Michael E. Karellas, MD, FACS, in honor of Prostate Cancer Awareness Month

Prostate screening is a critical part of early diagnosis. How would you encourage a man reading this to see his doctor to begin prostate screenings?

The decision to screen for prostate cancer is highly individualized, considering each man’s personal risk, race, as well as other potential health conditions. The PSA blood test along with a digital rectal exam are the usual starting points to evaluate a man’s risk of prostate cancer.  However, considering PSA is not specific for cancer, the concept of shared decision-making between a man and his physician should be encouraged. In general, for a man with average risk, the American Urological Association recommends a baseline PSA for a man in his 40s and then periodic screening afterwards based on the PSA level and individual risk factors going forward.  If the blood test is concerning, then further testing is generally recommended, which could include more accurate blood tests, and possibly a MRI of the prostate. Ultimately, if these tests are concerning, some men may need a prostate biopsy. On the other hand, for many older patients with significant health conditions, the decision to proceed with PSA screening is not as straightforward. Some men over age 75 do not benefit from some PSA testing, but this is generally handled on an individualized basis. 

What are new developments in the treatment of prostate cancer?

There are many recent advances in the diagnosis and treatment of prostate cancer. The routine use of multi parametric prostate MRIs has increased the accuracy of prostate biopsies and can also potentially minimize the number of unnecessary biopsies. Once prostate cancer has been diagnosed, we can now use a PSMA-PET scan, which is a whole-body scan that can often help determine the extent of disease prior to treatment.

Treatment options continue to evolve as we gain understanding for prostate cancer. In certain men with low or favorable intermediate risk prostate cancer, we can use genomic testing to stratify which patients may be optimal candidates for active surveillance. 

Alternatively, for those men who opt for treatment, robotic surgical techniques continue to evolve with improved urinary and sexual function outcomes. Some patients are candidates for focal therapy, which involves treating a portion of the gland, instead of removing or treating the entire prostate. Radiation therapy is also an effective option for cancer treatment with technical improvements delivering radiation that minimizes treatment-related side effects. When detected early, prostate cancer is highly curable by a variety of methods.

What inspires you to work in oncology and specifically with GU patients?

I enjoy practicing urologic oncology as I’m able to help guide men through these difficult decisions regarding screening, the possible need for a biopsy and, eventually, if cancer is detected, what treatment options are best. The field of urologic oncology also includes other cancers such as kidney, bladder, and testicular cancers in both men and women.  The overwhelming majority of urologic cancers are curable if detected early. I enjoy being able to offer surgery for patients who opt for this treatment as well as being part of a team that helps patients navigate their cancer journey.