Individualized medicine is an efficient and effective way of practicing medicine, explains H. Ballentine Carter, M.D., director of the Prostate Cancer Program at Johns Hopkins Medicine. He explains how individualized medicine can benefit men with prostate cancer.

PSA Test Measures Risk, Not Cancer

A man’s prostate cancer journey usually starts with a simple blood test, a PSA test. PSA (protein-specific antigen) is a protein that circulates in the blood. It’s often elevated in men who have prostate cancer.

However, this protein can be elevated in men who don’t have prostate cancer. Other factors that can cause elevated PSA levels include:

• An enlarged prostate
• Inflammation in the prostate

If every man with an elevated PSA level were approached the same way, they would all need to have a biopsy to determine whether they had prostate cancer. This would lead to a lot of unnecessary biopsies. With individualized medicine, we can use additional tests to better gauge the risk and determine which patients really need a biopsy.

Prostate Cancer Detection Involves Trade-Offs

Even if prostate cancer is found on a biopsy, we still don’t use a one-size-fits-all treatment approach. It would lead to not enough treatment for some patients and unnecessary treatment for others.

When we find prostate cancer, 60 percent of those men have a nonaggressive type of disease, meaning those men are at low risk of being harmed by the cancer. If they all get treatment, many will be overtreated and experience side effects that unnecessarily affect their quality of life. Prostate cancer treatment can cause declines in:

• Bowel function
• Urinary control and function
• Sexual function

At Johns Hopkins, our goal is to identify those men whose prostate cancer is unlikely to harm them. We offer them the option of active surveillance, which is when we monitor them regularly rather than beginning immediate treatment.

With the new tools and tests we have available today, we can better tailor treatments and address the most common treatment questions that patients with prostate cancer have, including:

• Is treatment necessary?
• If I need treatment, which is best?
• How much treatment do I need?
• When do I need treatment?
• In what order should I receive treatment?

Examples of Individualized Prostate Cancer Care

What does individualized prostate cancer look like? Most patients with localized prostate cancer today are diagnosed through a biopsy, guided by advanced imaging to get a more precise diagnosis. In addition, a patient may also have undergone additional testing such as:

• MRI , which helps doctors target any abnormal areas within the prostate
• Urine biomarker tests, which measure certain RNA levels and offers more insight into the likelihood of whether someone has prostate cancer
• Gene testing, as certain gene mutations put men at a higher risk for developing a very aggressive prostate cancer
• Tumor tissue panels, which can test a biopsied sample of prostate cancer and help determine how aggressive a cancer is

All these tests help doctors know more about the specific prostate cancer disease a man has, so they can help determine which treatment or approach is best.

Some patients may be best suited for a curative intervention such as radiation or a radical prostatectomy , a surgery that removes your prostate. Other patients may be best suited for active surveillance, which means receiving regular blood tests and biopsies to see if the cancer grows fast enough to warrant treatment.