Everything You Wanted to Know About Prostate Cancer, but Were Afraid to Ask

Those are just a two of the questions that rush through someone’s mind when the news is  delivered. But have no fear. One of the best prostate cancer doctors, researcher and innovator, Matthew Rettig, works at Greater Los Angeles VA. And, he’s serious about beating this type of cancer.      

Rettig leads the Precision Oncology Program for Cancer of the Prostate, POPCaP, for short, which means “the right drug for the right patient” and more.

Often, you find Rettig in the lab among test tubes, solutions and a group of junior researchers testing new ways to beat cancer cells.  

But first, what is prostate cancer? Better yet, what is the prostate?

What is the Prostate?

I asked a male friend of mine. He said “I know I have one but, I don’t know anything about it.” So I asked Dr. Rettig.  

“It’s a reproductive organ, that’s located below the bladder. What it does is it creates a a liquid that mixes with sperm it and to allow the sperm to be passed out upon ejaculation.”  

Some Interesting Facts About the Prostate

1. The prostate is located underneath the bladder and it hugs the urethra.
2. he prostatic fluid contains substances that allow the sperm cells to live and ensures that the sperm cells survives.
3. Proper function of the gland is crucial to sexual capability in men.
4. The prostate gland is surrounded and also contains muscle fibers that contract and press the fluid to combine with semen, which is then released.
5. The prostate gland is fueled by testosterone and depends on testosterone for it to function.

While testosterone is responsible for proper growth and function of the prostate, it’s also responsible for the growth of prostate cancer.

Prostate cancer is the most common cancer among men, except for skin cancer. Each year, more than 265,000 men are diagnosed with prostate cancer in the United States.

About Prostate Cancer

There are several facts about prostate cancer, Rettig explained. 

1. Men have male hormones that promote the growth of  a normal prostate, but they also promote the growth of a cancerous prostate.
2. The earlier you catch the cancer, the more treatment options you will have.
3. African American men have a higher risk of prostate cancer.
4. Family history increases risk.
5. You may not have symptoms, and still have prostate cancer.

“Most commonly people don't have symptoms, and they are diagnosed by a blood test called PSA which is a prostate specific antigen,” Rettig explained. “If the PSA is above normal, then the patient gets an MRI or a biopsy.” 

Roughly a quarter of the 288,000 cancer prostate cases, in a given year, will be aggressive, with a high risk of spreading to other parts of the body. 

So What's the Good News? A Simple Test

First of all, prostate cancer can be detected with a simple blood test called PSA which is a screening tool. “In general every man 40 to 45 years old should consider screening. Those with family history of prostate cancer, African Americans who have higher incidents of the disease, should be screened by age 40,” Rettig recommends. 

If PSA levels are high, then next would be imaging. “We’re lucky here at GLA in terms of the technology that we have,” Rettig noted. 

A State of the Art Imaging

In scanning for prostate cancer, the VA has been ahead of the community, using a special scan known as prostate-specific membrane antigen (PSMA PET-CT) scan. While the technology was approved for the community in 2021, we’ve had these scanners since 2018.  

These scans provide imaging of prostate cancer that's very sensitive, that “we can see prostate cancer at sites that would not be detectable on conventional imaging,” Rettig explained.  

What this procedure does is find prostate cancer cells anywhere in the body. A cell-targeting molecule is injected into the body and travels through the blood and attaches to a prostate-specific membrane antigen that is found on the surface of prostate cancer cells. and shows where the    prostate cancer cells are in the body.  

“In essence, it allows us to capture the cancer at a very, very early stage when they're very small and target those sites with radiation very effectively and very rapidly,” Rettig said. 

Unprecedented Program 

The prostate cancer program started in 2018. And it's been very successful. The program is called PopCap - precision oncology program for cancer of the prostate. The program includes clinical trials, genetic analysis and testing. The VA has been committing a substantial amount of funds to support precision oncology. In 2021, it was about $72 million, in 2022 it was about $100 million, and for the current fiscal year, it's about $170 million.  

Within this program, there are a lot of sub programs, that range from health disparities to working groups to bio repositories. All of them are aimed at trying to give access to every veteran to precision oncology, regardless where they are, including highly rural areas.  

“For example, when patients are in a highly rural area, in order for them to gain access to a clinical trial, they would typically need to be at a center that's running the trial.  

It's certainly easier to have every site in the country have a clinical trials program, but that's just unrealistic. So the vast majority of veterans are not going to be affiliated with one of the centers. 

“We actually now have a virtual clinical trials program. So even a patient residing in a highly rural areas can access those clinical trials, because we have all of the research infrastructure that's now virtual,” Rettig explains.  

All the regulatory and clinical coordination is done by virtual coordinators, the only thing they need to have is a clinical provider. The ultimate mission of this program is to provide precision oncology to every veteran so that all Veterans s get the best possible care.  

The AI 

So one of the programs is artificial intelligence or AI program.  

Prostate cancer, when it's initially diagnosed, can  have a wide range of aggressiveness. It could be a localized prostate cancer that doesn't even need to be treated. And, at the far end the disease is in the bones or other organs.  

Most patients when they're diagnosed, have disease that is clinically confined to the prostate. Some have a higher risk than others for the cancer to spread.  

What we mean by high risk is that there are certain clinical and pathologic features that predict if the patient would have a more an adverse outcome.  

This high risk population is the subject of the artificial intelligence program. It’s still very variable in how     patients will do with specific treatment. Some will never have a recurrence, and others rapidly spread. We really don’t have a way to predict. 

So the artificial intelligence program is doing something that's unique, that's never been done before. We're using existing data that is obtained as part of standard routine practice, such as scans and biopsies, to develop a super AI algorithm. 

Coming back to the question at the beginning of the article about the ability to function, Rettig went on to explain: 

“If we are better at screening, and we are quicker and better at treating those patients with high risk prostate cancer, and avoid the metastatic state, then we'd be able to more effectively avoid hormone therapy in the first place,” Rettig noted. 

“And, if we do have to use hormone therapy, we use it for a finite period of time, instead of lifelong. We do have a clinical trial that we already have gotten approved and executed and it looks to be very positive.  

“We treat advanced prostate cancer, while giving patients holidays off of that hormone therapy that suppresses testosterone, like a six month course. The majority of patients that we've been able to analyze recovered their testosterone and maintained a complete remission,”  Rettig said.