POSTED: September 04, 2015

PCa Risk Assessment Tools

Matthew CooperbergDr. Matthew Cooperberg is a genitourinary cancer specialist at the University of California, SF’s Helen Diller Family Comprehensive Cancer Center. He did his urologic oncology fellowship under the guidance of Dr. Peter Carroll. (See Prostate Forum Volume 15 Number 10 for a conversation with Dr. Carroll).

Cooperberg developed a new prostate cancer risk assessment tool called the Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score and has authored over 50 peer-reviewed scientific articles and nine chapters.

Prostate Forum recently spoke with him about prostate cancer risk assessment tools. To read the rest of our conversation with Dr. Cooperberg, subscribe to Prostate Forum or download Prostate Forum Volume 15 Number 12.

PROSTATE FORUM: Do you think the recent push to develop prostate cancer risk assessment tools is in some way a reaction to the anti-screening movement?

DR. COOPERBERG: No, it is something we’ve wanted to do for a long time. You’ll hear from the US Preventive Task Force members and others that what we really need is a better test than PSA. But that’s ridiculous. PSA is one of the most successful biomarkers in the history of oncology, but it’s far from perfect. The question has always been what can we do to augment PSA and then to augment what we can learn from the biopsy. But we’re not going to replace that first screening anytime soon.

I think it has taken a long time for the biomarker field to recognize that we need markers that can improve on the clinical gold standard, not just correlate with it. Because prostate cancer has such a long natural history, it takes decades of follow-up on specimens to really know who has done well and who hasn’t as well as who is at risk of dying of prostate cancer and who isn’t.

We started banking prostate tissue, blood, and urine at UCSF back in 2000 and it is really only now that we have enough follow up on what has happened to those men that the specimens are valuable. The same is true with most other research institutions. It takes a long time to build up the data and expertise to do this sort of research well.

Plus, technology is improving. Our ability to do RNA extraction from routinely archived pathology specimens is new. That didn’t exist a few years ago and now it does. Our ability to get at the biomarkers has also been improving. But the goal has been the same for a long time.

PROSTATE FORUM: What advice would you give a newly diagnosed man?

It would really depend on what they’ve been diagnosed with. Get past the “c-word” and recognize that what we call prostate cancer may range in seriousness from something you will never have to worry about your whole life to something that needs to be taken very seriously.

Unfortunately, I think some people never really get past the “you’ve got cancer” part of the conversation. The first point is that it is almost never an emergency. Even men with high-risk disease typically have at least a few months to begin treatment. And men with low risk disease can often defer treatment for years and in many cases forever. The most common cause of death in men with prostate cancer is heart attack, just as in men without prostate cancer.

My first piece of advice is to really understand the details of your own individual tumor: your individual Gleason score, how extensive your cancer is, and how all those variables interact with each other. This will help you understand where you fall in the spectrum of disease risk—low, intermediate or high—based on a CAPRA score or a nomogram or something that goes beyond the NCCN risk groups.

The second piece is that we’re increasingly aware that diet, lifestyle, and exercise play an important role in prostate cancer progression. Men who are able to make positive changes in their diet and exercise habits live longer and better than those who do not. And moreover, since most men with prostate cancer die of heart attacks, it’s a win-win to adopt better diet and lifestyle practices. That is another area of patient education for us here at UCSF.

My final bit of advice is make sure you’re treated in a high volume center with clinicians who have a bit of experience with the disease, know their own outcomes, and can stand behind their own numbers.

 


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