Prostate cancer diagnosis and treatment have evolved. Here’s where we are
No one is more aware of the status of this work than Dr. Mark S. Litwin.
The chair of urology at the David Geffen School of Medicine at UCLA and a member of UCLA’s Jonsson Comprehensive Cancer Center, Litwin has just published a review of the diagnosis and treatment of prostate cancer in JAMA (Journal of the American Medical Association).
In his review, Litwin assesses the optimal methods for the diagnosis and treatment of prostate cancer based on current evidence. That “current evidence” is important, because as evidence increases, knowledge grows. As knowledge grows, treatment evolves – and survival and outcomes improve.
This evolution is not always smooth, however. As Litwin begins:
“Although prostate cancer is common, the indolent course of many tumors and the potential for adverse treatment effects have generated controversy regarding the utility of screening and early detection. Even so, prostate cancer can threaten long-term health and remains the third-leading cause of cancer death in men. Since 2011, meaningful progress has been made in characterizing disease risk and identifying therapeutic options.”
Noting that the screening issue has been addressed (exhaustively, many would say) elsewhere, Litwin then summarizes the advances in prostate cancer diagnosis and treatment.
With diagnosis, he explores the merits and limitations of prostate biopsy and its variations, including the standard biopsy and those enhanced with new imaging technology. He also explains the various types of molecular and image-based biomarkers that could ultimately produce a clearer – and less invasive – picture of an individual’s disease and, more important, what to do about it.
Of the advances in diagnosis, he writes about staging of the disease – that is, determining how advanced it is – as well as treatment of localized disease, which currently amounts to what’s known as “watchful waiting,” surgery and radiation. Then he explores the treatment of metastatic disease and the increasingly complex options for treating it.
The topic is complex, full of data, nuance and an expert’s interpretation of science.
But Litwin’s take-home message for physicians – the audience of his article – is simple:
“Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference.”
The translation of that into lay language is a take-home, and equally simple, message for everyone:
Cancer treatment and diagnosis have improved. Each patient is different. Treatment is no longer one-size-fits-all.