isn’t the setback it once was. Courses of treatment have advanced greatly just in my lifetime. Today, most men diagnosed with prostate cancer are achieving a cure, and those who aren’t are livingmuch longer than ever before. When it comes to prostate cancer, the best option for you depends on several factors, and chief among these is how advanced the cancer is, and how old the patient is. Regard- less, your urologist will be able to take all factors into consideration and talk through the best options for you. Many men have slow-growing cancers and/or short life expectancy, and in these cases, a course of active surveillance or watchful waiting and careful monitoring is prudent. With regular checkups, patients and physicians may consider active treatment if symptoms get worse. Screening/Early Detection The prostate-specific antigen (PSA) blood test is still the best tool we have for spot- ting fast-moving prostate cancer. PSA is a protein made by cells in the prostate gland (both normal cells and cancer cells), found mostly in semen, but trace amounts find their way into the bloodstream. If your PSA level is high, you might need further tests, such as the following: • A prostate biopsy is the gold standard for diagnosing prostate cancer, as a tis- sue diagnosis is always required before treatment protocols can be created for a patient. • Prostate MRI is often used to image the gland and find some cancerous lesions that can be hard to detect on tradition- al prostate biopsy. These images can be combined with real-time ultrasound imaging to allow for an image-guided fusion biopsy. • The Prostate Health Index (PHI) com- bines the results of total PSA, free PSA, and pro-PSA, and may offer a clear pic- ture of how aggressive the cancer is. • The 4Kscore test is a more specific blood test than a traditional PSA, and includes total PSA and free PSA, along with other biomarkers. • Tests (such as Progensa) that gauge prostate cancer antigen 3 (PCA3) in the urine after a digital rectal exam (DRE). The higher the level, the more likely that prostate cancer is present. • Tests that uncover an abnormal gene change called TMPRSS2: ERG after a DRE. It is found in some prostate can- cers, but rarely in the cells of men with- out prostate cancer. Prostate Cancer Advancements AND THE FUTURE Even today, no single word stirs a health scare in the hearts of Americans like the word CANCER.