Prostate Cancer Awareness: A Q&A With the American Cancer Society

Guys always hear about how important prostate screenings are. If you had the chance to sit down one-on-one with them, how would you explain, in layman's terms, why a checkup is needed, what it could help and what it could prevent?

Dahut: I think screening should really be personalized and adaptive. As information develops over time, screening information should change. We know prostate cancer is a very common malignancy in men—it's the most common non-skin cancer malignancy in men—and folks have heard that many men who develop prostate cancer will be cured with treatment or won't need active therapy. Despite that, about 32,000 to 33,000 men die, per year, of prostate cancer. This continues to be a significant problem.

There was a time when you had a prostate cancer diagnosis where you felt fine after diagnosis but much worse from the treatment, because of side effects. We have more information now. First of all, we do know genetics can play a significant role in your risk of prostate cancer and also in your risk of having a more aggressive prostate cancer. When we say "more aggressive prostate cancer," we're talking about the kind of cancer that can escape the prostate to go to other parts of the body—lymph nodes, bone, liver, brain, lungs, too—can cause symptoms and, unfortunately, in far too many men, death.

I think it's important to know about your family history. Does your brother have prostate cancer, does your dad, is it uncles all on one side of the family? And it's also important to know, are there genes in your family that might put you at greater risk for prostate cancer?

I think a lot of men don't know about the breast cancer gene, the BRCA gene, particularly BRCA2, and that having the gene as a man puts you at about a five times greater risk of having prostate cancer. If you do develop prostate cancer, it's a much more aggressive prostate cancer.

If you knew you had that gene in your family or you knew there's a lot of breast cancer, ovarian cancer in your family, it would be important you were aware because your risk of cancer is likely higher. I think screening would then become more important for you.

Ultimately, [you should have] a sense of your own personalized risk. Looking at your race, if you're a Black man, your risk is going to be higher; if you have a family history, your risk of prostate cancer is higher, and detecting it earlier can lead to a better outcome. Or it may mean we just watch you very closely and if the cancer starts to progress, intervene in a way that your overall outcome should not be greatly different.

Survival rates are high for men whose prostate cancer is detected early, but the number drops drastically once cancer has spread. How simple it is to undergo a prostate exam versus what a man would go through if he's diagnosed with prostate cancer?

It's simple, because it really starts with a blood test. I think people are very concerned about the rectal examination, particularly younger men, but the blood tests, the prostate-specific antigen [PSA] test, is the best place to start. It does not diagnose prostate cancer, because the PSA is actually made in normal cells, too. But having an elevated PSA would warrant additional testing, whether that's an MRI [magnetic resonance imaging] where they can actually look at the prostate and look for individual tumors, an ultrasound or a biopsy.

There was a period of time when the number of men who were screened fell during about 2011 to 2012, and we then saw, about five or so years later, more men, when they were diagnosed, had more advanced disease. Not surprisingly, if you don't look early and you wait for symptoms, you would have more advanced disease. Some of those men's cancers were already metastatic at that point, and unfortunately for metastatic prostate cancer, there's not actually any therapies they can rely on.

With your position at ACS in research and science, are there some things coming in terms of advancements for diagnosing, testing and treatment for prostate cancer that you're excited about?

I think there's some things that are important for men to know. Some are actually things that have been approved relatively recently. Prostate cancer, for years, has been difficult to see in the prostate. The urologist would biopsy certain areas where the cancer was most likely to be, as opposed to biopsying a specific lesion, but a couple of things have happened.

First of all, our MRIs have gotten much better, so now we can see areas of the prostate where tumors are likely, and the images are then fused to an ultrasound probe, kind of like using GPS technology. As the urologist or the radiologist moves around the ultrasound picture, what they see is a picture of the MRI, making the biopsies much more accurate. That's dramatically different from how things were done in years past.

The second thing, we would see men who would have surgery or radiation to the point where they should really have essentially no PSA. But over time, sometimes we would see the PSA rise and we wouldn't know where the cancer was. Now, using new imaging with PET [positron emission tomography] scans and something called a PSMA—a prostate-specific membrane antigen PET scan—we are much better at detecting where prostate cancer is at the time of recurrence, and it's also better at detecting how far advanced the cancer might be at diagnosis. Oftentimes, when we see it, it's actually very small areas, which may be amenable to just treatment with radiation in one spot as opposed to going on hormonal therapy, which obviously has side effects.

What's been done is now that it can be imaged, the technology is linked to radiation. Through an IV infusion into the body, the radiation is directed specifically to the areas that express this PSMA. Once cancer is largely driven by that, it can be very effective as far as killing the cancer in those areas. It doesn't appear to last forever, but there are some dramatic responses with it. Combining that with other treatments is also now being studied.

The other thing being looked at in prostate cancer is how the disease has traditionally not been a cancer that responded well to immunotherapy, or using the body's own immune system, with the exception of a few subtypes. But there's a large group of highly trained scientists who are experts in that field now looking to study CAR T-cell therapy, which is basically using your own testosterone cells, immune-fighting cells, to recognize and treat cancer cells, again, often targeted against either PSMA or another antigen.

I think we're excited about sort of a very concentrated effort, bringing together some of the best scientists in the country to look at the ability to finally just have immunotherapy have a role in prostate cancer.

How can people find more information from your research team—studies, programs, support groups and other things you have going on at the ACS?

Well, I think going to the webpage on Cancer.org is where you start. I think folks need to know there is actually a phone number, a 1-800-number on the website, where you can call, and if you have questions, you can receive referrals or learn how to get to a cancer center for treatment. Don't be afraid to pick up the phone and talk to somebody.

I've been in research my whole career and I encourage men to be involved in clinical trials whenever possible. For cancer, by and large, we don't have clinical trials for men with active disease where somebody receives no therapy, so most clinical trials would be either a new therapy or a new therapy combined with the standard therapy. Patients on clinical trials receive a lot of attention, and outcomes—regardless of therapy—are often quite good because of the attention they receive. I certainly would encourage that.

Is there anything you would add that you feel is important to raising prostate cancer awareness?

Well, I think the thing that's also important is we know that Black men have a higher risk of having prostate cancer and also have a higher risk of dying from prostate cancer. So I do think, if you're a Black man, if you're an African American man, regardless of your country of origin, you do need to be particularly vigilant about prostate cancer.

There is clearly something different about the biology in Black men for prostate cancer than other races. So your readers who are Black men, there is an importance, particularly in that population, that you're screened, you encourage your sons, your brothers, your cousins, your friends to be screened, to get information and, potentially, screening at an earlier age because the risk is definitely greater.

We know if you find cancer early and it's treatable, the treatments have gotten much better. Men can live and have a life expectancy equivalent to what they would have if they didn't have cancer. But waiting until the cancer has spread can lead to not only a shortening of your life, but significant decrease in the quality of your life. Information is important and information about your risk can totally change how you feel and how long you live.