Physician's Weekly
January 6, 2023
Recent developments in cancer research – Prostate Cancer

Since last Friday’s Searchlight article on breast cancer, worldwide there were approximately 34,800 newly diagnosed cancer cases, while about 2,740 persons succumbed to cancer. This is the second in a series of installments that are devoted to breakthroughs for the more common solid and blood cancers. This week is dedicated to prostate cancer (PCa).

The prostate gland is exclusively found in males and is located just below the urinary bladder, abutting the front wall of the rectum, while encircling the base of the urethra, the tube which drains urine from the bladder. It is around 25ml in volume. The prostate produces seminal fluid which nourishes and helps with the transportation of sperm at the time of a male orgasm.

PCa is the most common cancer diagnosed in men. It is one of the leading causes of death from cancer in males. One in 6 Black men will develop PCa in their lifetime. In Black men, it tends to be more aggressive and is likely to spread faster when compared to other races. If diagnosed early the 5-year survival rate is 96%. The 5-year survival rate falls to 28% if the diagnosis is made when the PCa is advanced. Other established risk factors for PCa include age and a positive family history. The risk significantly increases after 55 and declines after 74. Other factors which may increase the risk of developing PCa include dairy products, high calcium-containing foods and supplements, exposure to agricultural chemicals, and a sedentary lifestyle.

Below are some recent advancements regarding PCa.

  • Darolutamide (Nubeqa), abiraterone (Zytiga), and enzalutamide (Xtandi) can extend the life expectancy of those with PCa which has spread. They block the androgen receptors on the PCa cells thereby significantly slowing the spread.
  • Work on the PCa vaccine Sipuleucel, which is designed to stimulate the immune system to attack PCa cells, is at an advanced stage and looks very promising.
  • The association between PCa and lycopene has been studied for over 2 decades. The latest evidence shows that lycopene, found in tomatoes, may prevent prostate cancer.
  • Researchers are looking into the extracts of certain foods, including broccoli, pomegranate, green tea, and turmeric, to treat PCa.
  • In recent times the MRI-guided Fusion Prostate Biopsy has emerged to play a pivotal role in radiologically assessing prostates. This technology is able to pinpoint suspicious areas within the prostate thereby facilitating precise prostatic biopsies. Ultimately improving detection rates of PCa, especially of aggressive tumours, and it reduces the chances of false negative results.
  • Colour doppler ultrasound is emerging as a very useful tool to map the blood flow through the prostate, with the cancerous areas having a higher blood flow. This can then aid in focal prostate biopsies.
  •  A number of tumour markers have been undergoing close scrutiny with regard to the early detection of PCa. These include phi, 4score test, Progensa, ConfirmMDX, and TMPRSS2:ERG.
  •  High-intensity focused ultrasound (HIFU) is a novel treatment for early PCa which is coming to the fore.

Recently diagnosed prostate cancer (PCa) patients should attend their doctor with a close family member or friend, and below are some questions that need to be asked:

  • Is the PCa an aggressive type?
  • What is the Gleason Score of the biopsy specimen? What does this mean?
  • Has the PCa spread beyond the prostate? What is the stage of PCa?
  • What are all the treatment options? Are they available locally? If not, what’s not?
  • What is the difference in prognosis if it is treated vs if it was closely monitored?
  • Is there a need for additional tests?
  • Would an MRI of the prostate be useful? If yes, where can this be done?
  • Would radiotherapy be needed? If yes, where can such be accessed?
  • Can copies of all the reports be provided?
  • Does the biopsy specimen need to be sent (overseas) for additional tests?
  • Is there any additional treatment that can be beneficial even if it means having to travel or pay to bring it into the country?
  • Are other doctors going to be involved in my treatment?
  • What are the possible side effects of the proposed treatments?
  • Is a second opinion locally or overseas recommended?

Colorectal cancer will be covered next Friday.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: [email protected], 1(784)570-9300, (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.