Prostate Cancer Risk and Screening
A major focus of our research is assessing new biomarkers to better predict those with aggressive cancers and providing options to men with increased risk of prostate cancer. Not all men require genetic testing. However, there are specific instances in which genetic testing would be helpful, especially those with a strong family history of breast and prostate cancer, especially young age, or metastatic prostate cancer. Different types of genetic testing are available; therefore, consultation is recommended to determine which would be more useful. We offer new testing the will provide a genetic risk score that may provide more information on your specific risk for prostate cancer and we could gage you screening intensity with specific information.
Elevated Prostate Specific Antigen (PSA)
PSA or Prostate Specific Antigen is a blood test traditionally used for prostate cancer screening. New data have suggested that this blood test may not be the best test for prostate cancer, yet is still very powerful. PSA lab values tend to rise and fall; therefore, potentially giving a false reading. There are many other tests that can be utilized in addition to PSA, but sometimes a simple conversation regarding you risk factors could be allow more expensive tests to be avoided. I explain that ordering a test because it is available is not the correct approach. We could determine how we would use the information various tests specific to your situation. Only after we have a clear understanding of how we will use a particular test would we embark on more expensive tests. On the "My Approach" page is a risk calculator that I utilize to describe risk and a a focal point of our discussions.
Prostate Biopsy
A prostate biopsy is a test that provides the diagnosis of prostate cancer. Using ultrasound we can visualize the prostate and take samples of prostate tissue. The procedure can be performed in the office or the operating room. Occasionally, an MRI imaging test was performed and could be utilized during the procedure. Dr. Liss started the UroNav fusion prostate biopsy program at UT health over 3 years ago. After researching prostate MRI since 2014 he brought new techniques to enhance the images to San Antonio. Not all MRI images are equal and specific ways to obtain the test are available through research protocols and UT Health San Antonio radiology. We are initiating several clinical trials that include the utilization of MRI guided prostate biopsy through the National Cancer Institute Early Detection Research Network (EDRN) and the Department of Defense. These entities have funded Dr. Liss to perform specialized MRI's using Restriction Spectrum Imaging prior to men undergoing a biopsy who have elected Active Surveillance as there prostate cancer monitoring strategy.
Cancer Monitoring (Active Surveillance)
Active Surveillance is a strategy that allows men with Low Grade (slow growing) prostate cancer to monitor prostate cancer. There are various treatment algorithms and not all physicians are the same. Our method tries to monitor the cancer as close as possible, yet minimize the number of visits. You can access your PSA test through MyChart and stay informed. We also will be rolling out a new platform where biomarkers and imaging tests can be stored and available to you on demand.
The more variation in practice means that there may not be good guidelines to follow, which makes Active Surveillance an ideal area of research. We have been enrolling men into the PASS study as a founding member. The study includes sites across the United States and run out of the the Fred Hutchinson Cancer Center sponsored by the Canary Foundation. Our patients have the benefit of being followed on a stringent protocol and when new biomarkers or tests become available, the patients may be provided additional information. I also feel this is a prime area for studies that could use diet, exercise, vaccine, and natural products to reduce the progression of cancer. We are actively pursuing these research programs to make them available to our patients.
Robotic Surgery
I am a urologic surgeon specializing in robotic surgery for the prostate and have a family history of prostate cancer. I have dedicated much training, time, and effort to provide the very best surgical outcomes for prostate cancer. I trained at the University of California-Irvine in the early period of robotic surgery learning from leaders in the field that discovered many of the techniques that are still used today. Not being enough, I then entered a 2-year specialized training program called a Fellowship at the University of California- San Diego. This fellowship is approved by the Society of Urologic Oncology and upholds the most stringent criteria and ethical conduct for its graduates.
Below, I provide links to my educational video, DaVinci surgery patient guide, before surgery instructions and after surgery instructions. The first figure shows the concept behind the removal of the prostate with emphasize on nerve preservation. The second figure shows that even in advanced cancer partial nerve sparing can be performed at different levels corresponding to distance from the prostate.
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Cancer Recurrence
If cancer returns, a patient can face many options and concerns. At UT Health San Antonio we have a team of specialized that can assist with options for therapy from radiation therapy, surgery, hormonal therapy, and chemotherapy. We have research studies looking at a "liquid biopsies" that may help us selected treatments in the future. We also have an affiliation with M.D. Anderson Cancer Center that allows our doctors to use similar treatment plans. Care does not stop after your initial evaluation or therapy. As for imaging, we offer the Auxmin Scan which is a new imaging test to detect the location of prostate cancer at an earlier state. See button below for more information.
Imaging
As for imaging, we offer the Auxmin Scan which is a new imaging test to detect the location of prostate cancer at an earlier state. See button below for more information.
