Current imaging trends for prostate cancer

New imaging technology, using prostate specific membrane antigen (PSMA) PET combined with computerised tomography (PET/CT), has proven highly useful for staging prostate cancer in both the newly diagnosed and recurrent setting (disease that has returned after primary treatment). Benefits include greater utility in making treatment decisions and lower radiation doses.

Australia has been leading the world in its practice of performing prostate biopsy via the skin (Transperineal Biopsy) instead of via the rectum (Transrectal). Movember’s Prostate Cancer Outcomes Registry shows that in Victoria, the majority of prostate biopsies are now performed via the skin. In 2013, it was only 5%.

Please click through to read more from Dr Jeremy Grummet on TREXIT.

Receiving a diagnosis of prostate cancer is a major life stress for most men and their loved ones. Suddenly, the things that matter most seem threatened and it is very normal to experience a wide range of feelings and emotions.

Sometimes you may feel more distressed than at other times. Your feelings might be more intense while waiting for test results, making treatment decisions or just before commencing treatment. Side effects from treatment may also cause stress and upset. After treatment, you may worry about the cancer returning.

Today, there are over 220,000 men living after a diagnosis of prostate cancer. For most men the long-term outlook is very good - relative to the general population and considering other causes of death, 95% of men with prostate cancer will survive at least five years after diagnosis and 91% of men with prostate cancer will survive 10 years or more.

To help improve the lives of men living with prostate cancer, there is a need for more evidence-based strategies to help them manage the challenges of living with the disease. There is growing evidence that mindfulness is one strategy that can be used to reduce symptoms of anxiety and depression associated with prostate cancer. 

Prostate cancer is the most commonly diagnosed cancer in Australian men, with about 17,000 men newly diagnosed each year. For most men the long-term outlook is very good - relative to the general population and considering other causes of death, 95% of men with prostate cancer will survive at least five years after diagnosis and 91% of men with prostate cancer will survive 10 years or more. Today there are around 220,000 Australian men alive after a diagnosis of prostate cancer.

Of concern to our mission, for men who develop advanced prostate cancer, the outlook is not as good. Prostate cancer kills more than 3,000 men in Australia every year, representing about 12% of all male deaths from cancer. So, what is advanced prostate cancer, how is it detected and how is it treated?

Medicare data suggests that up to 21% of Australian men aged 45–74 choose to have a Prostate Specific Antigen (PSA) Test each year, and about 19% of men aged over 74 also undergo testing.

While PSA testing helps to identify men with an increased risk of undiagnosed prostate cancer, and can help to diagnose prostate cancers earlier, it can also produce false positive results, and in some men picks up cancers that are so slow growing that they do not affect a man’s life expectancy, a finding known as over-diagnosis. False positives and over-diagnosis can cause harm, which means men and their doctors need to carefully consider the pros and cons of testing, based on each man’s age and other individual characteristics.

For men with no family history of prostate cancer and no symptoms, the current guidelines recommend that men who decide to undergo regular testing should be offered PSA testing every two years from age 50 to 69.

For men with a family history of prostate cancer who decide to undergo testing, the guidelines recommend men be offered PSA testing every two years from age 40/45 to 69, with the starting age depending on the strength of their family history.

What if a simple blood test could predict the effectiveness of a treatment for metastatic castration-resistant prostate cancer (mCRPC)? A recent Australian study suggests this is a possibility. Using a blood test, researchers were able to detect circulating cell free DNA and RNA for altered androgen receptors in the blood of men with mCRPC. Men who had altered androgen receptor DNA or RNA in their blood had a poor response to treatment.

Alarming new research has revealed about 70 per cent of Australians don’t know the signs and symptoms of prostate cancer, prompting Prostate Cancer Foundation of Australia to call for greater public investment in targeted community awareness activities.

The findings have been reported in the Not All Prostate Cancer is the Same report, released by the Prostate Cancer Patient Coalition – Asia Pacific (PCPC).

In a recent study, researchers have found that not all high-grade prostate cancers are the same. The research examined Gleason grade group 5 prostate cancers which are associated with aggressive disease and poor outcome and found that some cancers of this type were more aggressive then others based on differing patterns of gene expression. This is important work that may one day help clinicians decide how best to treat different subgroups of Gleason grade group 5 prostate cancers. The advantage of this is that men with less aggressive cancers may be spared the side effects of intensive treatment while those with more aggressive cancers receive intensive and more targeted treatment.