Kirsten Greene, MD, completed her fellowship training in urologic oncology during a critical paradigm shift in prostate cancer treatment. She worked with a team evaluating the safety of active surveillance — an important step forward in balancing treatment with quality of life.
"Prostate cancer is fascinating to me because there are so many decision points instead of one correct answer," shares Greene, now chair of the Department of Urology at UVA Health. "The options and outcomes really depend on each individual patient situation and preference."
In this Q&A, Greene shares how providers can help patients navigate prostate cancer testing and decision-making.
What should all providers know about prostate cancer?
Prostate cancer is usually detected early and active surveillance is appropriate for most men when they are diagnosed. This is not a fast-moving cancer and quality of life can be preserved.
At the same time, it is a real cancer. For many years, based upon prior USPTF recommendations, prostate cancer was almost not considered a cancer at all. It is real, and early detection saves lives, but treatment may not be urgent.
It’s a dichotomy that is challenging for all of us — patients and providers — to fully understand.
How can providers help patients with early detection and diagnosis?
Offer a PSA at age 40 for high-risk patients and 45 for everyone else and stop when there is < 10 year life expectancy.
Repeat any PSA > 3.0 ng/ml. PSA is so variable and imprecise that any one value is insufficient and we only believe two elevated values.
Talk with them about what PSA screening means and if they really want it. If they don’t, don’t send a PSA.
If they do and two values are abnormal, MRI is the next step. MRI is a really important part of early detection now.
Who's at risk for prostate cancer? Are there symptoms providers should look out for?
Risk factors include family history, history of BRCA related cancers, and African American ancestry.
Because of PSA screening, we diagnose prostate cancer 10-15 years before it becomes symptomatic. So there are no symptoms to watch out for if your patient has been getting PSA screening.
Why should providers consider referring a patient to UVA Health's urologic oncology program?
We see more than 90% of patients within two weeks of initial referral. We have a nurse navigator who will call your patient and help them through the entire process to be sure they feel comfortable and are seen promptly.
We have a team of ten providers who focus exclusively on urologic oncology. We work as a team with medical oncology and radiation oncology providers who focus only on urologic oncology.
We have the most cutting-edge surgical equipment, radiation delivery, diagnostic tests, and clinical trials.
If we don’t have it, we will get it for you or get you to the best place. We will reach out to other providers and other institutions to get the best care available for your patient.