Expert discusses differentiating prostate cancer from age-related issues

In a recent interview with Urology Times®, Stacy Loeb, MD, MSc, PhD (Hon), a professor in the departments of urology and population health at NYU Grossman School of Medicine and Perlmutter Cancer Center in New York, New York, discussed crucial aspects of prostate cancer diagnosis and staging, particularly in older men with advanced disease. She emphasized that diagnostic steps for high-risk cancer, such as Gleason 9 (as in President Biden's case), do not depend on age. All patients with high-grade cancer require a staging evaluation, including imaging, to determine whether the cancer has spread.

A significant challenge lies in differentiating prostate cancer symptoms from common age-related issues. Loeb highlighted that early-stage prostate cancer is often asymptomatic. Common misconceptions, such as frequent nighttime urination or bone pain being early warning signs, were addressed. She noted that President Biden's increased urinary symptoms prompted his medical attention, leading to the discovery of a suspicious nodule during a prostate exam, initiating his diagnostic pathway.

Advanced imaging techniques like prostate-specific membrane antigen (PSMA) PET scans and bone scans are deemed "extremely important" for initial diagnosis and staging. For high-grade cancers, determining whether the cancer is localized or has spread is critical for treatment decisions. Loeb stated that PSMA PET scans offer improved performance compared to bone scans and have been transformative in providing a clearer picture of the disease's true extent, already being widely used internationally before their broader adoption in the US.