Prostate cancer is the top cause of cancer-related death for men over 60 and the second highest for men overall. Though it still kills tens of thousands of men each year, the number of deaths caused by prostate cancer has dropped by over half since the early 1990s.

In fact, the overall quality of life for men who live with the disease—just under 200,000 men are estimated to be diagnosed with prostate cancer this year—is improving as well. That’s in no small part due to doctors better knowing whether or not to treat a man for prostate cancer after administering a prostate-specific antigen (PSA) test.

“In the old days some years ago, a man would have an elevated PSA blood test and would get a prostate biopsy and would get a cancer diagnosis and then would get a treatment,” describes Dr. Gary Kirsh, president of The Urology Group, which has a center at 350 Thomas More Parkway in Crestview Hills. “We have had a whole evolution in our ability to screen for (aggressive cancer)—meaning with the PSA and other less invasive measures before biopsy—and we’ve had a revolution in the way that we manage prostate cancer in that much of it is managed by observation.”

Genomic testing is used to determine if the DNA in cancer cells shows risk for metastasis. If that testing shows slower or higher growth than what appears under a microscope, doctors can decide with greater confidence if the tumor does or does not require immediate treatment. That can save those who have a slow-growing cancer from experiencing the quality-of-life diminishing side effects that come with getting treated.

In cases of no treatment, PSA levels are checked after another six months to make sure nothing has changed dramatically, and a follow-up biopsy can be scheduled for a year later. But if treatment is needed, better plans for attacking the cancer are being developed and made available.

Kirsh mentions a frequent scenario after a man has his prostate removed, when the question arises as to whether radiation therapy should begin right away or if doctors should wait to see if the surgery failed to remove all of the cancer. There is now available a DNA test to make that decision more quickly and a similar test for determining the efficacy of hormone treatment is currently in clinical testing.

These tests allow for greater confidence in how aggressively to treat prostate cancer and which treatment options will work best for each patient.

“Our ability to tailor the treatments using DNA tests is going to increase over time,” Kirsh adds.

Kirsh sees three major reasons for hope for men dealing with prostate cancer. First, testing can show if the cancer isn’t a serious threat to a patient’s health and can spare them from side effect-laden treatment. Second, newly diagnosed cancer that is still localized can be attacked with more targeted treatments like precision radiation and robotic surgery, which are less invasive and minimize side effects.

And for those with cancer that has spread, the last decade has seen survival rates more than double because of emergent treatment options, with better options still to come. The hope always is that these life-extending treatments can help more men live to see better options arrive or, eventually, a cure.

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