Prostate Cancer Breakthroughs from Georgia Urology’s Dr. Scott Miller

In the last few years, we have made great strides with prostate cancer diagnosis and treatment. Not only have we developed a better understanding of the cellular and genetic behavior of these rogue cells in a laboratory setting, but we have also applied this research to managing every stage of this cancer. Whether it’s diagnosed as a small tumor isolated to the prostate or as an advanced stage cancer in multiple areas of the body, we can address each stage better than ever.

To fully understand the significance of our advancements, one must look back 20 years to the Human Genome Project. In the early 1990s, scientists began decoding the entire human DNA. They successfully unraveled the code, which was more than three billion items long and represented more than 20 thousand human genes! Today, we can send a tissue sample from a prostate biopsy to a specialized lab to determine if an individual patient’s prostate cancer contains genes that would make it more aggressive. As a result, we can often determine which patients need more involved treatment and which patients may not need any treatment at all.

In the past, for those patients unfortunate enough to develop cancer that had spread to other areas of the body, there was only one reasonable treatment option: hormone deprivation therapy. By depleting the body of testosterone, prostate cancer cells would decrease in number, but only for a limited period of time. We now have two new categories of treatment to offer men once the hormone therapy stops working: immunotherapy and targeted chemotherapy. Immunotherapy involves removing the white blood cells from a unit of blood that the patient donates. A modified version of these white blood cells is then re-infused, thereby manipulating their immune system so that it specifically attacks the prostate cancer cells. Targeted chemotherapy, although still in its infancy, is a type of chemotherapy that destroys prostate cancer cells based on their unique genetic makeup as compared to normal cells.

Detecting prostate cancer poses several challenges. Some cancers are difficult to find. Some are more aggressive than others. The extent of disease can sometimes be difficult to determine. To help with these challenges, we now have a more advanced method for performing an MRI scan of the prostate. The machines are now much faster and more powerful. As a result, they can measure how the prostate cells process a substance injected into the veins. As it turns out, cancer cells and normal cells behave differently in a way that an MRI can measure. This test can also help determine the extent of the cancer and even guide a needle to biopsy the suspicious cells directly.

For the patient who undergoes treatment for early-diagnosed prostate cancer, recent advancements have led to a decrease in side effects. Robotic prostate removal has allowed other “add-on” technologies. For instance, nerves responsible for erectile and urinary function are often hidden from the surgeon. A nerve-monitoring device incorporated into the robotic surgical system can now help identify these nerves on the surgeon’s video display. For those patients who choose radiation therapy, the current technology delivers more of the beam to the prostate and less to the surrounding tissues responsible for vital functions.

These recent advancements in prostate cancer research have allowed us to treat beyond what the human eye can see, helping yesterday’s imagination become today’s reality.