New post-prostatectomy study sheds light on prostate size as potential indicator of cancer aggressiveness; may lead to stronger prostate cancer diagnostic tools.
NEW YORK, Feb. 9, 2012
Despite great strides in reducing prostate cancer deaths (http://www.roboticoncology.com), experts are continually challenged to develop better diagnostics for the accurate assessment of prostate cancer severity level once the disease is detected. New findings published in the Journal of Urology point to prostate size as a possible indicator of whether or not a man’s prostate cancer is likely to develop aggressively. A smaller prostate with a higher PSA level , they found, may mean a more destructive form of the disease.
Prostate cancer presents a great paradox to researchers and specialist alike. Some experts urge against the proactive treatment of prostate cancer, claiming men are far more likely to die with the disease than from it. Others, like Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, urge removal of a cancerous prostate, citing prostate cancer as the second leading cause of cancer deaths in men.
Unfortunately, the more aggressive forms of prostate cancer are nearly indistinguishable from their more benign counterparts, prompting many men to opt for aggressive treatments such as robotic prostate surgery. With better staging capabilities, doctors could offer patients a clearer understanding of their specific disease and recommend a more customized prostate cancer treatment course.
“Thanks to the PSA test , we’re diagnosing prostate cancer much earlier,” said Dr. Samadi. “But our knowledge is still somewhat limited. The more we could understand about a man’s unique type of prostate cancer, the better equipped we’d be to predict its progression. Those answers have the potential to guide a more diagnosis-appropriate course of treatment.” With more certain information, that treatment might also be more conservative.
Researchers at Vanderbilt University Medical Center found that men with smaller prostates were more likely to have a more aggressive form of prostate cancer. Each of the 1,200 men in the study were initially diagnosed with low-risk prostate cancer based on a low PSA level and Gleason score. Their prostates were analyzed following prostatectomy surgery and in 31 percent of the cases Gleason score was upgraded.
The answer, researchers explain, is in understanding the relationship between a man’s PSA level and the size of his prostate. A high PSA level in a small prostate is likely to indicate an aggressive tumor, verses a high PSA level in a large prostate that could simply be the result of benign prostatic hyperplasia (BPH), an enlarged prostate.
One third of the men in this study received an upgraded Gleason score, or risk level, after pathological examination of their prostate post-surgery. “The methodology of this research is also a good reminder of how much additional information is gleaned from surgery. What we learn from the PSA test and the biopsy paints only a partial picture. Prostatectomy surgery is the only way to see the true extent of the cancer first hand and ensure its complete removal,” explained Dr. Samadi.
The prostate-specific antigen (PSA) blood test and subsequent biopsy are the current combination for diagnosing prostate cancer. A Gleason score is then assigned to the diagnosis to label the severity of the prostate cancer.
“Identifying potential prostate cancer biomarkers, such as prostate size, is critical to optimizing the way we diagnose and treat the disease. However, today we’re not able to isolate the intricacies of prostate cancer severity with enough certainty for me to feel comfortable recommending a passive approach like watchful waiting,” Dr. Samadi cautioned, “For most men today, the best treatment course is to remove the prostate through robotic prostatectomy surgery.”