In the latest installment of our occasional conversations with Fort Worth leaders, Dr. Matthew Cavey, a radiation oncology physician on the medical staff of Texas Health Harris Methodist Hospital Fort Worth, discusses advances in prostate cancer screening and treatment.
This conversation has been edited for length and clarity. For the unabridged version, please listen to the audio file attached to this article.
Alexis Allison: Can you tell us a little bit about prostate cancer and how common it is?
Dr. Matthew Cavey: Prostate cancer is the most common cancer in men. One in eight men will be diagnosed with prostate cancer in their lifetime. There are approximately 250,000 new cases in the United States each year. And, prostate cancer leads to the second-most cancer deaths in men behind lung cancer, which results in approximately 35,000 deaths each year.
Allison: Typically, what does screening and prevention look like for prostate cancer?
Cavey: Well, there’s no true prevention for prostate cancer, but a man can reduce his prostate cancer risk by maintaining a healthy lifestyle with exercise and having a healthy diet. Screening involves a PSA blood test, typically at about the age of 45 or 50, depending on risk factors, and also includes a digital rectal exam, typically by the primary care physician.
Allison: How often are men recommended to get these tests?
Allison: It’s my understanding that there have been some advances in the world of prostate cancer screening and care. Can you tell us a little bit about those?
Cavey: In the recent past, when a gentleman had an elevated PSA blood test, the patient would be referred to a urologist and typically undergo a traditional prostate biopsy, in which the biopsy needle is passed through the rectal wall randomly into the prostate gland.
But now, an MRI is recommended prior to a biopsy. And if a suspicious area is noted in the prostate gland, we can now perform targeted biopsies. They’re 1.5-2 times more likely to diagnose an aggressive prostate cancer than the random, non-targeted biopsies.
So in addition, the preferred approach for a prostate biopsy is now to pass the needle through the perineum, which is the skin below the scrotum, instead of passing the needle through the rectum. So this transperineal approach is much safer and also allows for all areas of the prostate to be sampled.
Allison: How does the new process affect a person’s experience and recovery from these screenings?
Cavey: There have been some recent studies that have shown that this new method of doing a transperineal biopsy is equally as well tolerated as a traditional transrectal biopsy. And it can be done in the office — we do them in my office here, and we administer the patient nitrous oxide and use lidocaine to numb the area. They can also be done in the operating room under general anesthesia if the patient is not up to the procedure in the office.
Allison: If a person is diagnosed with prostate cancer, what happens next?
Cavey: Well, they typically would discuss their treatment options with a urologist and hopefully a radiation oncologist. The two upfront treatment options for prostate cancer are surgery and radiation therapy. And you know, not many centers in North Texas offer all forms of therapy, but fortunately here in Fort Worth, we do.
One of the treatments that’s not commonly offered is brachytherapy, or a prostate seed implant. Which is unfortunate, because it’s an excellent treatment option for prostate cancer and is twice as likely than other forms of radiation therapy to cure more aggressive cancers.
Allison: Can you tell us what a ‘prostate seed implant’ is?
Cavey: Basically, it’s internal radiation. The typical way radiation therapy is administered is externally — so there’s a machine that delivers high-energy photons typically to the target.
A seed implant is an internal form of radiation therapy. Radioactive pellets or seeds are surgically implanted into the prostate gland. It’s an outpatient surgical procedure, where the patient is under general anesthesia. With the patient under anesthesia, using transrectal ultrasound guidance, we place the seeds into the prostate through the perineum.
It’s a quick procedure that takes about 20 to 30 minutes and has excellent effectiveness in curing cancer but also is good as far as the quality of life that patients experience afterward. And it’s a very cost-effective treatment.
Allison: If people wanted to learn more about this specific treatment or prostate cancer in general, where would you direct them?
Allison: Is there anything else you’d like people listening to know about prostate cancer or these new options?
Cavey: One of the other exciting developments in the area of prostate cancer diagnosis and treatment is a field called theranostics, which is combining therapy with diagnostic capability. So basically it’s targeting receptors on the prostate cancer cells very specifically to locate where these cells are. And then the therapeutic part of it is then being able to basically deliver like heat-seeking missiles to these cells throughout the body. So this is kind of a cutting-edge and recent breakthrough, and we’ll see much more of this in the near future.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.