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Prostate Health, Cancer Risk Factors and Screening

Prostate cancer is the most common form of cancer among men (after skin cancer). Screening has helped doctors to find and treat this cancer in its early stages.

Listen in as Dr. Robert Dreicer, the Deputy Director of UVA Cancer Center, shares information about prostate health and examinations to detect prostate cancer.
Prostate Health, Cancer Risk Factors and Screening
Featured Speaker:
Robert Dreicer, MD
Dr. Robert Dreicer is deputy director of UVA Cancer Center, serves as the director of solid tumor oncology within the division of hematology/oncology and is a professor of medicine and urology.

Learn more about Dr. Robert Dreicer

Learn more about UVA Cancer Center

Melanie Cole (Host): Prostate cancer is the most common form of cancer among men after skin cancer. My guest today is Dr. Robert Dreicer. He's the Deputy Director of the UVA Cancer Center. Welcome to the show, Dr. Dreicer. A little physiology lesson, what is the prostate? What does it do?

Dr. Robert Dreicer (Guest): Well, the prostate is a small gland that is sort of encompassed by the bladder and it's important in terms of fertility, sperm formation, and it serves a number of other functions, as well.

Melanie: So, what happens to the prostate for men as they age?

Dr. Dreicer: So, something called “benign prostatic hyperplasia,” the number of prostate cells increase over time, the gland enlarges, and because the urethra--the tube that runs from the bladder to the outside world--lives in that area, so it begins to get squeezed. So, as the prostate gets bigger, we start having problems with the ability to urinate or having to urinate more frequently.

Melanie: So, then, is there anything men can do to stop this progression or is it pretty much common and most men will get BPH?

Dr. Dreicer: I think it's a pretty common thing. We don't yet have a way to prevent it. There are certainly medications that can help, but, unfortunately, we haven't yet figured out how to stop it.

Melanie: So, then what would you like men to know about coming in for annual screenings and, Dr. Dreicer, mostly men don't want to do these kinds of things and women have to push their men in to see a urologist or somebody to get that annual screening. Tell us about the screening.

Dr. Dreicer: So, prostate cancer screening is very controversial and, over the last couple of years, there have been actually sort of a change in some of the recommendations that come from the major societies. So, for example, the American Urologic Association basically recommends that PSA testing before the age of 40, or after age 70, is probably not appropriate and, even for most men between 40 and 54, it may not be appropriate, but there are clearly men who are at increased risk and those are men who have a first-degree relative--meaning a brother or a father--who had prostate cancer. Certainly, African-American men are at increased risk, so that men between 55 and 69, who at high risk because of these features, should have conversations with their physicians about screening.

Melanie: What's involved, then, in the screening? Blood test? Urinalysis? Digital? Explain some of the screening procedures.

Dr. Dreicer: So, typically, a prostate cancer screening would involve a digital rectal exam, meaning the physician examines the prostate through the rectum using just a finger as well as a blood test--Prostate Specific Antigen. That would be what we would think of as prostate cancer screening.

Melanie: Tell us about the PSA. What is that Prostate Specific Antigen and what numbers are what you want to look for?

Dr. Dreicer: So, that's a really great question. So, PSA, or Prostate Specific Antigen is a protein made by all prostate cells, so this isn't just a cancer marker and that's why it's a difficult marker to use with regards to a number. Unfortunately, what we've learned over the last decade or so is that there is actually no normal PSA range--meaning in a very large study that was done testing screening, what we found is that there are men who have PSAs below 1 who have prostate cancer. So, unfortunately, there's no normal range where we can say "If your PSA is below a certain value, you're home free." So, it's a complicated issue, that's why there really has to be a good conversation with your physician with regards to risks, benefits, and what's involved.

Melanie: When you do a digital exam, something most men are terrified of, what are you looking for?

Dr. Dreicer: You can feel the prostate, especially when it's enlarged, by a digital rectal exam, because the wall of the rectum where the finger goes, the prostate is right up against the wall. So, if the prostate is enlarged, typically a physician can feel some abnormality in the contour and the shape of a prostate gland.

Melanie: So, when a man comes to see you, he's taken his PSA, you've done this digital exam, what do you tell them about how often they should get this done and what they should do lifestyle-wise? Is there anything that they can do to modify their risk?

Dr. Dreicer: So, I'm going to flip the question and answer the last part first.

Melanie: Okay.

Dr. Dreicer: There are clearly some risk factors that we believe are modifiable. Certainly diet. Patients who eat a low-fat, well-balanced diet historically, probably have a lower risk. You know, it's a little difficult to say to a man who may be 50 years old that significant lifestyle modifications at that point can impact, but, certainly, a low-fat, well-balanced diet, avoiding smoking, exercising--whether or not it prevents prostate cancer, it's still good for your health. Back to your original question, it's very complicated and there are too many variabilities for me to be able to say "Well, if your test is this, you don't have to have a test for this long." Increasingly, however, we believe that patients who are at low-risk may have longer intervals before screening is really required. So, again, a point to discuss with your physician.

Melanie: Dr. Dreicer, is there a genetic component to prostate cancer and are there some genetic tests like the PCA-3 that are being done on a regular basis to see if there's this genetic component?

Dr. Dreicer: So, there's no question that we're learning a whole lot more about this. So, for example, we know that families who have BRCA-1 or BRCA-2 genes not only have higher risks to breast and ovarian cancer, they also may lead to higher risks of prostate cancer in some men. There are things called DNA mismatch repair enzymes that are sort of genetic mutations both, either in germline or somatic. These are also probably risk factors for men. In general, again, family risk, meaning having a brother or father, is probably the most well-characterized risk factor. Routine testing, genetic-wise, is not probably yet indicated.

Melanie: So, then if you do detect cancer, what's the first line of defense for a man? Because I know it depends on your staging, so explain that just a little bit and the Gleason Score. But then, do you tell--I mean things seem to have changed, Dr. Dreicer, as far as you're not doing as many prostatectomies and taking it all out. So, explain how this process has changed for you doctors.

Dr. Dreicer: Well, it's very clear that over the last couple of years, and actually there was data presented in a medical journal just this week, that there appears to be lower numbers of patients being diagnosed. The concern, of course, is that that doesn't translate into more men presenting with advanced disease. It's too early to know that. The reason why the screening paradigm is changing in this country is that broad recognition that we're making too many diagnoses of prostate cancer. Remember, there are a lot of men who die of other things who have prostate cancer in their gland and it never bothered them. The concern that the society has is to not over-diagnosis a disease that doesn't need to be treated, but yet not miss prostate cancer when it can be lethal. That’s why this is such a very complex area and it doesn't lend itself to sort of a simple pronouncement about how to manage the disease. It's an area of active research and we're going to need to watch this in terms of whether or not the screening paradigm that's recently changed is either a positive or a negative thing.

Melanie: So, tell us some exciting advances in immunotherapy being used in prostate cancer--just some things that you see on the horizon.

Dr. Dreicer: So, there is no question that immunotherapy is active in prostate cancer. The first cancer vaccine was approved in prostate cancer; something called Sipuleucel-T, or referred to a Provenge. But I think the most sort of exciting thing that's happening now, going back to your question about mutations, is that there's no question that we've now begun to identify DNA mismatch repair genes that are targetable by drugs that are called “PARP inhibitors”. So, there's been recent excitement about this and there are very large trials now being undertaken to begin to look at this particular target as new ways to treat this disease that are very different than the ways we've done before.

Melanie: And tell us about the UVA Cancer Center.

Dr. Dreicer: So, the UVA Cancer Center is in the midst of sort of explosive growth. We've been very fortunate to get large amounts of institutional support, we've been able to be competitive for grants nationally, the center is growing, and we’ve been able to recruit some outstanding young clinicians who are doing clinical research in a variety of different solid tumor and liquid tumors. This is a very exciting time to be at the UVA Cancer Center.

Melanie: Thank you so much for being with us. It's great information. You're listening to UVA Health Systems Radio and for more information, you can go to That's This is Melanie Cole. Thanks so much for listening.