In a relatively light-hearted interview for such a serious topic Dr. Schwartzberg talks about Prostate Cancer and outlines in clear terms some of the essential truths that most men need to understand. The key points are:
Prostate Cancer is the #1 cancer issue for men. He explains that it is so common that 80% of men in their 80’s will have some incidence of prostate cancer. However not all prostate cancers are the same. He explains that there are essentially two types:
- Low risk non-aggressive cancer which is very common
- High risk aggressive cancers which is less common
The key is early detection and treatment of high risk aggressive cancers and the avoidance of overtreatment of low risk non-aggressive cancer.
Men are generally advised to be screened for prostate cancer after they reach 50 but two categories of men need to be extra vigilant:
- Men of African descent in the USA are 3 times more likely to contract prostate cancer than white Caucasian men. Black men also contract the more aggressive form of prostate cancer and they get it in a part of the prostate that can be difficult to find in a biopsy.
- We also know that prostate cancer is extremely inheritable so men with a family history of prostate cancer ie fathers or brothers have a far higher chance of getting prostate cancer
Dr. Schwartzberg recommends that these men in the high risk categories should be screened for prostate cancer as early as 40 and certainly by 45 years of age.
However, the current screening process of PSA testing followed by a biopsy is problematic and controversial. PSA is a protein produced by the prostate gland. Blood tests measure your PSA levels. High PSA levels may be an indication of Prostate Cancer but in 7/10 cases men with high PSA levels do not have prostate cancer. Following the PSA test, the second stage is a biopsy. High PSA levels lead to unnecessary biopsies which themselves are not risk free and can lead to infection. The other problem with biopsies and the traditional physical examination is that they are “blind” i.e. biopsies are performed without knowing exactly where the cancer is in the prostate and the digital rectal exam is as accurate as “flipping a coin”. Therefore, prostate biopsies and the physical examination can easily miss the cancer.
The other problem with the PSA – Biopsy process is that if prostate cancer is detected it can lead to radical treatment for the low risk non-aggressive cancer which could have either gone untreated and treated far less aggressively.
The solution to the screening problem that Dr Schwartzberg recommends is the use of MRI imaging after the PSA stage and before a biopsy.
An MRI scan can tell the cancer cells from the healthy cells. It can also be used to guide the biopsy so that the lesion can be targeted accurately. Dr. Schwartzberg says that the MRI in advance of the biopsy allows the doctors “to look before they poke”.
If a patient is diagnosed with prostate cancer the traditional treatment is the removal of the prostate – called a radical prostatectomy. He explains that a similar approach was taken to treating breast cancer 100 year ago with full removal of the breast, surrounding muscle tissue etc. The prostate is positioned in a “delicate place” between the rectum and the bladder. It is a reproductive organ and therefore affects the urinary function. In the case of a prostatectomy the nerves of the surrounding areas may be damaged and this leads to the major downsides of impotence and incontinence.
Building on the accuracy and visibility of MRI scans of the prostate, Dr. Schwartzberg and his him team are performing a new type of treatment called IRE or Nanoknife. This type of treatment is known as focal therapy in that it targets the individual cancer cells without causing any damage to the surrounding tissue. This overcomes the problems of impotence and incontinence which is a major breakthrough for men. IRE or irreversible electroporation is administered with the use of electrodes. An electric current produces nanopores in the cell walls and the walls of the cancer cells crumble and die.
Dr. Schwartzberg and his colleague Dr. Cooper have partnered with Prof. Michael Stehling who is world’s leading expert in this ground breaking new treatment for prostate cancer.
If you are concerned about prostate cancer contact Vitus Prostate Center.