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A Bright, New Future for Prostate Cancer


Dr. Wayne Waltzer

Dr. Wayne Waltzer with nurse navigator Melanie Dale consulting with a patient at Stony Brook University Cancer Center
New tests and methods take on the most commonly diagnosed cancer in men

Prostate cancer is the most commonly diagnosed cancer in males, with about 240,000 diagnoses expected this year. And there are 2.5 million people currently living with this disease. Recently there have been some dramatic changes in the way prostate cancer is diagnosed and treated. Wayne Waltzer, MD, Chairman, Department of Urology, Stony Brook Medicine explains these major medical advances and what they mean for men across the nation.

"With prostate cancer being the number one solid organ cancers in the country, it is important for all men to be vigilant about getting screened," says Dr. Waltzer. "And a newly developed series of genetic tests is now offering a more accurate and individualized approach in identifying and treating prostate cancer."

Currently there are various blood tests in use. One is called the Prostate Health Index (PHI) and the other is called the 4K test. Both measure the variance of the PSA in the blood and are designed to reduce the number of unnecessary negative biopsies that detect only low-grade cancer. "This means that not all men with elevated PSA levels will require a biopsy, with its potential for complications and side effects,"says Dr. Waltzer.

There are also new tests available that help to further individualize biopsies, if one is required."“If the biopsy is positive for cancer, two tests - the Polaris and the Genomic Prostate Score - help doctors distinguish between aggressive cancers that need treatment and those that are slow growing and may need only the "watch and wait" approach," says Dr. Waltzer. "These tests work by measuring a series of genomic patterns to reveal how the cancer cells are wired to behave."

If the biopsy is negative but you still have elevated PSA levels, there is now a test called Confirm MDX that helps ensure that cancer cells were not missed during the biopsy. "The biopsy may have sampled tissue that was in an area where there were no cancer cells," says Dr. Waltzer. "This could give you a false negative. This new test looks for hyper methylation, which indicates the presence of individual prostate cancer tissue near the site of the biopsy."

If no hyper methylation is detected, the biopsy is considered negative. If some is detected, additional testing will be needed. Another test, the PCA3 test is also available in case of negative biopsy. This gene-based urine test offers additional information on the probability of finding prostate cancer in the biopsy.

In addition, if you have had prostate cancer surgery, there are genetic tests post-surgery that help determine whether additional treatment is needed based on the genetic composition of the cancer cells and the risks associated with it.

"These new tests, which are available at Stony Brook Medicine, are absolutely the future for cancer diagnostics - and not just for prostate cancer," says Dr. Waltzer. "These innovations are happening for almost every form of cancer, with more on the horizon."

Dr. Waltzer says, gene analysis of tissue, the study of genetic markers, patterns, sequencing and abnormalities, is providing physicians with unprecedented information on who to treat and how to treat them. "Not only is it helping us to find the most appropriate approach and treatment for people with cancer, but it also keeping many people with the less aggressive forms of the disease from undergoing the rigors of treatment unnecessarily. This is both a health issue and a quality of life issue. The fact that we can take such a highly individualized approach for very specific forms of cancer also means that we can look forward to better and more predictable outcomes."

About Stony Brook Medicine:
Stony Brook Medicine integrates and elevates all of Stony Brook University's health-related initiatives: education, research and patient care. It includes five Health Sciences schools - Dental Medicine, Health Technology and Management, Medicine, Nursing and Social Welfare - as well as Stony Brook University Hospital and more than 50 community-based healthcare settings throughout Suffolk County. To learn more, visit www.stonybrookmedicine.edu.
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