News Center

Prostate cancer is the most common cancer in men in the U.S. other than skin cancer. As men age, it becomes increasingly common. The prostate gland is an organ, part of the male reproductive system, that sits just below the bladder.

For Jack Melson, M.D., a medical oncologist at VCU Massey Comprehensive Cancer Center who specializes in the treatment of prostate cancer, his patients and a constantly evolving treatment landscape are a driving force for him every day.

“Patients’ ability to face these diagnoses and approach treatment, that in and of itself is inspiring,” Melson said. “Additionally, the way we practice oncology now is different from the way it was five, 10 years ago. I’m motivated to provide the best available treatment options for my patients and those options are always changing.”

Melson completed his residency at the University of Virginia. It was there where he was drawn to oncology, a field of medicine that offered an interesting blend of science and different clinical disease states. Melson likes the multidisciplinary nature of cancer care, through which he gets to operate routinely as part of a team of specialists.

While completing his oncology fellowship at Tufts Medical Center in Boston, Melson began to focus on urologic oncology treating patients with prostate, bladder, kidney and testicular cancers. He enjoys the ability to identify personalized treatment options that are most effective for each individual patient.

“We rarely repeat the exact same approach, one patient to another, in regard to their treatment,” Melson said. “We’re always tailoring treatment to fit the person in front of us.”

For Prostate Cancer Awareness Month, we sat down with Melson to learn more about prostate cancer risk, screening and treatment options.

Are there any symptoms of prostate cancer?

With early-stage disease, the majority of patients do not have symptoms from prostate cancer at the time of diagnosis. When symptoms are present, we can see lower urinary tract symptoms, including increased urinary frequency, incomplete emptying of the bladder, weak urinary stream or other changes to baseline urinary function. However, those can also be symptoms of benign conditions so there is really no one clinical sign or symptom that would distinguish the two. I would encourage anyone with new urinary symptoms to see their doctor to discuss ways to determine the cause.

Are there any screening options?

Prostate cancer screening is an important part of cancer care. Our main tool for screening is a blood test known as a PSA, or prostate-specific antigen, test. The PSA level is typically elevated in men with prostate cancer. However, the normal, healthy prostate gland produces PSA so an elevated PSA level is not always an indicator of cancer, and the result of a screening PSA test should be interpreted thoughtfully. If you’re pursuing prostate cancer screening, it should be in conversation with your primary care doctor or your urologist.

The American Cancer Society recommends men age 50 who are at average risk should begin a discussion about screening, and earlier for men who are at an increased risk. Black men are at increased risk of developing prostate cancer and guidelines recommend consideration of prostate cancer screening starting at age 40 or 45. If you have a family member who was diagnosed with prostate cancer, knowing the details about when they were diagnosed can help determine when is the right time to start screening.

If a screening PSA test is performed and the result is suspicious for prostate cancer, an MRI of the prostate is often performed to help guide the decision whether or not to pursue a prostate biopsy.

Does testosterone cause prostate cancer?

Testosterone does not seem to cause prostate cancer. However, when a prostate cancer develops, testosterone can drive that tumor to grow. There is a close interplay between male hormones and cancer progression, and much of how we think about treatment deals with that interplay.

What treatment is available?

Treatment can look very different based upon whether the cancer is contained within the prostate gland or if it has spread outside of the prostate.

For localized cancer, we talk about definitive local therapy, treatment that is intended to cure the cancer. This is typically surgery—a prostatectomy performed by a urologist—or radiation therapy. Radiation therapy is often combined with a time-limited course of androgen deprivation therapy – medications that suppress the testosterone level. Surgery and radiation have different potential benefits and potential side effects so the decision often comes down to a thoughtful discussion with the patient regarding their preferences. High-intensity focused ultrasound (HIFU) is a different type of local treatment that just recently became an option for patients at Massey. High-intensity focused ultrasound (HIFU) is one of a number of cutting-edge prostate cancer treatments and therapies offered at Massey.

If a localized prostate cancer has very low-risk features, active surveillance can be a good option for many men, in which we monitor the PSA levels and imaging over time to look for signs of disease progression. Definitive treatment with surgery or radiation can then be pursued when necessary.

For men with more advanced prostate cancer, the goal of treatment is to control the cancer rather than cure it. Medications are often the focus of treatment in this setting. Depending on the circumstances, we may recommend androgen deprivation therapy (testosterone suppression), other testosterone-blocking medications, chemotherapy, or targeted therapies. Genetic testing is a standard part of the treatment plan as it can identify specific treatment options. We may recommend combining medications with radiation-based treatments as well. With many treatment options available, it becomes critical to match the specific treatment approach to the individual patient.

Why is it important to be treated at a multidisciplinary, comprehensive cancer center like Massey?

When we have multiple treatment options available to patients, there is opportunity to find the best treatment plan but the choices and decision-making can seem overwhelming. Using a multidisciplinary framework, the different providers on our team—surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, geneticists —can offer their own insights about how their particular aspect of care could impact a patient’s wellbeing or quality of life. Our urologic oncology team meets weekly as a group to have these conversations. Getting multiple perspectives allows us to give every patient the best information to make the choice that is right for them when deciding between multiple options.

What are some common side effects of prostate cancer treatment?

For curative-intent treatments like surgery or radiation to the prostate, in localized disease, the side effects are often impacts on urinary function, sexual function, or bowel function. With hormone-based therapies, when we lower testosterone levels, that can lead to side effects noticeable in the short-term, including hot flashes, sweats, fatigue, sexual dysfunction, and impaired cognitive function. Long-term, testosterone suppression can increase the risk of weight gain and loss of muscle mass, which are associated with increased risk of heart disease, diabetes and stroke, so it’s important to try and manage modifiable cardiovascular risk factors for these patients, particularly for men with pre-existing cardiovascular disease. All of these side effects can impact mental health and quality of life. Prostate cancer has a propensity for spreading to bones which can cause pain or increase the risk of a fracture. Testosterone suppression can also increase the risk of osteoporosis over time. When I’m seeing patients with advanced prostate cancer, I’m often thinking about pain management and bone health, how we can help maintain bone integrity.

Are there ways to reduce prostate cancer risk?

The best thing people can do is know their family history and be proactive with screening. At the very least, I would recommend all men have a discussion with their doctor about when might be the right time for them to consider prostate cancer screening. When detected early, prostate cancer is curable.

Are there clinical trials available at Massey?

Clinical trials are the best way for us to bring new and innovative treatment options to the Richmond community. Our urologic oncology team seeks to have trials available for all of our patients, including those with early and advanced prostate cancer diagnoses. Massey is continually evaluating the latest cancer therapies through one of the largest selections of clinical trial offerings in Virginia. I’m currently the lead investigator on three clinical trials for prostate cancer at Massey and my colleagues are leading many others. Anyone interested in learning more about the clinical trial options we have available should reach out to our prostate cancer team.

More information about available prostate cancer treatment options at Massey can be found here. 

More information about clinical trials at Massey can be found at here.

Written by: Blake Belden