Ask the experts

If you have the BRCA Gene, is there a link between Breast and Prostate Cancer? 

The prostate is an organ deep down in the pelvis of men only. Its only known function is to help thin out the semen of men, but it is best known for all the problems it causes. This includes infections, inflammation, benign prostatic hyperplasia (BPH) and cancer. 

Prostate cancer is the second-leading cause of cancer for men in the U.S. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. This year, nearly 175,000 men will be diagnosed with the disease.

Family history is a known risk factor for prostate cancer, but sometimes prostate cancer risk can be tied back to your genes, even if you don’t have a family history or you don’t know your family history. The most common gene that can cause prostate cancer is called the BRCA gene, which is best known for causing breast cancer. If your family has the BRCA gene, it also places the men at higher risk of being diagnosed with prostate cancer. 

The most common way to find out if you have that gene is through the use of a genetic counselor and genetic testing. That can be done through something as simple as a blood test or a cheek swab. It may be a good option for men who don’t know their family history due to not communicating with them or if they are adopted. It might be worthwhile to ask your doctor for more information about getting tested for the BRCA gene. 

Scott Eggener, MD, specializes in the care of patients with prostate, kidney and testicular cancers and is co-director of the University of Chicago Medicine High-Risk and Advanced Prostate Cancer Clinic (UCHAP). 

 What is a Transperineal Prostate Biopsy?

A prostate cancer biopsy is a type of minor urologic procedure used to detect cancer. For a prostate biopsy, tiny pieces of tissue are removed from the prostate and looked at under a microscope. The pathologist is the doctor who will look carefully at the tissue samples for any cancer cells. This is largely the only way to know for sure if you have prostate cancer.

The prostate specific antigen (PSA) blood test and digital rectal examination (DRE) are two tests used to screen for prostate cancer. The decision to have a biopsy is based on the results of these tests, but can be recommended even if you have no symptoms. Your doctor will also consider your family history of prostate cancer, ethnicity, biopsy history and other health factors.

A transperineal biopsy is when your doctor puts a needle into the prostate through the skin behind the testicles, an area known as the perineum. They will take a number of tissue samples, which are then sent to the lab for review.

An advantage of the transperineal biopsy is that it markedly reduces the potential of infection or bleeding, which can be a complication of the biopsy. 

The biopsy is often done as an outpatient procedure. General anesthesia is used to provide more comfort.  

Alexander Kutikov, MD, is chief of the Division of Urologic Oncology at Fox Chase Cancer Center in Philadelphia.

 what are some options for managing ic? 

Lifestyle changes, known as “behavioral therapy,” are often the first treatments used to manage a chronic bladder health issue called interstitial cystitis (IC). In behavioral therapy, you make some changes in the way you live day-to-day. This may include changing your diet, or practicing methods that may help control your symptoms. Most patients don’t get rid of all their symptoms with lifestyle changes, but many report fewer symptoms afterward. 

If lifestyle changes and prescription drugs don’t work, or pain or side effects interfere with your quality of life, more advanced therapies may be a better choice. You will most likely be referred to a specialist who treats patients with IC, such as a urologist. After reviewing your treatment history, the specialist may suggest Neuromodulation therapy or treatment with Botox®

Neuromodulation and Botox® are mostly approved for refractory urgency and frequency and overactive bladder (OAB) patients. Patients with IC typically can have urgency and frequency and therefore these treatment options may also work.

Neuromodulation therapy is the name given to a group of treatments that deliver harmless electrical impulses to nerves to change how they work. 

Injections of Botox® can also be given if other treatments have not provided adequate symptom control. Small doses of this drug can relax muscles. When injected into the bladder muscle, it may relax the bladder and help with the pain of IC/BPS. This treatment can wear off, and you may need to have another treatment 6 to 9 months after the first.

Veronica Triaca, MD, is the medical director of the Center for Urologic Care’s Pelvic Medicine, Continence and Sexual Health Program at Concord Hospital in Concord, N.H.  |  FALL 2019  |  UROLOGYHEALTH extra