Advances in prostate cancer diagnosis and treatment Dr Nick Mehan

Host: Michelle Odian (My Health Academy) Guest Expert: Dr. Nicholas Mehan (Urological Surgeon specializing in prostate cancer, robotic surgery, and laser ablation)Episode SummaryDr. Nicholas Mehan provides an overview of how prostate cancer care has evolved over the past two decades. The discussion covers the shift away from broad PSA screening toward targeted early detection, modern diagnostic tools (mpMRI and transperineal biopsy), updated Australian clinical guidelines (PCFA & RACGP Red Book), and harm-minimizing treatments like focal laser ablation and robotic surgery.Key Discussion Topics & HighlightsThe PSA Screening Dilemma & Historical ContextPre-PSA Era: Before blood testing in the 1990s, prostate cancer was typically detected at late, metastatic stages with high mortality.Overdiagnosis & Overtreatment: The introduction of PSA testing increased early detection but led to 20–40% overdiagnosis of indolent, low-risk cancers, subjecting many men to aggressive treatments that caused incontinence and erectile dysfunction.Guideline Re-evaluation: Confusion following the 2012 US Preventive Services Task Force (USPSTF) recommendation against PSA testing led to long-term trial analyses that confirmed the value of targeted early detection.Diagnostic Breakthroughs (The Past 10 Years)Multiparametric MRI (mpMRI): Used as a triage tool before biopsy. Federally funded in Australia since 2018, allowing ~50% of low-risk men to safely avoid biopsy altogether.Transperineal (TP) Biopsy: Replaced transrectal (TRUS) biopsies, reducing post-procedure sepsis risk from up to 2–5% down to ~1 in 1,000.Active Surveillance: Standard of care for low-risk (Grade Group 1) disease, with ~90% of eligible Australian men choosing monitoring over immediate surgery or radiation.Updated Clinical Guidelines (PCFA & RACGP 10th Edition Red Book)Risk-Based Approach: Recommends baseline PSA testing from age 45–49 for high-risk men (family history, BRCA2 gene mutation, Black ancestry).Routine Testing: Recommended every 2 years for well-informed men aged 50–69 (with re-testing triggered at PSA > 3.0).Digital Rectal Exam (DRE): No longer recommended for routine screening in asymptomatic men.Treatment Innovations & Harm MinimizationFocal Therapy (Organ Preservation): Targets the MRI-visible "index lesion" while preserving surrounding prostate tissue, resulting in 0% incontinence and low erectile dysfunction rates. Dr. Mihan highlights Nepean Hospital’s ProFocal laser ablation trial, which achieved an 84% cancer-free rate in treated areas.Robotic Surgery: Robotic-assisted radical prostatectomy reduces blood loss, complication rates, pain, and hospital stays compared to open surgery.Radiotherapy & Hydrogel Spacers: Stereotactic body radiation (SBRT over 5 days) combined with hydrogel spacers (e.g., SpaceOAR) protects the rectum from collateral radiation damage.Advanced Disease: PSMA PET scans enable precise staging and recurrence tracking, while novel anti-androgens significantly extend survival in castrate-resistant disease.Key Audience Q&ADoes a prostate biopsy cause cancer to spread? No. Prostate biopsy utilizes a closed true-cut needle system and is completely safe.Focal Therapy Modalities (NanoKnife vs. Laser vs. HIFU): Different energy sources (electrical pulses, laser thermal heat, ultrasound) are chosen based on the lesion's specific anatomical location inside the prostate.Post-Surgical Erectile Dysfunction Management: Treated using daily low-dose PDE5 inhibitors (tadalafil), vacuum pumps, intracavernosal injections, or penile implants.Continuing Professional Development (CPD): Australian general practitioners can obtain CPD points for listening to this episode from our education partner, My Health Academy.Myhealth Academy Link: https://lms-academy.myhealth.net.au/login/index.php?tenant=MHAC01Access your favourite conferences by podcast: https://www.armchairmedical.tv/podcastsEnjoying the episode?⭐ Rate thi