According to the American Cancer Society, one in seven men will be diagnosed with prostate cancer during their lifetime. Caught and treated while it is still localized, prostate cancer has a nearly 100% survival rate. Because prostate cancer tends to be slow-growing, it is rare in men under 40 and rises significantly after age 50. About 60% of cases occur in men 65 and older. Having a first-degree relative (father or brother) who has had prostate cancer more than doubles a man’s risk of developing it himself.
Screening for Prostate Cancer
The American Cancer Society recommends that healthy men without symptoms discuss with their healthcare providers when PSA screening may be appropriate for them. All men with a close family history of prostate cancer should talk to their provider by age 40 to discuss screening options. Black men have a statistically higher risk of developing prostate cancer than other races, and those at average risk should initiate this conversation by age 45. All other men at average risk should do so by age 50. Your clinician will help you decide if and when PSA screening should begin. Men whose PSA levels are low typically need to be retested only every two years, while men whose PSA is elevated should have it done annually.
Discovering Prostate Cancer
In the majority of cases, prostate cancer grows slowly and produces no symptoms early on. Most cases of localized prostate cancer are discovered via screening. In many cases, doctors choose to monitor localized prostate cancer instead of actively treat it, as it is possible to live a full and healthy life with prostate cancer, provided it is a non-aggressive form. Early discovery of prostate cancer provides active surveillance as an option for nearly one third of men.
Getting Answers with Prostate MRI
Once PSA levels have been determined to be continually rising, the task becomes to discover if cancer is present and, if so, whether it is localized or has spread, and if it is potentially aggressive. Certain tests, like bone scans and CT, are incapable of imaging prostate cancer until PSA levels become quite high. That’s why magnetic resonance imaging, or MRI, has become the advanced imaging tool of choice to diagnose and treat prostate cancer.
“MRI is so sensitive, it can detect prostate cancer in men whose PSA levels are persistently elevated even if their systemic biopsy is negative,” says Diagnostic and Body MRI subspecialist Dr. Edson G. Cortes. “That’s why many referring clinicians favor prostate MRI as the first radiological test for possible prostate cancer. It provides information about the precise location, grade and stage of cancer.”
Prostate MRI is a non-invasive, radiation-free imaging test that uses radio waves and a strong magnetic field to capture a series of images that are sent to a specialized computer, which assembles them into a nearly 3-D quality composite of the prostate and related internal organs and structures. MRI reveals whether there is cancer present, where it is in the body, and what stage it has reached.
MRI creates a detailed map of the prostate and highlights abnormalities including intermediate and high-risk cancers. In cases where biopsy proves necessary, MRI greatly increases the speed, safety and efficacy of biopsy by providing pinpoint guidance to the area, avoiding excess or inaccurate sample collection.
As many as 30% of prostate cancers never grow large enough to become life-threatening, and MRI can also help avoid overtreatment in those cases. Men with localized and low grade prostate cancer usually have the option to monitor their condition using regular MRI exams, PSA monitoring and clinical evaluations instead of undergoing surgery, chemotherapy or other treatments.
Prostate Cancer Recurrence
While early prostate cancer is treated with exceptionally high effectiveness, recurrence is common, particularly in men who had high grade disease and lymph node involvement. Even after successful treatment, prostate cancer is likely to return in 20-40% of cases, which is why periodic PSA testing remains important.
PSMA for Recurring Cancer Detection
RAO’s Medical Imaging Center at Windsor Oaks is one of the few regional centers to offer PSMA, an FDA-approved PET/CT scan that can identify recurrent prostate cancer in men who previously underwent surgery or radiation. Unlike tests requiring a dramatic rise in PSA levels (10-50) before cancer will show in images, PSMA can capture even tiny tumors in men with PSA levels of 10 and below, and differentiate between a localized recurrence and one that has metastasized. PSMA can prevent costly delays in discovery, promoting the quickest and most reliable treatment options. For qualified patients, PSMA is often times covered by Medicare.
Remember, prostate cancer is manageable, treatable and survivable. If you have rising PSA levels or have been diagnosed with prostate cancer, talk to your clinician about whether painless prostate MRI might be right for you.
