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Prostate Cancer Research

Discoveries for a Brighter Future in Prostate Cancer

At the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer, our patient care is rooted in the most advanced and researched approaches. To set that standard, our experts continue seeking answers to challenges facing today’s patients. These insights will help ensure a promising future for tomorrow’s patients.

Screening Questions

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Is the prognosis for patients who had surgery for high-grade prostate cancer (Gleason score of 8, 9 or 10) similar to those with low-grade prostate cancer?

Misop Han

Misop Han

Principle Investigator | View Profile

Although most patients with high-grade prostate cancer experience a recurrence after surgery, men with a Gleason score of 8 have a better survival than those with Gleason scores of 9-10. Even among those with high Gleason scores, there is a subgroup of men with longer survival.


Read more on Pubmed

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Should patients with metastatic hormone-sensitive prostate cancer get tested for the cancer mutation AR-V7?

Emmanuel Antonarakis

Emmanuel Antonarakis

Principle Investigator | View Profile

Not at this time. Testing for the AR-V7 mutation is primarily meant for patients with metastatic castration-resistant prostate cancer, or cancer that has spread to other parts of the body. If the patients’ test results are negative for the AR-V7 mutation, they may do well with prescription drugs abiraterone or enzalutamide. AR-V7-positive patients may do better with chemotherapy.


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Should older men have prostate-specific antigen (PSA) screenings to test the level of the PSA protein in the blood?

Patrick Walsh

Patrick Walsh

Principle Investigator | View Profile

Although there is a widespread belief that PSA testing should stop at age 70, a recent study indicates that this may be bad advice for healthy men with many years of life ahead of them. Our research has shown that men diagnosed with prostate cancer after age 75 who had undergone screening were much less likely to be diagnosed with high-risk, advanced disease than men who were not screened.


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Beyond the prostate-specific antigen (PSA) screening, are there other blood tests to predict if someone has prostate cancer?

Ashley Ross

Ashley Ross

Principle Investigator | View Profile

Yes. There are several new blood tests used for detecting prostate cancer. The FDA-approved Prostate Health Index (PHI) has been used at Johns Hopkins since 2014. In our urology practice, we have found this test to be superior to PSA screening for the prediction of prostate cancer. We are continuing to investigate ways to improve prostate cancer detection using blood tests and medical imaging.


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Would either an abnormal testosterone level or testosterone therapy to treat a testosterone deficiency increase the risk of developing prostate cancer?

Arthur Burnett

Arthur Burnett

Principle Investigator | View Profile

Prostate cancer appears to be unrelated to testosterone levels measured in the bloodstream, and testosterone replacement therapy does not appear to increase the risk of prostate cancer development. However, further investigation with longer follow-up studies remain necessary.


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What does the PI-RADS score on my prostate MRI mean?

Katarzyna Macura

Katarzyna Macura

Principle Investigator | View Profile

The Prostate Imaging-Reporting and Data System (PI-RADS) is a scoring system developed for prostate MRIs based on the available evidence and radiology expert consensus opinion about how likely it is that you may have prostate cancer. The PI-RADS version 2 assessment uses a five-point scale based on the likelihood that a combination of MRI features correlates with the presence of a clinically significant cancer for each lesion detected on MRI in the prostate gland.


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Diagnosis Questions

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If I am diagnosed with low volume or "oligo" metastatic disease either at initial diagnosis or following previous treatment of my prostate cancer, is it feasible to treat my metastatic lesions directly?

Phuoc Tran

Phuoc Tran

Principle Investigator | View Profile

Stereotactic ablative radiotherapy (SABR) in men with oligometastatic prostate cancer is feasible and well tolerated. Our preliminary data suggests this approach is worthy of further study. We will have more definitive conclusions about this once we’ve completed our prospective randomized Baltimore ORIOLE trial.


Read more:
https://www.ncbi.nlm.nih.gov/pubmed/27725639
http://www.redjournal.org/article/S0360-3016%2816%2931573-5/abstract

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Which patients are more likely to benefit from MRI-targeted prostate biopsies?

Katarzyna Macura

Katarzyna Macura

Principle Investigator | View Profile

In men with elevated PSA levels who have not had a prostate biopsy, MRI-targeted biopsy uncovered higher grade cancers in 16 percent of men that would have been missed by nontargeted biopsy.


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Can multiple independent cancer lesions be present in the prostate?

Michael Haffner

Michael Haffner

Principle Investigator | View Profile

Molecular studies have shown that it is not uncommon that a diseased prostate can harbor multiple, genetically independent prostate cancers. Through further research, we will decipher the genomic changes of these lesions and evaluate how they may be contributing to disease progression. This will allow for the possibility of a precise and highly personalized therapy.


Read more:
https://www.ncbi.nlm.nih.gov/pubmed/24638011
https://www.ncbi.nlm.nih.gov/pubmed/24135135

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What is the Gleason scoring system and why did some think it was inadequate?

Jonathan Epstein

Jonathan Epstein

Principle Investigator | View Profile

The Gleason grading system was developed between 1966 and 1974, and ranges from 2-10, with more than 25 different possible combinations. The current application of Gleason grading differs dramatically from the original system, due to changes in prostate cancer diagnosis and treatment. Visit our Health Library to learn more about Gleason scores and prostate cancer staging.


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What are prostate cancer grade groups and how do they differ from Gleason scores?

Jonathan Epstein

Jonathan Epstein

Principle Investigator | View Profile

We developed and verified a new grading system, which is more accurate than the current Gleason system and gives patients a more accurate representation of risk with the potential to reduce overtreatment of less aggressive prostate cancer and reassure an initial strategy of active surveillance when appropriate. Visit our Health Library to learn more about Gleason grading.


Read more on PubMed

Treatments Questions

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Some men experience rising PSA scores after surgery and/or radiation. Do larger amounts of pomegranate extracthelp slow down the rise of these scores better than smaller amounts?

Channing Paller

Channing Paller

Principle Investigator | View Profile

No. There was no difference in the changes of PSA doubling times between patients consuming a single capsule of pomegranate extract (equivalent to one 8-ounce glass of juice) per day, and those consuming three capsules per day.


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What causes erectile dysfunction after radical prostatectomy and how can we prevent it?

Trinity Bivalacqua

Trinity Bivalacqua

Principle Investigator | View Profile

The nerves to the penis are found alongside the prostate and can be injured or removed during surgery, causing dysfunction. However, even if your surgeon is able to spare the nerves, you may still develop severe erectile dysfunction caused by nerve degeneration (death). Our research has identified factors that may contribute to nerve death, including age, high blood pressure and diabetes.


Read More:
https://jhu.pure.elsevier.com/en/publications/caspase-3-dependent-nitrergic-neuronal-apoptosis-following-cavern
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816854/
https://jhu.pure.elsevier.com/en/publications/early-stage-type-2-diabetes-mellitus-impairs-erectile-function-an

Recurrence Questions

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If I have had my prostate surgically removed to treat my prostate cancer, are there new tests that could predict the risk that my cancer will come back and threaten my life?

Alan Meeker

Alan Meeker

Principle Investigator | View Profile

We recently found that microscopic analysis of specific parts of the chromosomes, called telomeres, in a patient’s surgically removed tumor significantly helped to inform predictions of the likelihood of aggressive disease recurrence (e.g. relapse involving cancer spread to other parts of the body). However, research is ongoing to further validate this new test and optimize it for routine clinical use.


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Some men develop recurrent prostate cancer even after surgical treatment. Is there a way to identify if prostate cancer cells are present in the bone marrow at the time of surgical treatment?

Alan Meeker

Alan Meeker

Principle Investigator | View Profile

We have developed a novel method to obtain bone marrow at the time of surgery. We have studied over 300 men now and are well underway to answering this important question.


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Is there a way to determine whether my disease will return after radiation treatment?

Phuoc Tran

Phuoc Tran

Principle Investigator | View Profile

Your PSA score taken during the last week of a course of radiation therapy and hormonal treatment may indicate how the disease might respond to treatment and the likelihood of prostate cancer recurrence.


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Could prostate cancer that returns after surgery be caused by cancer cells that invaded the bone marrow before the surgery? Is there a way to identify if prostate cancer cells are present in the bone marrow at the time patient has surgery?

Kenneth Pienta

Kenneth Pienta

Principle Investigator | View Profile

We have developed a novel method to obtain bone marrow at the time of surgery. We have studied over 300 men now and are well underway to answering this important question.


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Is it possible to predict cancer grade in men in active surveillance for prostate cancer?

Ballentine Carter

Ballentine Carter

Principle Investigator | View Profile

Yes. Using cumulative data collected from men enrolled in active surveillance, where prostate cancer is carefully monitored for signs of progression, we have created a model that accurately predicts final surgical cancer grade if the prostate were to be removed ("true" cancer state). This information may help patients make decisions about whether to remain on surveillance or opt for treatment of their cancer.


Read more on Pubmed

Genetics Questions

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If my father died of prostate cancer, does that make me more likely to carry the BRCA2 gene mutation associated with more aggressive prostate cancers?

William Isaacs

William Isaacs

Principle Investigator | View Profile

Yes, but the likelihood depends upon when your father died. The older your father was when he died, the lower your chance of having inherited a BRCA2 mutation. Men whose fathers die before age 60 have the highest chance of having the mutation; men whose fathers die after age 80 have the lowest chance. However, all men who have relatives with lethal prostate cancer should consider genetic testing to assess their risk of carrying a BRCA2 mutation.


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Can inherited genetics be risk factors for aggressive prostate cancer?

Paula Hurley

Paula Hurley

Principle Investigator | View Profile

Yes, inherited genetics can be a risk factor for aggressive prostate cancer. Certain inherited genes are associated with developing prostate cancer that spreads to areas of the body other than the prostate.


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Are there any tissue-based genetic tests that could provide more information about whether a prostate tumor is likely to behave more aggressively?

Tamara Lotan

Tamara Lotan

Principle Investigator | View Profile

Yes. A simple tissue-based test on a prostate tumor biopsy can show if the PTEN gene has been lost in the cancerous cells. PTEN is a gene that helps suppress tumors. In lower-grade tumors, PTEN loss is associated with an increased risk that a more serious disease is present in the prostate, or the cancer has metastasized. In prostate tumors after radical prostatectomy, it indicates that the tumor could recur or be life-threatening.


Read more on Pubmed:
https://www.ncbi.nlm.nih.gov/pubmed/24993522
https://www.ncbi.nlm.nih.gov/pubmed/27693448
https://www.ncbi.nlm.nih.gov/pubmed/26615022
https://www.ncbi.nlm.nih.gov/pubmed/27617307