This week,former Miami Heat basketball star Alonzo Mourning became the latest celebrity to announce he had prostate cancer, reinforcing the need for men to get screened and reigniting the debate over how and when to treat the disease.
Mourning said he had felt physically fitwhen he learned of his cancer in February, after his Prostate-Specific Antigen (PSA) test levels came back abnormally high. A biopsy confirmed aggressive prostate cancer, and Mourning started his journey to rid himself of the disease. The Basketball Hall of Famer, and current Heat executive, revealed earlier this week that he had surgery to remove his prostate and is now “cancer-free.”
But not all doctors advocate the route Mourning took.
Most agree that men over 50 need to check their PSA levels regularly to screen for the disease and ask for the test if it isn’t offered. Mourning’s urologist, Dr. Maury Jayson of Pembroke Pines, recommends regular PSA screenings and a physical exam. “Men need to do both. It’s important,” Jayson said.
However, not everyone with a diagnosis may need the prostate removed. Even as robotic surgery for prostate cancer advances, some Florida doctors advise doing nothing after a diagnosis other than “wait and watch.”
“Because of Alonzo’s age and his specific cancer, that was the right route for him, but not everyone with prostate cancer needs to go the surgery route,” saysDr. Sanoj Punnen, a urologic oncologist with the University of Miami Sylvester Comprehensive Cancer Center.
What the debate is about
Prostate cancer is the second-leading cause of cancer death among men in the United States. However, it usually grows slowly, and prostate cancer cells can range in their risk for spreading.
“Just 10 years ago, we wanted to find and treat every bit of cancer we could,” Punnen said. “But surgery and radiation have side effects, and for some men there is downside and no benefit because the tumor was never going to hurt them. We’ve gotten better at selecting who needs treatment.”
The list of high-profile celebrities who have gone public with their prostate cancer diagnosis includes actors Robert De Niro and Ben Stiller, TV anchor Al Roker, and baseball Hall of Famer Ken Griffey. While these men survived the disease, celebrities who have died from it this year include O.J. Simpson and Dexter Scott King, the youngest son of Martin Luther King Jr.,
“The challenge for patients and physicians is determining what treatment is needed for whom,” said Dr. Jonathan Silberstein, a urologic oncologist with Memorial Healthcare System. “Any treatment is going to cause some diminution of quality of life. But if it’s not treated or diagnosed, will it progress and result in someone’s demise? Striking that balance is critical.”
New innovations are shaping treatment
New innovations now give doctors more information. A prostate-specific MRI can reveal whether a biopsy should be done and where a lesion is located. There’s also a Gleason grading system, which uses biopsy samples to give a risk score for how fast the cancer may grow and how likely it is to spread.
Much of the prostate cancer debate centers on what to do with biopsy results.
“It requires the right physician to have a nuanced conversation and explain the options carefully,” Silberstein said.
Some doctors push for radiation of the prostate or removal with robotic surgery. Some advise focused treatments that use either cold or heat to target and destroy specific cancer cells. All interventions have possible side effects, including incontinence and erectile dysfunction. That’s why some Florida doctors now advocate no treatment, just monitoring.
“About 50 percent of men are able to avoid treatment and instead receive active surveillance,” saidDr. Alberto Pieretti a urologic oncologist with Cleveland Clinic Florida in Weston. “With ongoing monitoring, if it does change we are able to catch it before it gets aggressive enough to cause harm and we can still treat it.”
Pieretti says an expert will consider biopsy results and the patient’s age, health condition and life expectancy before pushing for aggressive treatment such as prostate removal. Data from the National Cancer Institute suggests the average age of diagnosis is 66, and most men die of other causes before their prostate cancer becomes advanced or clinically significant. However, Black men are at risk for more aggressive prostate cancer,according to the institute.
Robotic surgery advances
Mourning said his cancer was encapsulated in the prostate and aggressive. He went to Advent Health Orlando’s Global Robotics Institute for a prostatectomy. Years ago, a prostatectomy required a traditional open surgery.
Now Dr. Vipul Patel, founder and medical director of the Florida Hospital Global Robotics Institute, specializes in robotic-assisted prostatectomies. He uses state-of-the-art technology to guide him through the laparoscopic surgery to remove the prostate in a way that allows men to heal faster with fewer side effects. He uses the fifth iteration of the da Vinci robotic device.
“Our patients are going home faster and healing much better,” Patel said.“All men should have access to robotic surgery. It’s the gold standard.”
Most insurances cover the procedure, he said. His center performs eight surgeries a day on men who arrive from all over the world.
“In the future, I think we will use AI guidance to minimize complications and help us perform surgery in an even better way,” Patel said.
At Cleveland Clinic Florida, Pieretti does Retzius-sparing robotic-assisted prostatectomies. “Instead of going in through the interior, we come from behind,” Pieretti explained.
One of a handful of surgeons in the state using the technique, he said the method has helped men restore continence sooner. “It’s changing patient satisfaction,” he said.
Punnen at UM emphasizes that anyone diagnosed with prostate cancer should get a second opinion regarding whether to get treatment and which type.
“At least get another doctor to read your slides,” he said. “This is a very complicated journey.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
