Helping men understand the diagnosis of Prostate Cancer

Article Ong XRS , Bagguley D, Yaxley JW, Azad AA, Murphy DG & Lawrentschuk N, 2020, ‘Understanding the diagnosis of prostate cancer’, The Medical Journal of Australia, 213.

In Australian men, prostate cancer is the most commonly diagnosed cancer and is the third leading cause of death. With this growing health concern for Aussie men it is important men have access to information to guide them through their diagnosis and treatment of prostate cancer. Dr Elmes aims to provide his patients with detailed information and support during the diagnosis and treatment process to ensure each patient is comfortable and put at ease during this difficult time. He offers his patients the best range of advanced minimally invasive treatment options to ensure reduced risk and positive quality of life moving forward.

Firstly, it is important for men to understand the screening process to ensure early detection of prostate cancer. From here, understanding whether active surveillance, surgery or radiation is the best treatment pathway option for each patient is decided. Of course various factors such as patient existing medical history and other lifestyle factors are also taken into account by Dr Elmes to ensure the best course of treatment is undertaken.

Below is a summary by Ong et al. to help guide men through their prostate cancer journey.

A simple blood test, known as a PSA (prostate specific antigen), is a protein produced by both normal and cancerous cells of the prostate gland. Elevated readings can indicate prostate cancer although there are other variables which may indicate an increased PSA for non cancerous reasons including, age, size of your prostate, an enlarged prostate (BPH – benign prostatic hyperplasia) or prostatitis (inflammation of prostate).

Guidelines for PSA screening for Australian men by The Prostate Cancer foundation of Australia is as follows. Dr Elmes carefully considers all other variables such as family history to determine what is best for each individual patient to ensure thorough investigations and best patient outcomes.

Who to offer PSA screening – well-informed men aged 45-69

Early PSA screening – well informed men aged 45-69 years estimated to be 2.5-3 times higher than average risk* and well informed men aged 40-69 years estimated to be 9-10 times higher than average risk*

How often to screen - PSA test every 2 years

*Due to presence of risk factors such as a brother diagnosed with prostate cancer particularly if diagnoses at <60 years of age.

DRE – Digital rectal exam still provides valuable information in the diagnosis and staging of prostate cancer. It can sometimes detect cancers in patients with low PSA levels.

Multi-parametric MRI of the prostate has advanced the way in prostate cancer diagnostic pathway. For men with an elevated PSA an MRI is now available to evaluate this further and has resulted in a decrease of many unnecessary biopsies while also improving the accuracy of prostate biopsy. Findings show that if patients received a multiparametic MRI before biopsy then this might allow 27% of men to avoid an unnecessary primary biopsy and increase the detection of clinically significant cancers. The ability to locate the suspected cancer lesion with mpMRI has allowed for more targeted biopsy technique thus improved accuracy of biopsy results.

Dr Elmes utilises the MRI stratified pathway for patients who have suspected prostate cancer where patients presented with abnormal PSA levels or have an abnormal rectal examination. With the use of MRI offering improved visualisation and “aid targeting prostate biopsies to abnormal areas“, Dr Elmes is able to perform multiple biopsies in the area of interest with the use of the Artemis device resulting in improved detection rates of clinically significant prostate cancer while reducing clinically insignificant prostate cancer.

Predicting the likelihood of clinically significant prostate cancer through image and reporting data is a result of multi-parametric MRI of the prostate and has improved the diagnostics of prostate cancer and future staging.

Diagnostic prostate Biopsy allows for targeted cores to be examined and determine the grade of clinically significant cancers. Scoring systems have been designed with prostate imaging reporting and data systems. As mentioned above Dr Elmes utilises the Artemis for Computer Targeted MRI ultrasound fusion Transperineal prostate biopsy.

For men found with prostate cancer on biopsy, one of the latest and most accurate tools used to detect the location of their cancer is the PSMA-PET scan which is used for staging. PSMA-PET scan can see small deposits of prostate cancer down to a few millimetres in size, so it is particularly good at detecting prostate cancer in the early stages when it first starts to spread. PSMA PET is superior for staging compared with conventional scans.

Once the above process has been completed, Dr Elmes examines the results and has a detailed discussion around the best treatment option for you and whether that be Active surveillance, Active treatment in the form of Robotic Surgery Dr Elmes has available to his patients, Radiation therapy or watchful waiting pathway.

Active surveillance combines PSA, DRE and prostate biopsy to closely monitor a patient’s prostate cancer with the conversion to active treatment if progression occurs. Decisions on active surveillance should be made by a specialist who will consider many variables to make an informed decision as to whether this is the right pathway for you.